Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Pancreatic cancer is often difficult to diagnose due to its asymptomatic nature, silent progression or symptoms overlapping with more common benign conditions. We present a case of a 30-year-old male with chronic worsening back pain, weight loss, and Grey Turner's sign, ultimately leading to the diagnosis of a neuroendocrine tumor in the tail of the pancreas. The rarity of this diagnosis in a young patient with atypical symptoms emphasizes the importance of considering uncommon diagnoses and expanding differentials, even when presented with seemingly typical symptoms, to enable early detection and intervention.
Case Presentation: 30-year-old male past medical history of hypertension, morbid obesity, and chronic back pain that started in 2017 after a motor vehicle collision. However, the pain worsened in January 2023, requiring consistent NSAID for attenuation, multiple visits to the emergency department, and follow-up visits with his PCP and chiropractor. On a routine follow up with his PCP and posterior to MRI, he was found to have a herniated disc; however, his back pain continued to intensify, and NSAID requirement increased. Additionally, the patient had a weight loss of around 100 pounds in less than a year. In April 2023, he went to the emergency department due to excruciating back pain, jaundice, abdominal distention, bloating, flank pain, and a hematoma over his left lower abdomen. He also presented with bilateral leg edema and dyspnea on exertion of 24 hours of evolution. Blood work revealed cytopenia (anemia and thrombocytopenia). CT of the abdomen revealed a pancreatic tail mass with multiple diffuse liver nodules concerning metastatic disease and hepatosplenomegaly. The liver biopsy was consistent with metastatic carcinoma of pancreatic origin, categorized as neuroendocrine neoplasm. Posterior to stabilization in the hospital the patient decided to pursue palliative chemotherapy.
Conclusion: This case demonstrates the importance of considering rare diagnoses in young patients with chronic back pain and associated symptoms. Despite the typical late-stage diagnosis of pancreatic cancer, this unique presentation underscores the significance of diligently exploring alternative causes when common symptoms fail to respond to treatment. Physicians must remain vigilant and expand their differentials when encountering atypical presentations to ensure timely and accurate diagnoses.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Rojas Huen, Jennifer; Flores, Gilbert Jr.; Polo Pérez, Ismael Pavel; and Sarhill, Nabeel, "Grey Turner's Sign Unveiling a Rare Case of Neuroendocrine Tumor in the Tail of the Pancreas: A Reminder to Expand the Differential in Young Patients with Chronic Back Pain" (2024). Research Symposium. 20.
https://scholarworks.utrgv.edu/somrs/2023/posters/20
Included in
Grey Turner's Sign Unveiling a Rare Case of Neuroendocrine Tumor in the Tail of the Pancreas: A Reminder to Expand the Differential in Young Patients with Chronic Back Pain
Background: Pancreatic cancer is often difficult to diagnose due to its asymptomatic nature, silent progression or symptoms overlapping with more common benign conditions. We present a case of a 30-year-old male with chronic worsening back pain, weight loss, and Grey Turner's sign, ultimately leading to the diagnosis of a neuroendocrine tumor in the tail of the pancreas. The rarity of this diagnosis in a young patient with atypical symptoms emphasizes the importance of considering uncommon diagnoses and expanding differentials, even when presented with seemingly typical symptoms, to enable early detection and intervention.
Case Presentation: 30-year-old male past medical history of hypertension, morbid obesity, and chronic back pain that started in 2017 after a motor vehicle collision. However, the pain worsened in January 2023, requiring consistent NSAID for attenuation, multiple visits to the emergency department, and follow-up visits with his PCP and chiropractor. On a routine follow up with his PCP and posterior to MRI, he was found to have a herniated disc; however, his back pain continued to intensify, and NSAID requirement increased. Additionally, the patient had a weight loss of around 100 pounds in less than a year. In April 2023, he went to the emergency department due to excruciating back pain, jaundice, abdominal distention, bloating, flank pain, and a hematoma over his left lower abdomen. He also presented with bilateral leg edema and dyspnea on exertion of 24 hours of evolution. Blood work revealed cytopenia (anemia and thrombocytopenia). CT of the abdomen revealed a pancreatic tail mass with multiple diffuse liver nodules concerning metastatic disease and hepatosplenomegaly. The liver biopsy was consistent with metastatic carcinoma of pancreatic origin, categorized as neuroendocrine neoplasm. Posterior to stabilization in the hospital the patient decided to pursue palliative chemotherapy.
Conclusion: This case demonstrates the importance of considering rare diagnoses in young patients with chronic back pain and associated symptoms. Despite the typical late-stage diagnosis of pancreatic cancer, this unique presentation underscores the significance of diligently exploring alternative causes when common symptoms fail to respond to treatment. Physicians must remain vigilant and expand their differentials when encountering atypical presentations to ensure timely and accurate diagnoses.