Publication:

A case report of primary small bowel neuroendocrine tumor with large metastatic lymph node at root of mesentery with tumor fibrosis

Small bowel neuroendocrine tumors (NETs) are rare but are increasing in incidence advances in imaging techniques. NETs are a heterogeneous group of tumors with diverse clinical and imaging presentations. Although these tumors are typically smaller in size, they can cause significant fibrotic reactions in the bowel wall, lymph nodes, and mesentery. Due to the relatively rare occurrence of these tumors, limited awareness among physicians and nonspecific clinical symptoms, patients with small bowel NETs often experience considerable delays in diagnosis and inappropriate management. We present a case of a 58-year-old female who came with recurrent abdominal pain, distension, vomiting, significant weight loss and poor appetite. Although imaging findings were suggestive of a mesenchymal tumor, intraoperatively we could find a stricturising lesion in the ileum with a mesenteric mass. She underwent resection and anastomosis of the small bowel lesion along with mesenteric nodal excision. Interestingly, the postoperative biopsy revealed a well-differentiated Grade 2 intermediate-grade ileal NET with mesenteric nodal involvement. On immunohistochemistry (IHC), tumour cells show low Ki-67 index with positive for chromogranin and synaptophysin.