Navigating Tumor Thrombus: Transhepatic Portal Vein Stenting in Pancreatic Neuroendocrine Tumor

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are typically indolent but may occasionally present with advanced disease involving major vascular structures. Portal vein invasion with associated tumor thrombus can lead to clinically significant portal hypertension. In patients with symptomatic portal venous obstruction and severe portal hypertension, transhepatic portal vein stenting across the tumor thrombus may provide effective palliation. We report a case of a Grade 2 pancreatic neuroendocrine tumor presenting with refractory ascites and recurrent gastrointestinal bleeding secondary to malignant portal vein obstruction that successfully managed with transhepatic portal vein stenting. This case highlights the role of endovascular intervention as a valuable palliative strategy for restoring portal venous flow and alleviating symptoms in patients with complex malignant portal venous obstruction.