Year 2024 / Volume 116 / Number 6
Digestive Diseases Image
“Grey areas” in large rectal neuroendocrine tumors: when endoscopic ultrasound becomes the silver lining

334-335

DOI: 10.17235/reed.2023.9893/2023

Vi­tor Macedo Silva, Joana Magalhães, Sílvia Leite, José Cotter,

Abstract
A 50-years old male with irrelevant medical history underwent colonoscopy for colorectal cancer screening. On the distal rectum, a subpedunculated (Paris classification Isp) lesion with 15mm was detected. This lesion presented yellowish mucosa and had irregular surfaces, suggesting a subepithelial lesion. Bite-on-bite biopsy confirmed a well-differentiated neuroendocrine tumor (r-NET), positive for synaptophysin, with a low-proliferative index. As r-NETs with 10-20mm fall on a grey area between endoscopic or surgical treatment, a lower endoscopic ultrasound (EUS) was performed, showing a round hypoechoic “salt and pepper” lesion of the mucosa, with focal involvement of the submucosa (3rd layer), but without muscularis propria invasion or regional lymph node involvement (uT1N0). No distal metastases were detected on computed tomography. Thus, the patient was proposed for endoscopic submucosal dissection. With this case we aim to recall EUS importance in large r-NETs, as adequate staging is crucial when deciding optimal therapeutic options.
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References
Pavel M, Öberg K, Falconi M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(7):844-860.
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Macedo Silva V, Magalhães J, Leite S, Cotter J. “Grey areas” in large rectal neuroendocrine tumors: when endoscopic ultrasound becomes the silver lining. 9893/2023


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Publication history

Received: 05/08/2023

Accepted: 31/08/2023

Online First: 21/09/2023

Published: 04/06/2024

Article Online First time: 47 days

Article editing time: 304 days


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