Management of sub-5 mm rectal carcinoids with lymph node metastases

Toh, James Wei Tatt; Henderson, Christopher; Yabe, Takako Eva; Ong, Evonne; Chapuis, Pierre; Bokey, Les

doi:10.1093/gastro/gou073

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…properties were similar to those of the previously resected rectal Although multicentricity is not considered a risk factor for metastasis from rectal NETs, cases of lymph node metastasis from multiple small rectal NETs have been reported [8][9][10]. [4,6].…”

Section: Case Reportsupporting

confidence: 78%

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors

김선아¹,

최지은²,

김병창³

et al. 2019

Korean J Med

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The incidence of rectal neuroendocrine tumors (NETs) has increased worldwide, including in Korea. Rectal NETs are usually single lesions, but synchronous multiple lesions are reported in 2-4.5% of patients. Small rectal NETs (≤ 10 mm) are usually confined to the submucosal layer and rarely give rise to lymph node or distant metastases. Here we describe the case of a 54-year-old woman referred to National Cancer Center for the management of two rectal subepithelial tumors. Because computed tomography revealed a small hepatic nodule suggesting atypical hemangioma rather than metastasis, endoscopic submucosal dissection was performed. However, the size of the nodules increased during follow-up. The pathologic results of a liver biopsy confirmed metastatic NET. This case was unusual in that synchronous small rectal NETs and distant liver metastasis occurred in the absence of any risk factors for metastasis. Thus, patients with rectal NETs should be carefully evaluated, especially for the possibility of metastasis.

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Section: Case Reportsupporting

confidence: 78%

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors

김선아¹,

최지은²,

김병창³

et al. 2019

Korean J Med

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“…Well-differentiated NETs, which have malignant potential, are characterized cytologically by bland uniform cells with round to oval nuclei, indistinct nucleoli, and coarsely granular chromatin [ 6 , 7 ]. Distant metastasis resulting from unexpected tumor aggressiveness is therefore of clinical concern in patients with well-differentiated NETs [ 8 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Identification of Phosphohistone H3 Cutoff Values Corresponding to Original WHO Grades but Distinguishable in Well-Differentiated Gastrointestinal Neuroendocrine Tumors

Kim

Kwon

Kang

et al. 2018

BioMed Research International

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Mitotic counts in the World Health Organization (WHO) grading system have narrow cutoff values. True mitotic figures, however, are not always distinguishable from apoptotic bodies and darkly stained nuclei, complicating the ability of the WHO grading system to diagnose well-differentiated neuroendocrine tumors (NETs). The mitosis-specific marker phosphohistone H3 (PHH3) can identify true mitoses and grade tumors reliably. The aim of this study was to investigate the correspondence of tumor grades, as determined by PHH3 mitotic index (MI) and mitotic counts according to WHO criteria, and to determine the clinically relevant cutoffs of PHH3 MI in rectal and nonrectal gastrointestinal NETs. Mitotic counts correlated with both the Ki-67 labeling index and PHH3 MI, but the correlation with PHH3 MI was slightly higher. The PHH3 MI cutoff ≥4 correlated most closely with original WHO grades for both rectal NETs. A PHH3 MI cutoff ≥4, which could distinguish between G1 and G2 tumors, was associated with disease-free survival in patients with rectal NETs, whereas that cutoff value showed marginal significance for overall survival in patient with rectal NETs. In conclusion, the use of PHH3 ≥4 correlated most closely with original WHO grades.

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“…and Kim et al. made similar case reports, and while angiolymphatic invasion and multicentricity were identified as common risk factors for metastasis, the detailed mechanism was not explained [ 22 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple distant metastases arising from a single, low-grade rectal neuroendocrine tumor: an autopsy case report

et al. 2023

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Background Rectal neuroendocrine neoplasms are rare epithelial neoplasms of the rectum. The incidence of these tumors has increased over the past decades. However, many questions remain unanswered regarding their clinicopathology, including the possible mechanisms in which these tumors may grow and metastasize. Case presentation In this case report, we report the findings of an autopsy of a 65-year-old Japanese woman diagnosed with multiple liver metastases from a single, low-grade rectal neuroendocrine tumor. The diagnosis was made in late 2018 to early 2019, and subsequently the patient underwent several rounds of standard chemotherapy. However, due to unfavorable side effects, she opted for palliative care at our hospital instead from December 2020. The patient’s condition was generally stable for the next 17 months, but in May 2022, she was hospitalized for increased abdominal pain. Despite enhanced pain control therapy, she eventually passed away. An autopsy was conducted to determine the exact cause of death. The primary rectal tumor was found to be small, but showed strong histological evidence of venous invasion. Metastases in the liver, pancreas, thyroid gland, adrenal glands, and vertebrae were also present. On the basis of the histological evidence obtained, we deduced that the tumor cells may have mutated and gained multiclonality as they spread vascularly to the liver, contributing to the distant metastases. Conclusions The results from this autopsy may provide an explanation for the possible mechanism by which small, low-grade rectal neuroendocrine tumors metastasize.

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Management of sub-5 mm rectal carcinoids with lymph node metastases

Cited by 3 publications

References 34 publications

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors

Liver Metastasis of Synchronous Small Rectal Neuroendocrine Tumors in the Absence of Risk Factors

Identification of Phosphohistone H3 Cutoff Values Corresponding to Original WHO Grades but Distinguishable in Well-Differentiated Gastrointestinal Neuroendocrine Tumors

Multiple distant metastases arising from a single, low-grade rectal neuroendocrine tumor: an autopsy case report

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