Inoue Manabu, Tsukamoto Shunsuke, Moritani Konosuke, Sekine Hideki, Saito Yutaka, Kanemitsu Yukihide
Department of Colorectal Surgery, National Cancer Center Hospital, 1-1-5 Tsukiji Chuo-ku, Tokyo 1040045, Japan.
Department of Colorectal Surgery, National Cancer Center Hospital, 1-1-5 Tsukiji Chuo-ku, Tokyo 1040045, Japan.
Int J Surg Case Rep. 2022 May;94:107037. doi: 10.1016/j.ijscr.2022.107037. Epub 2022 Apr 5.
Neuroendocrine tumors (NETs) measuring <10 mm are widely thought to be at low risk of lymph node metastasis. Here we report a case of lymph node metastasis in a patient with a 4-mm NET that was classified as grade 2.
A 32-year-old woman was referred to our hospital after a positive fecal occult blood test. Colonoscopy revealed a 4-mm yellowish submucosal tumor, which was diagnosed as NET of the upper rectum and removed by endoscopic submucosal resection with ligation. Pathological examination of the specimen showed a 4-mm grade 2 NET with a Ki-67 labeling index of 4.4% without lymphatic or venous invasion. In accordance with the European Neuroendocrine Tumor Society guidelines, we performed robotic-assisted laparoscopic low anterior resection with lymph node dissection. Final pathological examination revealed invasion confined to the submucosal layer and metastasis to one lymph node (pT1aN1M0, Stage IIIB). There were no residual tumor cells in the scar after endoscopic submucosal resection with ligation.
Should G2 neuroendocrine tumors smaller than 5 mm be surgically resected?
We encountered a rare case of a small NET with lymph node metastasis that was treated by robotic-assisted laparoscopic low anterior resection with lymph node dissection. Additional surgery is an option to be considered for grade 2 NET even if it is small because of the possibility of lymph node metastasis.
直径小于10毫米的神经内分泌肿瘤（NETs）被广泛认为发生淋巴结转移的风险较低。在此，我们报告一例直径4毫米的2级NET患者发生淋巴结转移的病例。
一名32岁女性在粪便潜血试验呈阳性后被转诊至我院。结肠镜检查发现一个4毫米的淡黄色黏膜下肿瘤，诊断为直肠上段NET，并通过内镜下黏膜下剥离术加结扎切除。标本的病理检查显示为一个4毫米的2级NET，Ki-67标记指数为4.4%，无淋巴管或静脉侵犯。根据欧洲神经内分泌肿瘤学会指南，我们进行了机器人辅助腹腔镜低位前切除术并清扫淋巴结。最终病理检查显示侵犯局限于黏膜下层，且有一个淋巴结转移（pT1aN1M0，ⅢB期）。内镜下黏膜下剥离术加结扎术后瘢痕处无残留肿瘤细胞。
直径小于5毫米的G2神经内分泌肿瘤是否应行手术切除？
我们遇到了一例罕见的小NET伴淋巴结转移的病例，通过机器人辅助腹腔镜低位前切除术并清扫淋巴结进行了治疗。对于2级NET，即使肿瘤较小，由于存在淋巴结转移的可能性，额外的手术也是一种可考虑的选择。
