Background : Pancreatic neuroendocrine tumors (PNETs) are uncommon neuroendocrine neoplasms with reported incidence of <1 per 100 000 persons per year in population-based studies from Europe and Asia. Pancreatic neuroendocrine tumors (NETs) are rare. Less than 2% of all cancers found in the pancreas each year are pancreatic NETs. We report a case of large cell neuroendocrine carcinoma of the pancreas in 41-year-old male with intermittent pains in the upper right part of his abdomen, feeling unusually tired.

Methods : A 41-year-old male was referred to our hospital showed in April 2019. Multidisciplinary team decided an undergo RAMPS procedure. We underwent RAMPS+ partial gastrectomy due to large cell neuroendocrine carcinoma of the pancreas with direct invasion into stomach and spleen /pT3N2Mx pancreas exocrine/. On IHC: Chromogranin diffuse positivity on tumor, Ki67-15-20%. In April 2019.

Results : The 5-year relative survival rate for a pancreas NET is 53%. We performed RAMPS. Because of PNETs in April 2019.After operation in July 2021.As a result of suspicious lesion in the liver. Patients was taken biopsy that was metastatic PNETs. We performed 3 times TACE at the metastatic lesion in 2022. Based on the chemotherapy schema. We used Afinitor 17 courses, XELOX schema for the cancer in June 2023. After that chemotherapy we carried on right hepatectomy. Patients has survived for 4 year 9 months.

Conclusions : Pancreatic neuroendocrine tumor is uncommon; however, this possibility should be considered in patients with PNETs can benefit combinated surgery, locoregional therapy, systemic therapy, and complication control.