Oligosymptomatic neuroendocrine neoplasm of the small intestine with metastases spread to the heart, bones, muscles and intraperitoneally after a few years in remission – diagnostic and therapeutic challenges

Abstract

A fifty-one-year-old male patient with a history of recurring abdominal pains and signs of subileus, without carcinoid syndrome signs, underwent a laparatomy with a resection of the small intestine segment. Histopathology revealed a well­-differentiated neuroendocrine neoplasm of the small intestine. Due to the lack of hormonal activity and low malignancy potential the patient was not qualified for adjuvant therapy. The yearly computed tomography did not indicate a recur­rence of the neoplasm. The patient did not report any “red flag” symptoms. After a few years in remission [68Ga]-DOTATATE PET/CT revealed a dynamic development of the illness. The patient was qualified for palliative treatment with long-acting somatostatin analogue. Due to the treatment’s ineffectiveness and further progression of the disease, the patient received Peptide Receptor Radionuclide Therapy (PRRT). In spite of the therapy his condition did not improve and progression was observed. The patient died because of a malfunction of the cardiac conduction system caused by metastases in the heart.