Rusu Octavia Cristina, Costea Radu Virgil, Popa Cristian Constantin, Iliesiu Andreea, Dumitru Adrian, Becheanu Gabriel, Neagu Stefan Ilie
Second Department of Surgery, Emergency University Hospital, Bucharest, Romania.
Department of Pathology, Emergency University Hospital, Bucharest, Romania.
Maedica (Bucur). 2015 Sep;10(4):352-356.
Neuroendocrine tumors are derived from cells that have the unique ability to synthesize, store and secrete a variety of metabolically active substances, peptides and amines, characteristic of the tissue of origin, which can cause distinct clinical syndromes.
We present the case of a 58-year-old patient diagnosed and surgically treated in January 1996 for stage III inferior rectal cancer, who was readmitted after 18 years presenting persistent diarrheic syndrome and asthenia. Investigations performed (abdominal CT) showed multiple liver metastases, initially suspected as being related to the rectal cancer. Biopsy of liver metastases and pathological and immunohistochemical analysis demonstrated the neuroendocrine origin (moderately differentiated neuroendocrine tumor). Seven months after the identification of liver metastases and after initiation of oncological therapy with Interferon and Somatostatin, the patient presented severe hypoglycemia (serum glucose 13-70 mg/dl) proved to be due to insulin-like factors (serum insulin level 64.9 ìU/ml) secreted by metastases. Due to the aggressive evolution of neuroendocrine tumor, with multiple episodes of severe hypoglycemia, resistant to treatment, the patient died approximately one month after the occurrence of hypoglycemic episodes.
Despite comprehensive tests (abdominal CT scan, colonoscopy, bone scintigraphy and PET/CT), the primary site of the neuroendocrine tumors remained unknown.
神经内分泌肿瘤起源于具有独特能力的细胞，这些细胞能够合成、储存和分泌多种代谢活性物质、肽类和胺类，这些物质具有起源组织的特征，可导致不同的临床综合征。
我们报告一例58岁患者，1996年1月因III期低位直肠癌被诊断并接受手术治疗，18年后因持续腹泻综合征和乏力再次入院。所进行的检查（腹部CT）显示有多处肝转移，最初怀疑与直肠癌有关。肝转移灶活检及病理和免疫组化分析证实为神经内分泌起源（中度分化神经内分泌肿瘤）。在发现肝转移并开始使用干扰素和生长抑素进行肿瘤治疗7个月后，患者出现严重低血糖（血清葡萄糖13 - 70mg/dl），经证实是由于转移灶分泌的胰岛素样因子（血清胰岛素水平64.9μU/ml）所致。由于神经内分泌肿瘤进展迅速，多次出现严重低血糖且治疗无效，患者在低血糖发作后约1个月死亡。
尽管进行了全面检查（腹部CT扫描、结肠镜检查、骨闪烁显像和PET/CT），神经内分泌肿瘤的原发部位仍不清楚。
