A subcentimeter duodenal neuroendocrine neoplasm with a liver metastasis upgraded to G3: a case report
| Autor: | Takashi Ito, Shinji Uemoto, Takamichi Ishii, Hiroyuki Katsuragawa, Tomoya Kitada, Satoshi Ogiso, Yosuke Kasai, Satoru Seo, Toshihiko Masui, Yuichiro Uchida |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Submucosal Lesion lcsh:Surgery Case Report Metastasis 03 medical and health sciences 0302 clinical medicine High grade Biopsy medicine Duodenal neuroendocrine neoplasm Liver metastasis Lymph node medicine.diagnostic_test business.industry Esophagogastroduodenoscopy Magnetic resonance imaging lcsh:RD1-811 medicine.disease Dissection medicine.anatomical_structure 030220 oncology & carcinogenesis Intratumor heterogeneity 030211 gastroenterology & hepatology Radiology Hepatectomy business |
| Zdroj: | Surgical Case Reports, Vol 7, Iss 1, Pp 1-7 (2021) Surgical Case Reports |
| ISSN: | 2198-7793 |
| Popis: | Background Although duodenal neuroendocrine neoplasms (DuNENs) usually have indolent phenotypes, some DuNENs exhibit aggressive clinical manifestations. Tumor size > 1 cm, lymph node metastasis, and high grade have been associated with poor prognosis. However, preoperative risk evaluation is often difficult, because Ki-67 index on biopsy is frequently underestimated due to the intratumor heterogeneity. Here, we present a case of a subcentimeter DuNEN with a low Ki-67 index on endoscopic biopsy, who developed lymph node metastasis and high-grade liver metastasis. Case presentation The patient was a 52-year-old female who presented an epigastric pain. Esophagogastroduodenoscopy revealed a duodenal submucosal lesion with a size of 8 mm. The endoscopic biopsy showed DuNEN with a Ki-67 index of 3.3% (G2 categorized by the World Health Organization 2019 classification). We performed an open partial duodenectomy with adjacent lymph node dissection. Pathological examination of the resected specimens revealed a Ki-67 index of 13.5% (G2) in the “hot spot” and lymph node metastasis. A hepatic low-density area detected on preoperative contrast-enhanced computed tomography appeared to be a liver metastasis on postoperative gadoxetic acid-enhanced magnetic resonance imaging. Subsequently, we performed a laparoscopic partial hepatectomy. Pathological examination of the liver specimen showed a metastatic neuroendocrine tumor with a Ki-67 index of 27.5% (NET-G3). The patient has been alive for 14 months since the hepatectomy. Conclusions This case shows the possibility of high malignant potential of DuNEN even if the primary lesion is |
| Databáze: | OpenAIRE |
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