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- Title
WHAT IS HIDDEN BEHIND AN "OCCULT BLEEDING"? -- A SMALL BOWEL NEUROENDOCRINE TUMOR CASE REPORT.
- Authors
Lung, Georgiana Daniela; Iacob, Andra; Costea, Nicolae Cristian
- Abstract
Introduction: Neuroendocrine tumors of the intestine have shown an increase in incidence in recent decades. NETs originate from the Kulchitsky cells, which are neuroendocrine cells located in the Lieberkühn crypts of the intestinal mucosa. The malignant behavior is directly proportional to the size of the tumor. This condition doesn't have specific symptoms, leading to a delay in diagnosis. The small intestine represents the second most common location for neuroendocrine tumors of the gastrointestinal tract, after the appendix. Case Report: We present the case of a 48 years old female who was admitted to the gastroenterology department for investigations following rectal bleeding and a positive occult blood test. The patient has Helicobacter pylori associated gastritis, for which she is undergoing antibiotic treatment, as well as non-alcoholic fatty liver disease, hypercholesterolemia and mild hypertriglyceridemia. Physical examination does not detect any pathological changes. Labor analysis expose slightly elevated fibrinogen levels(432 mg/dl), without anemic syndrome. Colonoscopy reveals a polypoid submucosal mass(2-3cm), highly vascularized, located in the terminal ileum, 3 cm from the ileocecal valve. Contrast CT shows the tumor, the tomographic aspect suggesting a possible GIST (Gastrointestinal Stromal Tumor) or NET (Neuroendocrine Tumor), and several mesenteric and retroperitoneal lymphadenopathies (5- 10mm). Biopsy: mucosal proliferation of cells with insular arrangement, with luminal outlining, positive for chromogranin and synaptophysin, focally positive PanCK (AE1/AE3), leading to the diagnostic of low-grade neuroendocrine tumor. The patient underwent surgical treatment consisting of ileal resection and right hemicolectomy followed by ileotransversal anastomosis. Discussions : Endoscopic biopsy of the tumor was attempted, and it triggered a self-limiting laminar hemorrhage. Considering the high rate of malignancy in submucosal tumors and its size(>2 cm), surgical consultation is recommended for tumor resection. Conclusions: The smallest sign can reveal a significant pathology. In the case of the patient, a simple occult bleeding (even in the absence of an anemic syndrome) led to the diagnosis of a pathology that, if left untreated, could have lethal potential. With the appropriate treatment, the patient has a favorable prognosis and a high life expectancy.
- Subjects
ROMANIA; GASTROINTESTINAL hemorrhage; CONFERENCES &; conventions; FECAL occult blood tests; NEUROENDOCRINE tumors; RECTUM
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p186
- ISSN
2668-7755
- Publication type
Article