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Spontaneous intra-abdominal hemorrhage of a well-differentiated, grade 3 gastric neuroendocrine tumor during drug-based treatment

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Abstract

Grade 3, well-differentiated, gastric neuroendocrine tumors (NET G3) are extremely rare. Herein, we report the case of a 64-year-old man with a grade 3 neuroendocrine tumor of the stomach who experienced intra-abdominal bleeding during the course of drug treatment. The patient was referred to our hospital for examination of a gastric tumor that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy revealed an elevated lesion with a central ulcer in the upper body of the stomach, and biopsy specimens confirmed the pathological diagnosis of NET G3. Abdominal contrast-enhanced computed tomography (CT) showed a 25-cm, well-defined mass lesion showing heterogeneous enhancement in the liver. A clinical diagnosis of NET G3 with multiple liver metastases was given, after which everolimus was administered in combination with a somatostatin analogue. However, the patient developed sudden-onset epigastric abdominal pain and general fatigue 2 months later, and emergency abdominal contrast-enhanced CT confirmed the presence of intra-abdominal hemorrhage. Following blood transfusion, the patient’s symptoms and general condition improved. Although the patient was treated with streptozocin, abdominal CT indicated progression of the liver metastases. Unfortunately, despite receiving best supportive care, the patient died 8 months after the initial of the treatment. To the best of our knowledge, this is the first case of a patient who developed spontaneous hemoperitoneum during drug treatment for a NET G3 to be reported in the English literature. It is essential that additional data be obtained to determine the optimal treatment for this disease.

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Tsutomu Namikawa, Keiichiro Yokota, Sachi Yamaguchi, Ian Fukudome, Masaya Munekage, Sunao Uemura, Hiromichi Maeda, Hiroyuki Kitagawa & Kazuhiro Hanazaki

  2. Nursing Department, Kochi Medical School Hospital, Kochi, Japan

    Kiyo Mibu

  3. Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan

    Michiya Kobayashi

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  1. Tsutomu Namikawa
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Correspondence to Tsutomu Namikawa.

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Tsutomu Namikawa, Keiichiro Yokota, Sachi Yamaguchi, Ian Fukudome, Masaya Munekage, Sunao Uemura, Hiromichi Maeda, Hiroyuki Kitagawa, Kiyo Mibu, Michiya Kobayashi, and Kazuhiro Hanazaki declare that they have no conflict of interest.

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Namikawa, T., Yokota, K., Yamaguchi, S. et al. Spontaneous intra-abdominal hemorrhage of a well-differentiated, grade 3 gastric neuroendocrine tumor during drug-based treatment. Clin J Gastroenterol 14, 1244–1249 (2021). https://doi.org/10.1007/s12328-021-01433-3

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  • DOI: https://doi.org/10.1007/s12328-021-01433-3

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