Korean J Gastroenterol.  2020 Nov;76(5):251-255. 10.4166/kjg.2020.096.

Low-grade Rectal Neuroendocrine Tumor Recurring as Multiple Hepatic Metastasis after Complete Endoscopic Removal: A Case Report

• Jo IH
• Lee KM
• Kim DB
• Lee JM

• KMID: 2508875
• DOI: http://doi.org/10.4166/kjg.2020.096

Abstract

The World Health Organization classified rectal neuroendocrine tumors (NETs) as malignant in 2010 owing to their distant metastasis potential. On the other hand, in cases of small rectal NETs (<10 mm), which have a low risk of metastasis, endoscopic removal is the first-line therapeutic option, and regular surveillance is not recommended. The authors report a case of a small, well-differentiated rectal NET, which recurred as multiple hepatic metastases 5 years after apparent complete removal using endoscopic methods.

Keyword

Neuroendocrine tumors; Rectum; Carcinoid tumor; Neoplasm metastasis

Figure

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  Fig. 1 (A) Oval bulging lesion in the mid rectum, approximately 0.8 cm in size, covered with normal mucosa. (B) Endoscopic ultrasonography revealed a hypoechoic lesion originating from the submucosa (third layer), with poorly demarcated boundaries and heterogeneous echogenicity.

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  Fig. 2 (A) In resected tissues, round cells of a similar size were arranged in nests or cord-like structures (H&E stain, ×400). Immunohistochemical staining was positive for (B) CD56 (×40) and (C) synaptophysin (×40).

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  Fig. 3 Abdominal computed tomography images 5 years after the endoscopic resection. Multiple enhancing hepatic masses were identified (white arrows).

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  Fig. 4 Microscopic findings of ultrasound-guided biopsy specimens. (A) Cells of uniform size and shape clustered in the nest form (H&E stain, ×40) and (B) exhibiting CD56a, synaptophysin, and chromogranin positivity in immunohistochemical staining (respectively ×40).

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