Li Lihong, Chen Ziyue, Zhu Dajian, Lv Qianbao, Zhang Tianpeng, Lai Jinsong
Department of Gastrointestinal surgery, Shunde Women and Children's Hospital of Guangdong Medical University (Maternal & Child Healthcare Hospital of Shunde Foshan), Foshan 528300, China.
Postgraduate of Guangdong Medical University, Zhanjiang 524002, China.
Int J Surg Case Rep. 2025 Feb;127:110963. doi: 10.1016/j.ijscr.2025.110963. Epub 2025 Jan 30.
Neuroendocrine tumors (NETs) can occur in almost any organ of the body, and they vary in size and volume. The small tumors may be <1 cm in size, but the large ones can exceed 20 cm. The probability of developing NETs in different organs varies greatly, but rectal NETs are relatively common. Our aim is to tell the surgeon that rectal NETs metastasize to the pelvic lateral lymph nodes even in the early stages and small sizes.
In this report, we present the case of a 47-year-old man who was asymptomatic and incidentally diagnosed with a small NET in the rectum during an enteroscopy for physical examination. The diagnosis was confirmed by pathological examination of the biopsy. The CT of the patient was performed pre-hospital for daily physical examination, but nothing could be seen in the rectum from the CT. Then, the diagnostic local resection and a wide free margin was performed on the patient, and a second operation (radical resection of rectal cancer and extensive lateral pelvic lymphadenectomy) was performed due to the post-operative pathological report and the discovery of enlarged pelvic lymph node by PET-CT (positron emission tomography CT). After the surgery, the patient is in good condition and have no other symptoms except for a slight feeling of defecating.
NETs could metastasize to the pelvic lateral lymph nodes, if so, the Total mesorectal excision (TME) should be performed, and the invasion and metastatic spread in NETs have to do with the regulatory factor named snail1 and Foxc2. We find that there is no standardized treatment approach for rectal NETs, which should be neither overtreated nor undertreated as far as possible, so the timing of surgery plays an important role, and long-term follow-up of the patients is extremely important.
The purpose of the presentation of this case is to highlight the potential for rectal NETs to metastasize to the pelvic lateral lymph nodes even in the early stages and small sizes, without muscular layer or neurovascular invasion, and lateral lymph node dissection were necessary, emphasizing the importance of timing for surgery.
神经内分泌肿瘤（NETs）几乎可发生于身体的任何器官，其大小和体积各异。小肿瘤可能小于1厘米，但大的肿瘤可超过20厘米。不同器官发生NETs的概率差异很大，但直肠NETs相对常见。我们的目的是告知外科医生，直肠NETs即使在早期且肿瘤较小的情况下也会转移至盆腔外侧淋巴结。
在本报告中，我们呈现了一名47岁男性的病例，该患者无症状，在因体检进行肠镜检查时偶然被诊断出直肠有一个小的NET。活检的病理检查确诊了该诊断。患者在入院前进行日常体检时做了CT，但CT未发现直肠有任何异常。随后，对该患者进行了诊断性局部切除并切缘充分，由于术后病理报告以及PET-CT（正电子发射断层扫描CT）发现盆腔淋巴结肿大，又进行了第二次手术（直肠癌根治术及广泛盆腔外侧淋巴结清扫术）。术后，患者状况良好，除了有轻微的排便感外无其他症状。
NETs可转移至盆腔外侧淋巴结，若如此，则应进行全直肠系膜切除术（TME），且NETs的侵袭和转移扩散与名为snail1和Foxc2的调节因子有关。我们发现对于直肠NETs尚无标准化的治疗方法，应尽可能避免过度治疗或治疗不足，因此手术时机起着重要作用，对患者进行长期随访也极为重要。
本病例报告的目的是强调直肠NETs即使在早期且肿瘤较小、无肌层或神经血管侵犯的情况下也有转移至盆腔外侧淋巴结的可能性，需要进行外侧淋巴结清扫，强调了手术时机的重要性。
