Neuroendorine tumor in the background of adenocarcinoma of midrectum
Introduction: Synchronous neuroendocrine tumor in the background of midrectal adenocarcinoma is rare. It is a very slow-growing tumor and symptomatic only late in the course of the disease. Case Summary: This is a 60 years old gentleman with no past medical illness presented with persistent lo...
| Main Authors: | , , , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2015
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/58385/ http://irep.iium.edu.my/58385/ http://irep.iium.edu.my/58385/13/58385.pdf http://irep.iium.edu.my/58385/2/poster%20net%20rectum.pdf |
| Summary: | Introduction:
Synchronous neuroendocrine tumor in the background of midrectal adenocarcinoma is
rare. It is a very slow-growing tumor and symptomatic only late in the course of the
disease.
Case Summary:
This is a 60 years old gentleman with no past medical illness presented with persistent
loose stool with mucus for 3 months. Colonoscopy found clinically not obstructed upper
rectal tumor and biopsy came back as adenocarcinoma. CEA was not raised. CT scan
staging showed no distant metastasis and MRI staging reported as T3N0. Intraoperatively,
we found midrectal tumor with mucosal ulceration and small liver nodule at segment
V. Low anterior resection encompassed of good oncological resection with covering ileostomy
was done. Moderately differentiated adenocarcinoma of midrectum with staging
of p T2 N0 Mx.
Initially, the pathologist reported as the distal doughnut of the specimen was involved.
However, after consultation with few experienced pathologist noted an incidental neuroendocrine
tumor, grade 1 at the distal doughnut of the specimen with positive immunohistochemical
staining for synaptophysin, chromogranin and CD56. Histologically,
there were solid nest and occasional rosette of neoplastic cells confined within the submucosal
layer, sparing the overlying mucosa. There was no necrosis or muscularis propria
invasion. Mitotic figure is low, around 0-1/10 high power field. The Ki67 proliferative
index is about 1%. PET scan was arranged to confirm the suspicious liver nodule to
rule out metastasis. Serum chromogranin A was pending. He was arranged for oncology
review after the PET scan for further plan. |
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