Small intestinal NET - Interesting Case

53 year old lady presented with weight loss, weakness, anorexia, loose motions, abdominal discomfort & melena. Her CT scan of the abdomen & pelvis showed a small intestinal tumor with lymph node mass suggestive of a NET. Further work up with DOTA-PET confirmed it as a NET. It also showed a tiny metastatic tumor in the liver. Tumor marker work up with chromogranin and 24 hour urinary 5-HIAA showed the former having normal levels and the later raised significantly further confirming the SI-NET with a functioning component like a carcinoid disease.

The patient was operated after necessary medical work-up and a wide small bowel resection with the lymph node mass and liver metastatectomy was performed. Intraoperatively 5 more tiny tumor were detected, hence the wide resection. Patient recovered uneventfully and was discharged home soon. Her 24 hour urinary 5-HIAA showed a significant drop and bringing it to within normal limits, thus confirming the success of the surgery.

Patient will be monitored regularly to detect early any recurrence, metastasis or a new disease.

Points to note:

1. Extensive work-up can still miss tiny tumors (additional 5 tiny tumors in small intestine picked up during surgery)
2. A timely surgery is important.
3. An advanced stage disease can also be cured.
4. A regular surveillance in the postoperative period is necessary.

To know more about gastroenteropancreatic NETs, click here..