Somnay Kaumudi, Surpur Swapnil, Saini Prerna, Gibson Christopher, Luo Jean
Gastroenterology, NewYork-Presbyterian Queens Hospital, New York City, USA.
Internal Medicine, Jawaharlal Nehru Medical College, Belgaum, IND.
Cureus. 2023 Sep 5;15(9):e44718. doi: 10.7759/cureus.44718. eCollection 2023 Sep.
Neuroendocrine tumors (NETs) are tumors that originate from neuroendocrine cells and can be found throughout the body but are most commonly seen in the gastrointestinal tract, pancreas, and lungs. There is an increase in the diagnosis of NETs due to advances in diagnostic modalities. Although mucosal tumors are easily visualized on upper GI endoscopic imaging, neuroendocrine tumors are often missed due to their deep mucosal origin with normal overlying mucosa. We first present the case of a 46-year-old woman with anemia and epigastric discomfort who was found to have an incidental submucosal mass in the duodenal bulb on esophagogastroduodenoscopy (EGD), which on endoscopic ultrasound (EUS) with a fine needle biopsy (FNB) showed a neuroendocrine tumor. Imaging with CT, however, failed to detect the presence of the mass in the duodenum. Furthermore, a DOTATATE scan showed only a nonspecific signal near the liver. The patient then underwent an EGD-guided, laparoscopic, robot-assisted transduodenal resection of the tumor, together with the removal of enlarged peritumoral lymph nodes. Pathology showed a well-differentiated neuroendocrine tumor of the duodenal bulb with metastasis to one lymph node, which was confirmed via immunohistochemistry staining. The second case is of a 51-year-old female who presented with occasional constipation and rectal pain and was found to have a rectal polypoid lesion on her colonoscopy, jumbo biopsies of which revealed a NET. An EUS done for staging and endoscopic mucosal resection (EMR) revealed a grade 1 well-differentiated NET on pathology, which was confirmed by immunohistochemistry staining. These cases stress the need for timely, definitive diagnosis and intervention. Here, we discuss the clinical features and investigations of neuroendocrine tumors for early diagnosis and management.
神经内分泌肿瘤（NETs）是起源于神经内分泌细胞的肿瘤，可在全身各处发现，但最常见于胃肠道、胰腺和肺部。由于诊断方法的进步，神经内分泌肿瘤的诊断有所增加。尽管在上消化道内镜成像中黏膜肿瘤很容易被观察到，但神经内分泌肿瘤因其起源于黏膜深层且覆盖黏膜正常，常被漏诊。我们首先介绍一例46岁女性患者，该患者有贫血和上腹部不适，在食管胃十二指肠镜检查（EGD）时发现十二指肠球部有一个偶然的黏膜下肿块，经内镜超声（EUS）和细针穿刺活检（FNB）显示为神经内分泌肿瘤。然而，CT成像未能检测到十二指肠内肿块的存在。此外，DOTATATE扫描仅在肝脏附近显示一个非特异性信号。该患者随后接受了EGD引导下的腹腔镜机器人辅助经十二指肠肿瘤切除术，并切除了肿大的肿瘤周围淋巴结。病理显示十二指肠球部高分化神经内分泌肿瘤，有一个淋巴结转移，通过免疫组织化学染色得以证实。第二例是一名51岁女性，她偶尔出现便秘和直肠疼痛，在结肠镜检查时发现直肠有息肉样病变，对其进行的大块活检显示为神经内分泌肿瘤。为进行分期而做的EUS和内镜黏膜切除术（EMR）显示病理为1级高分化神经内分泌肿瘤，通过免疫组织化学染色得以证实。这些病例强调了及时、明确诊断和干预的必要性。在此，我们讨论神经内分泌肿瘤的临床特征及检查，以实现早期诊断和管理。
