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Rectal neuroendocrine tumor with extracapsular lymph node metastasis: a case report

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Abstract

The presence of extramural tumor deposits without lymph node structure (EX) is an important prognostic factor in patients with colorectal carcinoma. However, there is no English literature on neuroendocrine tumor (NET) with EX. We report a patient with rectal NET with extracapsular metastasis of a regional lymph node that was considered to be EX. A 51-year-old Japanese woman with diabetes was referred to our hospital for further examination of a submucosal tumor in the lower rectum. She was diagnosed as having rectal NET by immunohistochemical analysis of a biopsy, and underwent laparoscopic low anterior resection with lymph node dissection and covering ileostomy. Pathological findings of the resected specimen showed that the primary tumor was NET-G1 without any lymphatic or venous invasion. A single metastatic deposit was found near the capsule of a NET-negative regional lymph node. She has been free from recurrence for nine months without adjuvant treatments. Extracapsular metastasis of NET on a dissected lymph node in our case was considered to correspond to EX as defined for colorectal carcinoma. This rare case suggests that NET can disseminate to form EX in a similar manner to colorectal carcinoma.

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References

  1. Öberg K, Knigge U, Kwekkeboom D, et al. Neuroendocrine gastro-entero-pancreatic tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23:VII124–30.

    Article  Google Scholar 

  2. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97:934–59.

    Article  Google Scholar 

  3. Ito T, Sasano H, Tanaka M, et al. Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol. 2010;45:234–43.

    Article  Google Scholar 

  4. Masui T, Ito T, Komoto I, et al. Recent epidemiology of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN) in Japan: a population-based study. BMC Cancer. 2020;20:1104.

    Article  Google Scholar 

  5. NCCN Clinical Practice Guidelines in Oncology. Neuroendocrine tumor of the gastrointestinal tract, lung and thymus. Version 2; 2020.

  6. Japan NeuroEndocrine Tumor Society (JNETS). Clinical Practice Guidelines for Gastroenteropancreatic Neuroendocrine Neoplasms (GEP-NEN) 2019. 2nd ed. Tokyo: KANEHARA & Co., LTD; 2019.

  7. Konishi T, Watanabe T, Kishimoto J, et al. Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut. 2007;56:863–8.

    Article  Google Scholar 

  8. Zhou X, Xie H, Xie L, et al. Factors associated with lymph node metastasis in radically resected rectal carcinoids: a systematic review and meta-analysis. J Gastrointest Surg. 2013;17:1689–97.

    Article  Google Scholar 

  9. Shields CJ, Tiret E, Winter DC, International Rectal Carcinoid Study Group. Carcinoid tumors of the rectum: a multi-institutional international collaboration. Ann Surg. 2010;252:750–5.

    Article  Google Scholar 

  10. Sohn B, Kwon Y, Ryoo SB, et al. Predictive factors for lymph node metastasis and prognostic factors for survival in rectal neuroendocrine tumors. J Gastrointest Surg. 2017;21:2066–74.

    Article  Google Scholar 

  11. Brierley JD, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. 8th ed. Oxford: Wiley-Blackwell; 2017.

    Google Scholar 

  12. Ueno H, Mochizuki H, Shirouzu K, et al. Actual status of distribution and prognostic impact of extramural discontinuous cancer spread in colorectal cancer. J Clin Oncol. 2011;29:2550–6.

    Article  Google Scholar 

  13. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal and anal carcinoma: the 3d English Edition. J Anus Rectum Colon. 2019;3:175–95.

  14. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76:182–8.

    Article  Google Scholar 

  15. Soga J. Carcinoids of the rectum: an evaluation of 1271 reported cases. Surg Today. 1997;27:112–9.

    Article  CAS  Google Scholar 

  16. Prabhudesai A, Arif S, Finlayson CJ, Kumar D. Impact of microscopic extranodal tumor deposits on the outcome of patients with rectal cancer. Dis Colon Rectum. 2003;46:1531–7.

    Article  Google Scholar 

  17. Kimura K, Yamano T, Matsuda I, et al. Multiple rectal neuroendocrine tumors with recurrence of inguinal lymph nodes. Jpn J Gastroenterol Surg. 2018;51:170–7.

    Article  Google Scholar 

  18. Klöppel G, Couvelard A, Perren A, et al. ENETS consensus guidelines for the standard care in neuroendocrine tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology. 2009;90:162–6.

    Article  Google Scholar 

  19. Ramage JK, De Herder WW, Delle Fave G, et al. ENETS consensus guidelines update for colorectal neuroendocrine neoplasms. Neuroendocrinology. 2016;103:139–43.

    Article  CAS  Google Scholar 

  20. Frilling A, Clift AK. Therapeutic strategies for neuroendocrine liver metastasis. Cancer. 2015;121:1172–86.

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Akira Sakamoto, Hiroaki Nozawa, Hirofumi Sonoda, Hiroaki Ishii, Shigenobu Emoto, Hiroyuki Anzai, Yuichiro Yokoyama, Koji Murono, Kazuhito Sasaki, Kazushige Kawai & Soichiro Ishihara

  2. Department of Pathology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Munetoshi Hinata & Tetsuo Ushiku

Authors
  1. Akira Sakamoto
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  2. Hiroaki Nozawa
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  3. Hirofumi Sonoda
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  4. Munetoshi Hinata
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  5. Hiroaki Ishii
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  8. Yuichiro Yokoyama
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  9. Koji Murono
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  10. Kazuhito Sasaki
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  11. Kazushige Kawai
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  13. Soichiro Ishihara
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Correspondence to Akira Sakamoto.

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Sakamoto, A., Nozawa, H., Sonoda, H. et al. Rectal neuroendocrine tumor with extracapsular lymph node metastasis: a case report. Clin J Gastroenterol 14, 1426–1430 (2021). https://doi.org/10.1007/s12328-021-01447-x

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  • DOI: https://doi.org/10.1007/s12328-021-01447-x

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