Ovarian metastases of ileal neuroendocrine tumor

Abstract

A 55-year-old, menopausal woman with history of breast carcinoma was referred for recurrent abdominal pain without diarrhea. Physical examination, routine biological investigation, and serum CA15-3 were normal. Abdominal contrast-enhanced computed tomography (CT) found a 15-mm ileal hyper-vascularized lesion with mild intestinal dilation and a mesenteric mass of about 20 mm. Both ovaries were moderately enlarged without radiological overt signs of malignancy. CT findings were consistent with ileal neuroendocrine tumor (ileal-NET) with mesenteric invasion. Serum value of chromogranin A was normal. 18F-Fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography (PET)/CT was added to the preoperative work-up 1 Addeo P. Poncet G. Goichot B. et al. The added diagnostic value of 18F-fluorodihydroxyphenylalanine PET/CT in the preoperative work-up of small bowel neuroendocrine tumors. J Gastrointest Surg. 2017; 22: 722-730 Crossref PubMed Scopus (7) Google Scholar and distinctly identified the primary ileal-NET with the mesenteric involvement. Moreover, intense and pathological 18F-FDOPA uptake was shown in both ovaries and 1 peritoneal nodule of a few millimeters in the Douglas space (Fig 1, A), suggesting ovarian metastases with peritoneal carcinomatosis. Surgical exploration found the primary tumor and the mesenteric lesion that were removed by a 20-cm ileal resection and mesenteric lymphadenectomy. Intervention was completed by bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies (Fig 1, B). Postoperative course was uneventful, and pathology confirmed a 20-mm, well-differentiated grade-2 ileal-NET (Ki-67: 4%) with mesenteric invasion, ovarian bilateral spread, and pelvic peritoneal metastases as small as a few millimeters in size (pT4N2M1, UICC 2016).