Title: Neuroendocrine Tumour of the Ileum Presenting As Intestinal Obstruction in a 23 yr Old Female: A Case Report and Literature Review

Authors: Dr Archit Gupta, Dr Jagdish Gupta, Dr Kavita Mardi, Dr Amritanshu Sharma

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i2.29

Abstract

Primary small bowel tumors are rare and constitute only 1-3% of GI malignancies. Neuroendocrine tumors are rare tumors that arise from enterochromaffin cells in GI Tract. These may present with non-hormonal features due to partial obstruction of bowel or with hormonal features due to secretion of serotonin and other biochemical substances into circulation. WHO in 2010 classified these tumors according to Ki 67 index and mitotic count which is believed to be a useful prognostic factor and related with tumor size, invasion and metastasis. Treatment is mainly surgical comprising of segmental resection of small bowel with associated lymph node clearance.

We present a case of a who grade 2 neuroendocrine tumor presenting in a 23 year old female as intestinal obstruction without metastasis. We are reporting this case because of early age of onset and its presentation as intestinal obstruction which lead to early diagnosis of the disease before it metastasised, hence improving the prognosis. Review of literature done to emphasise the clinicopathological features, diagnosis and treatment of the disease. 

References

1.      Marcelo A, Karina S. Primary tumors of jejunum and ileum as a cause of intestinal obstruction: a case control study. Internati-onal Journal of Surgery 2007;5(3);183-191

2.      Miles RM, Crawford D, Duras S. The small bowel tumor problem: an assessment based on a 20 yr experience with 116 cases. Ann Surg. 1979;189:732-738

3.      William J, Kenneth J, Carlos J. Neuroend-ocrine tumors of the gastrointestinal tract: Case reports and literature review. World J Gastrointest Oncol. 2014 Aug 15; 6(8): 301–310.

4.      Burke AP, Thomas RM, Elsayed AM, Sobin LH. Carcinoids of the jejunum and ileum: An immunohistochemical and clinicopathologic study of 167 cases. Cancer 1997;79:1086-93.

5.      Ciresi DL, Scholten DJ. The continuing clinical dillema of primary tumors of small intestine. Am Surg. 1995;61:698-703

6.      Fischer C, Bass BL. Tumors of small intestine. In Zinner MJ, Ashley SW edsMaingot’s Abdominal Operations 12th edition China: McGraw Hill publications;2013.611-612

7.      Pan SY, Morrison H. Epidemiology of cancer of small intestine. World J Gastrointest Oncol. 2011;3:33-42

8.      Oeberndorfer S. Uber die "Kleinen Dunndamcarcinome". Verhandl Deutsch Pathol, 1907; 11: 113-16

9.      Gould M, Johnson RJ. Computed Tomography of abdominal carcinoid tumor. British J. of Radiol. 1986; 59, 881-885.

10.  Moosavy SH, Andrabi Y, Esmaeeli S, Amini A. Small bowel obstruction by a terminal ileum carcinoid tumor: a case rep-ort. Medical Journal of Islamic Republic of Iran, Vol. 25, Nov 2011;165-169

11.  Niederle B, Pape UF, Costa F, Gross D, Kelestimur F, Knigge U, et al. ENETS Consensus guidelines update for Neuroendocrine Neoplasms of the Jejunum and Ileum. Neuroendocrinology. 2016; 103: 125-138.

12.  Johannesen E, Nguyen V. WHO Grade 2 Neuroendocrine Tumor in a 15-Year-Old Male: A Case Report and Literature Review. Case Reports in Pathology. 2014; 426161:1-4

13.  Jonathan Strosberg: Neuroendocrine tumours of the small intestine. Best Pract Res ClinGastroenterol. 2012; 26: 755-773

14.  Levy AD, Sobin LH: Gastrointestinal Carcinoids: Imaging features with clinico pathologic comparison. Radiographics 2007; 27(1):237-257

15.  Basson MD, Ahlman H, Wangberg B, et al.: Biology and managementof the midgut carcinoid. Am J Surgery 1993, 165:288-297

16.  Prasad ND, Manmadharao V, Babji K, Reddy DK. Intestinal Obstruction by Carcinoid Tumour in Ileum: A Case Report. Int J Sci Stud 2015;2(10):166-168

17.  Khan AN, Carcinoid. Gastrointestinal. emedicine, July, 2005. Available online at: http://www. emedicine.com. Accessed 10 Jan 2017

18.  Gould M, Johnson RJ. Computed Tomo-graphy of abdominal carcinoid tumor. British J. of Radiol. 1986; 59, 881-885

19.  Singhal H: Carcinoid tumor, Intestinal. Available online at: http:// www.emedicine.com.Accessed 2 Jan 2017

20.  Srirajaskanthan R, Toumpanakis C, Meyer T, Caplin ME. Review article: future therapies for management of metastatic gastroenteropancreatic neuroendocrine tumours. Aliment PharmacolTher. 2009;29:1143–1154

21.  Celotti A, Pulcini G, Schieppati M. An Unusual Case of a well differentiated neuroendocrine tumor of the ileum with peritoneal carcinomatosis: a case report. World Journal of Surgical Oncology. 2015;13:169-176

22.  Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. WHO Classification of Tumours of the Digestive System. Geneva, Switzerland: WHO Press; 2010.

23.  Rindi G, Kloppel G, Alhman H, et al; and all other Frascati Consensus Conference participants; European Neuroendocrine Tumor Society (ENETS). TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2006;449(4):395-401

24.  Miller HC, Drymousis P, Flora R, Goldin R, Spalding D. Role of Ki-67 proliferation index in assessment of patients with neuroendocrine neoplasiasregarding the stage of disease. World J Surg. 2014; 38(6): 1353-61.

Corresponding Author

Dr Archit Gupta

Post Graduate Student, Dept of General Surgery

Indira Gandhi Medical College, Shimla, Himachal Pradesh

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone no. : 9805189895