Background

Pancreatic neuroendocrine tumors (PNET) are rare neoplasms that comprise 1-2% of all pancreatic tumors. However, they are the second most common solid pancreatic neoplasms. They have a wide range of imaging appearances, but most of the time they are solitary well-marginated enhancing solid masses. We present a 61year old male with multiple comorbidities (including BMI > 67, Hypertension, Non Insulin Dependent Diabetes Mellitus, venous stases, osteoarthritis), who was evaluated in the Emergency Room for suspected pulmonary embolism ; with incidental findings of right renal mass on CT angiogram of the chest. Further studies were done; including CT abdomen and pelvis with contrast. CT guided biopsy and FNAB of the pancreas and thyroid revealed a well- differentiated pancreatic endocrine neoplasm (PEN) and benign follicular neoplasm respectively. Pathology specimen showed right kidney renal cell carcinoma (RCC). Subsequent evaluation for Von Hippel-Lindau (VHL) disease was negative. Despite significant increase in the incidence of PNETs in the United States, this disease remains an understudied and underfunded area of research. Our review intends to discuss the major challenges associated with the management of PNETs (2). The patient discussed in this case report may be one of the first cases reported of concomitant PEN and RCC in the same patient.