Abstract

Gastrointestinal neuroendocrine tumors (GINETs) (also known as “carcinoids”) are rare tumors with reported incidence of up to 6.98 per 100,000 which has increased significantly due to the increased detection on imaging and endoscopy. They are most commonly located in the small bowel, particularly the terminal ileum. Patients with small bowel NETs may present with abdominal pain, diarrhea, or carcinoid syndrome. However, the disease is mostly asymptomatic, and patients are usually diagnosed incidentally during routine colonoscopy. Although the ileum is the most common site for GINETs, terminal ileal (TI) intubation is not always completed during routine colonoscopy. With terminal ileum intubation being successful in at least 70% of colonoscopies and the rate of neuroendocrine tumor detection 0.1–1% of those intubations, one critical question remains unanswered: should terminal ileal intubation be considered a part of the definition of a complete colonoscopy? Herein, we present nine cases of NETs found incidentally on routine colon cancer screening colonoscopy in asymptomatic patients. This case series adds to the sparse literature and highlights the importance of TI intubation technique in early detection of small bowel NETs which could potentially affect the outcome.

Highlights

  • Gastrointestinal neuroendocrine tumors (GINETs) are rare tumors. e incidence has increased significantly due to the increased detection on imaging and endoscopy. ey are most commonly located in the small bowel, the terminal ileum. e disease is mostly asymptomatic, and patients are usually diagnosed incidentally during routine colonoscopy

  • Patients with small bowel NETs may present with abdominal pain, diarrhea, nausea, and vomiting especially when they have carcinoid syndrome [4]

  • The disease is mostly asymptomatic and patients are usually diagnosed when NETs are incidentally found during routine colonoscopy [5]. e mainstays of testing for small intestinal NETs are urine or serum 5-hydroxyindoleacetic acid (5HIAA) and chromogranin A (CgA)

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Summary

Introduction

Gastrointestinal neuroendocrine tumors (GINETs) ( known as “carcinoids”) are rare tumors. e incidence has increased significantly due to the increased detection on imaging and endoscopy. ey are most commonly located in the small bowel, the terminal ileum. e disease is mostly asymptomatic, and patients are usually diagnosed incidentally during routine colonoscopy. A CT scan abdomen\pelvis was performed and showed a mesenteric nodule measuring 9 mm adjacent to the terminal ileum, with no evidence of metastasis She underwent laparoscopic right hemicolectomy, and histopathology confirmed the diagnosis of low-grade neuroendocrine tumor involving the muscularis propria with metastatic tumor in 7 out of 19 resected lymph nodes (T2N1M0). A CT scan chest\abdomen\pelvis was performed and showed a faint enhancement of the terminal ileum with no evidence of metastasis He underwent a laparoscopic ileocolectomy, and histopathology confirmed the diagnosis of malignant carcinoid tumor with metastasis to 2 out of 15 resected lymph nodes (T4N1M0). A CT scan chest\abdomen\pelvis and NM octreotide (tumor localization) scan were performed and showed no definitive lesions suspicious for metastasis She underwent a right laparoscopic hemicolectomy, and histopathology confirmed the diagnosis of carcinoid invading the submucosa with metastasis to 6 out of 29 resected lymph nodes (T1N1M0). Surveillance: Case 1 66 Male personal history of colon polyp

57 Female
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