Amphicrine (mixed adenoneuroendocrine carcinoma) of the duodenum and coexistent metastatic well differentiated neuroendocrine tumour

A 56-year-old man with a clinical history of pancreatitis was diagnosed with a periampullary carcinoma during investigation for increase of liver enzymes. Biopsies confirmed an adenocarcinoma. A Whipple resection showed an amphicrine carcinoma and a metastatic neuroendocrine tumour to the peripancreatic lymph nodes. High-grade amphicrine carcinoma did not spread to nodes. It is unlikely that the well differentiated tumour is part of the duodenal amphicrine carcinoma but rather from a separate, undetected well differentiated neuroendocrine carcinoma located elsewhere.This case highlights an unusual combination of neuroendocrine tumours.