J Korean Soc Radiol.  2017 Sep;77(3):187-191. 10.3348/jksr.2017.77.3.187.

Primary Presacral Neuroendocrine Tumor: A Case Report and Review of MRI Findings

• Kim JM
• Lee NK
• Kim S
• Ahn SJ
• Suh DS
• Han GJ
• Lee JW

• KMID: 2405734
• DOI: http://doi.org/10.3348/jksr.2017.77.3.187

Abstract

Primary presacral neuroendocrine tumor (NET) is extremely rare. Furthermore, its preoperative diagnosis is very difficult, and its imaging characteristics are not well described. We report the case of a 70-year-old female with presacral NET, and describe its imaging features on diffusion-weighted magnetic resonance imaging.

MeSH Terms

Aged
Diagnosis
Diffusion Magnetic Resonance Imaging
Female
Humans
Magnetic Resonance Imaging*
Neuroendocrine Tumors*
Sacrum

Figure

• 

  Fig. 1 A 70-year-old woman presented with primary presacral neuroendocrine tumor. A. Contrast-enhanced CT reveals an 8 cm-sized presacral mass (arrow) which abutted the sacrum without bony erosion or destruction. The mass is well-defined, solid with heterogeneous enhancement and it shows internal cystic degeneration and calcification. B. Sagittal T2-weighted image (left) shows a presacral mass with pressure erosion and bone marrow change (arrow) in the sacrum. The mass shows heterogeneous intermediate signal intensity on T2-weighted image (left), hypointensity on T1-weighted image (middle), and avid enhancement on contrast-enhanced T1-weighted image (right). Focal hyperintense foci (arrowheads) within the mass are noted on T1- and T2-weighted images. C. The tumor exhibits hyperintensity on diffusion-weighted image (left) at a b value of 1000 s/mm2 with a low apparent diffusion coefficient (ADC) value (mean, 0.632 × 10−3 mm2/sec) on the ADC map (right). D. Photomicrograph of the tumor cells (left, hematoxylin and eosin stain, × 200) shows an infiltrative border in the background of fibrotic stroma. Tumor shows monomorphic, plasmacytoid neuroendocrine cells, with insular, solid and trabecular growth patterns. Immunohistochemical examinations show approximately 15% increase in the Ki-67 labeling index (middle, × 400) and positivity for synaptophysin (right, × 200). E. Positron emission tomography-CT shows multiple pulmonary nodules, which are suspicious for metastasis.

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