Year 2023 / Volume 115 / Number 12
Letter
Gastric variceal bleeding as a form of presentation of a pancreatic neuroendocrine tumor

735-736

DOI: 10.17235/reed.2023.9757/2023

Andrea García Soria, Alicia Brotons Brotons, Eva Girona Torres, Irene Pascual Sánchez, Asuncion Ojeda Gómez, Julia Sáez Fuster, Mariana Fe García Sepulcre, Javier Sola-Vera Sánchez,

Abstract
NETs (neuroendocrine tumors) constitute a heterogeneous group of epithelial-type neoplasms with a predominantly neuroendocrine differentiation. Although the most common locations are the pancreas, digestive tract, and lung, this type of neoplasm can arise in virtually any organ in the body. They are rare tumors with a wide variety of clinical presentations. Symptomatic tumors are more frequent in younger patients and present at more advanced pathological stages. We present the case of a 42-year-old male with idiopathic splenomegaly and bicytopenia (anaemia and thrombocytopenia) under study by haematology department who was admitted due to an episode of melena and hemoglobin of 4.5 mg/dl. Isolated gastric varices (IGV1) with red spots were confirmed at gastroscopy and endoscopic variceal obturation using cyanoacrylate was performed in two sessions. An endoscopic ultrasonography was performed, showing thrombosis of the splenic vein extending towards the splenoportal confluence with anechoic serpiginous structures outside and inside the gastric wall suggestive of collateral circulation with gastric varices (GV). An increase in portal caliber was observed, with no signs of liver cirrhosis. Computed tomography confirms the findings. Two months/week/days later he was readmitted with rebleeding signs after starting anticoagulant treatment, so it was decided to perform a splenectomy due to failure of the endoscopic treatment. Histology revealed infiltration of the spleen by a well-differentiated neuroendocrine tumor (NET). Gallium PET/CT and Octreotid scan showed uptake in the body and tail of the pancreas with positivity for somatostatin receptors previously undetected by other means. Finally, treatment was completed with distal pancreatectomy and splenoportal axis trombectomy with vascular esplenic resection and the patient was discharged from hospital.
Share Button
New comment
Comments
No comments for this article
References
1. Raphael MJ, Chan DL, Law C et al. Principles of diagnosis and management of neuroendocrine tumours. CMAJ. 2017 Mar 13;189(10):E398-E404.
2. Ito T, Igarashi H, Jensen RT. Pancreatic neuroendocrine tumors: clinical features, diagnosis and medical treatment: advances. Best Pract Res Clin Gastroenterol. 2012 Dec;26(6):737-53.
3. Hurtado-Pardo L, Breeze CE, Cienfuegos JA, Benito A, Valentí V, Martí-Cruchaga P, Zozaya G, Martínez Regueira F, Pardo F, Rotellar Sastre F. Comparison of phenotypes and outcomes following resection of incidental versus symptomatic pancreatic neuroendocrine tumors. Rev Esp Enferm Dig. 2022;114:317-322. doi: 10.17235/reed.2021.8096/2021.
4. Henry Z, Patel K, Patton H, Saad W. AGA clinical practice update on management of bleeding gastric varices: expert review. Clin Gastroenterol Hepatol. 2021;19(6):1098–1107.e1.
5. Hu Z, Zhang D, Swai J, Liu T, Liu S. Risk of rebleeding from gastroesophageal varices after initial treatment with cyanoacrylate; a systematic review and pooled analysis. BMC Gastroenterol. 2020 Jun 9;20(1):181. doi: 10.1186/s12876-020-01333-9. PMID: 32517718; PMCID: PMC7285616.
Related articles

Letter

Upper gastrointestinal bleeding and Rigler triad

DOI: 10.17235/reed.2023.9731/2023

Letter

Surgical indication of type I gastric neuroendocrine tumors

DOI: 10.17235/reed.2023.9681/2023

Letter

Carcinoid syndrome and somatostatin analogues

DOI: 10.17235/reed.2023.9525/2023

Letter

A full hemostatic repertoire in a complex cirrhotic patient

DOI: 10.17235/reed.2022.9039/2022

Letter

Ectopic ACTH syndrome in a patient with Crohn’s disease

DOI: 10.17235/reed.2022.8825/2022

Digestive Diseases Image

Bezoar: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2021.8311/2021

Letter

COVID-19 and aorto-enteric fistula

DOI: 10.17235/reed.2021.8272/2021

Digestive Diseases Image

Endoscopic resection of a duodenal neuroendocrine tumor

DOI: 10.17235/reed.2021.8232/2021

Digestive Diseases Image

A rare cause of extrahepatic biliary tract stricture: a neuroendocrine carcinoma

DOI: 10.17235/reed.2020.6491/2019

Letter

Klatskin-mimicking neuroendocrine tumor

DOI: 10.17235/reed.2019.6382/2019

Letter to the Editor

Author´s reply: Cystic pancreatic neuroendocrine tumors. A diagnostic challenge

DOI: 10.17235/reed.2018.5415/2017

Letter to the Editor

A case of a mixed adenoneuroendocrine tumor of the colon

DOI: 10.17235/reed.2017.5008/2017

Letter to the Editor

Neuroendocrine tumors of the pancreas: keys issues in dealing with heterogeneity

DOI: 10.17235/reed.2017.4997/2017

Letter to the Editor

Pancreatic neuroendocrine tumors. Prognostic factors

DOI: 10.17235/reed.2017.5109/2017

Letter to the Editor

Gangliocytic paraganglioma: an unusual cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2017.4808/2016

Letter to the Editor

Pancreatic neuroendocrine tumors

DOI: 10.17235/reed.2017.4725/2016

Editorial

Pancreas neuroendocrine tumors - not so rare or benign

DOI: 10.17235/reed.2016.4672/2016

Letter to the Editor

Unusual presentation of obstructive jaundice

DOI: 10.17235/reed.2017.4501/2016

Letter to the Editor

Gastric neuroendocrine tumor presenting with gastrointestinal bleeding

DOI: 10.17235/reed.2015.3998/2015

Case Report

Downhill varices: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2015.3697/2015

Citation tools
García Soria A, Brotons Brotons A, Girona Torres E, Pascual Sánchez I, Ojeda Gómez A, Sáez Fuster J, et all. Gastric variceal bleeding as a form of presentation of a pancreatic neuroendocrine tumor. 9757/2023


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1251 visits.
This article has been downloaded 71 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 30/05/2023

Accepted: 17/07/2023

Online First: 04/08/2023

Published: 12/12/2023

Article Online First time: 66 days

Article editing time: 196 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology