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+A 60-year-old male visited our outpatient clinic with a mass on his left hip.
+He had diabetes and alcoholic hepatitis.
+On physical examination, a large mass measuring 10 cm in diameter was observed on his hip and an approximate 5 cm left inguinal lymph node was palpable (Figure ​1).
+Serum tumor markers, including CEA and CA 19-9, were within normal limits, whereas serum amylase (227 IU/L, normal range 43-116 IU/L), lipase (378 IU/L, normal range 7-60), fasting blood sugar (144 mg/dL, normal range, 70-100 mg/dL), and liver function test levels [including aspartate aminotransferase (178 IU/L, normal range, 7-38 IU/L), alanine aminotransferase (225 IU/L; normal range, 4-43 IU/L), and serum alkaline phosphatase (370 IU/L, normal range, 103-335 IU/L)] were all above normal ranges.
+An abdominal computerized tomography (CT) scan demonstrated not only a left hip mass and an enlarged left inguinal lymph node, but also a huge heterogeneous enhancing mass on the body of the pancreas (Figure ​2).
+On a PET scan, additional metastases were not found.
+We planned a staged surgery and performed a hip and inguinal mass excision on December 19, 2014.
+The histopathological report revealed a metastatic small cell neuroendocrine carcinoma with a maximal diameter of 10.5 cm on the buttock mass and a 7 cm growth on an inguinal lymph node.
+The mitotic index was over 50 mitoses per 50 HPF and the Ki-67 index measured at 50%.
+On January 21, 2015, we performed a total pancreatectomy and a total gastrectomy, with the findings revealing a tumor of the body of the pancreas about 9 cm × 6 cm in diameter involving the left gastric artery, splenic artery, and splenic vein.
+The histopathological report was the same as that of a metastatic lesion.
+Additionally, the tumor had spread to 8 of the 32 lymph nodes (Figure ​3).
+On the 7th post-operative day, the patient developed a high fever and leukocytosis.
+We administered an abdominal CT scan, which revealed infected fluid collection in the lesser sac and a 4.7 cm-sized recurring mass which was detected at the operative bed of the left hip (Figure ​(Figure4).4).
+After infection of the abdominal cavity was treated by antibiotics, we removed the left hip recurring mass on February 3, 2015.
+The histopathology was the same as in the previous report; with a maximum diameter of 7.5 cm.
+The patient was discharged without other complications on February 9, 2015.
+He is currently receiving chemotherapy based on etoposide and cisplatin treatment.