Vnitr Lek 2018, 64(10):966-969 | DOI: 10.36290/vnl.2018.135

Multiple neuroendocrine tumor of the small bowel: a case report and a review of literature

Lumír Kunovský^1,2, Milan Dastych¹, Oldrich Robek², Roman Svaton², Jakub Vlazny³, Jakub Hustý⁴, Michal Eid⁵, Karolina Poredska¹, Petr Kysela^2,*, Zdeněk Kala²

¹ Department of Gastroenterology, University Hospital Brno Bohunice, Faculty of Medicine, MU, Brno

² Department of Surgery, University Hospital Brno Bohunice, Faculty of Medicine, MU, Brno

³ Department of Pathology, University Hospital Brno Bohunice, Faculty of Medicine, MU, Brno

⁴ Department of Radiology, University Hospital Brno Bohunice, Faculty of Medicine, MU, Brno

⁵ Department of Hematology, Oncology and Internal medicine , University Hospital Brno Bohunice, Faculty of Medicine, MU, Brno

Primary malignant tumors of small bowel constitute only about 1-2% of all gastrointestinal neoplasms. Although neuroendocrine tumors (NETs) are relatively rare, they still represent the second most common malignancy of the small bowel (after adenocarcinoma). Clinical manifestations include abdominal pain, bowel obstruction, diarrhea, weight loss and bleeding. The differential diagnosis of obscure gastrointestinal bleeding can sometimes be challenging for endoscopy as well as for radiology methods. We present the case of an 80-year-old man suffering from severe hypochromic anemia. Routine endoscopic methods did not show any appropriate pathology. Finally, a single ulcerative infiltration of the ileum was diagnosed by capsule endoscopy (CE). CT enterography did not reveal any other lesions. In accordance with a positive chromogranin A, endoscopic and radiologic methods, a suspicion of NET was expressed. During the surgery, 7 lesions were found and a resection of 120 cm of ileum was performed. The histology confirmed a diagnosis of NET grade 1, with a total number of 15 NET lesions in the specimen. The following octreotide scan did not show any residual infiltration. We present a patient with 15 NET lesions in the ileum diagnosed by CE and successfully cured by surgical resection of the ileum.

Keywords: capsule endoscopy; carcinoid syndrome; gastrointestinal carcinoids; neuroendocrine tumor; obscure gastrointestinal bleeding; small bowel; surgery

Received: April 11, 2018; Accepted: June 3, 2018; Published: October 1, 2018  Show citation