Myocardial, Retro-orbital, and Bilateral Testicular Metastases of an Ileal Neuroendocrine Tumor in 68 Ga-DOTATATE PET/CT

ABSTRACT

A 71-year-old man with a newly discovered metastatic grade II neuroendocrine tumor of the terminal ileum was referred for a 68 Ga-DOTATATE PET/CT scan to stage the disease and assess suitability for PRRT (peptide receptor radionuclide therapy). The patient was known to have secondary nodal and bone/liver metastatic disease through prior morphological investigations. PET images revealed an atypical pattern of metastatic disease, showcasing secondary lesions in bilateral extraocular muscles, the myocardium, and both testes. The patient was pauci-symptomatic and only reported fatigue and diarrhea. Management involved lanreotide administration, and PRRT is being envisaged.

Focal loss of mural stratification as a radiological predictor for small bowel adenocarcinoma in Crohn's disease

AIM

Patients with Crohn's disease (CD) are at higher risk of small bowel adenocarcinoma (SBA). We aimed to identify radiological predictors of SBA in CD.

METHODS

We conducted a retrospective case-control study at two tertiary inflammatory bowel disease centers and identified CD patients diagnosed with SBA between 2003 and 2019. Patients were matched with up to four controls. Pre-operative imaging (magnetic resonance imaging (MRI) or computed tomography (CT)) were reviewed by three gastrointestinal radiologists.

RESULTS

Nineteen patients with CD-associated SBA with a mean age of 54.9 and 32 matched controls were included. Mean length of small bowel involvement was 216 (± 188) mm in the SBA group versus 156 (± 167) mm in the control group (p = 0.76). Only 11.8 % of cases had a diagnosis of SBA made preoperatively. In univariate analysis, focal loss of mural stratification (odds ratio [OR], 11; 95%CI, 2.43-49.5, p = 0.002), and wall thickening (OR, 1.32; 95%CI, 1.05-1.66, p = 0.02) were significantly associated with SBA. After adjustment, focal loss of mural stratification was the only independent risk factor (OR, 11; 95 % CI, 2.43-49.5, p = 0.002).

CONCLUSIONS

Focal loss of mural stratification was identified as a predictor of CD-associated SBA, which should be described in imaging reports and further validated.

[Preoperative diagnosis of small intestinal cancer associated with Crohn's disease: a case report]

The patient was a 46-year-old woman with a history of Crohn's disease for several years. At 45 years of age, a colonoscopy was performed, and a protruding lesion in the terminal ileum was detected. Pathological analysis of a biopsy specimen noted high suspicion for a well differentiated adenocarcinoma. The patient underwent ileocecal resection, and histological examination of the specimen revealed that infiltration of the well differentiated adenocarcinoma was limited to the mucosa. To the best of our knowledge, this is the first known case of early small intestinal cancer associated with Crohn's disease in Japan. Both endoscopy and a biopsy of any protruding lesions may be useful for making a preoperative diagnosis of small intestinal cancer associated with Crohn's disease.

Ileal Ulcer Associated With a Large Bezoar Mimicking Malignancy on FDG PET/CT

A 34-year-old woman presented with abdominal pain for 2 months. Abdominal CT revealed a large bezoar in the distal ileum with surrounding thickened ileal wall and enlarged mesentery lymph nodes. On FDG PET/CT, the thickened ileal wall and enlarged mesentery lymph nodes showed increased FDG uptake. Ileal malignancy with mesentery lymph node metastasis was suspected. The distal ileum and enlarged mesentery lymph nodes were removed. Benign ileal ulcer and mesentery reactive lymphoid hyperplasia were confirmed by histopathology.

CT detection of primary and metastatic ileal carcinoid tumor: rates of missed findings and associated delay in clinical diagnosis

PURPOSE

To determine the rate of missed CT findings of ileal carcinoid tumor prior to pathologic diagnosis and the resultant diagnostic delay.

METHODS

Initially, 74 patients with abdominal and pelvic CT prior to pathologically-proven diagnosis of ileal carcinoid were identified. Patients were excluded when the original CT study (n = 6) or report (n = 4) was not available, resulting in a final cohort of 64 patients (mean age, 58.3 years; 29 M/35F); 27 (42%) patients had more than one abdominal CT prior to diagnosis. All available CT studies prior to diagnosis were retrospectively reviewed for the presence of the primary ileal tumor and metastatic disease (mesenteric and hepatic).

RESULTS

Primary ileal tumors were prospectively missed on at least one CT scan in 64% (32/50) of patients with retrospectively identifiable disease. CT findings of mesenteric spread were missed at least once in 46% (25/54) of cases where present in retrospect. By the final pre-operative CT, hepatic metastases and bowel wall thickening were present in 55% (35/64) and 52% (33/64) of cases, respectively. In patients with missed ileal and/or mesenteric findings resulting in diagnostic delay, mean delay was 40 months (range 4-98 months).

CONCLUSION

Initial presentation of ileal carcinoid tumor, even with mesenteric involvement, is often missed prospectively at abdominal CT, leading to delay in diagnosis until bowel or mesenteric findings become more obvious, or hepatic metastatic disease manifests. Radiologists should make a concerted effort to evaluate the bowel and mesentery in patients with long-standing vague abdominal symptoms.

Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease: A case report

RATIONALE

Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.

PATIENT CONCERNS

We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.

DIAGNOSES

The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.

INTERVENTIONS AND OUTCOMES

The patient underwent surgical resection and is disease free at 6 years follow-up.

LESSONS

This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.

A case report on metastatic ileal neuroendocrine neoplasm to the breast masquerading as primary breast cancer: A diagnostic challenge and management dilemma

RATIONALE

Metastatic neuroendocrine neoplasms (NENs) to the breast are very rare entities comprising only 1% to 2% of all metastatic breast tumors. In this article, we describe a case of a neuroendocrine ileal neoplasm metastatic to breast and liver, with breast metastatic tumor to be the initial manifestation of the disease.

PATIENT CONCERNS

We herein report a rare case of a female patient admitted to our department with a palpable painful mass on her left breast.

DIAGNOSIS

The surgical and histological investigation revealed a metastatic neuroendocrine neoplasm to the breast originated from terminal ileum.

INTERVENTIONS

A left lumpectomy, right hemicolectomy, cholecystectomy, left hepatectomy along with liver metastasectomies (V, VI, VIII) plus radiofrequency ablation of lesions to the right liver lobe plus standard lymphadenectomy was performed.

OUTCOMES

Considering the advanced stage of the disease, the patient received an adjuvant therapy of somatostatin analog plus everolimus. Under the guidance of oncological consultation, patients follow-up with CT and MRI scan and clinical re-evaluations in the first 3 and 6 months, substantiates no evidence of recurrence and she presents herself asymptomatic.

LESSONS

An appropriate level of suspicion and selective immunohistochemistry in these cases, particularly where no prior history of a known primary neuroendocrine neoplasm occurs, may help to diagnose a previously undetected neuroendocrine tumor elsewhere in the body and provide guidance for the appropriate treatment selection.

Sonographic diagnosis of an ileal adenomyoma in a neonate

An ileal adenomyoma leading to intussusception is very rare. We describe the case of a 4-month-old boy who presented with hematochezia. He was diagnosed with ileal adenomyoma by sonography, which was confirmed by histopathology. This case confirms that sonography is the preferred modality to diagnose an ileal adenomyoma.

Sporadic Burkitt's lymphoma masquerading as an intussuscepted Meckel's diverticulum in a 9-year-old child

We report the case of a 9-year-old boy who presented with abdominal pain and was found to have an intussusception with a sporadic Burkitt's lymphoma (BL) lead point. Our case was unusual in that the patient did not present with the typical clinical features of BL, nor was he in a high-risk demographic for this uncommon disease.

Bone Lesion in a Patient with Transplanted Liver for a Metastatic Carcinoid. The Role of Somatostatin Receptor Scintigraphy

A patient who had previously undergone ileal resection and liver transplantation for a gastroenteropancreatic (GEP) tumor was evaluated with somatostatin receptor scintigraphy (SRS) using 111In-DTPA-D-Phe1-pentetreotide. Eighteen months after surgery, during follow-up procedures, conventional imaging techniques (ultrasound, computed tomography, magnetic resonance imaging) only showed a relapse in the gastropancre-atic lymph nodes, while SRS demonstrated skeletal spread. This case report emphasizes the clinical impact of SRS on the management of patients affected by neuroendocrine gastroenteropancreatic tumors.

Primary Adenocarcinoma of Terminal Ileum with Clinical and Gross Morphologic Features Simulating Crohn's Disease. A Case Report

We report a case of primary adenocarcinoma of the terminal ileum, which presented with clinical, radiologic and surgical findings indistinguishable from Crohn's disease. The age of the patient and the rapidly progressing symptoms were the only preoperative clues to the diagnosis of an occult malignancy. Frozen sections of an intraoperative biopsy established the correct diagnosis and led to a radical change in the treatment. This is the third report of adenocarcinoma of the small bowel simulating Crohn's disease.

Contribution of the virtual colonoscopy in a case of intestinal intussusception

The present paper describes a case of ileocecal intussusception detected by ultrasound and confirmed by CT, including the imaging characteristics allowing its diagnosis. The patient was referred for colonoscopy, which could not be completed, to assess the cause of intussusception. Then it was decided to resort to Virtual colonoscopy, which allowed to identify and characterize a cecal neoplasm serving as a lead point for the intussusception.

[A Case of Small Intestinal Malignant Lymphoma Presenting with Perforated Peritonitis]

An 85-year-old man presented to the emergency department with vomiting. He had tenderness in the left abdomen and under the umbilicus. Laboratory data showed an increase in the inflammatory response. Enhanced abdominal computed tomography showed thickening ofthe small intestinal wall in the lower left abdomen with a small amount ofadjacent free air. The fat tissue around the small intestine also revealed a high density area suggestive of inflammation. A diagnosis of peritonitis caused by intestinal perforation was made and an emergency operation was performed. We resected part of the ileum about 90 cm from the ileum end. The resected specimen showed a 1 by 1 cm mass with an ulcer and perforation at the base of the tumor. Histopathological findings revealed densely increased numbers of monomorphic medium-sized lymphoma cells infiltrating into all layers ofthe intestine. Immunohistochemically, the lymphocytes were positive for CD3, CD20, CD30, and CD79a. We diagnosed diffuse large B-cell lymphoma. Two cycles ofchemotherapy were given post-operatively. A recurrence was not observed. After chemotherapy he was transferred to rehabilitation.

[A Case of Neuroendocrine Tumor of the Ileum Manifesting as Fecal Occult Blood]

A 42-year-old woman was admitted to our hospital because of a positive fecal occult blood test. Colonoscopy examination revealed an elevated lesion measuring 25mm in diameter at the terminal ileum. A histological diagnosis of neuroendocrine tumor(NET)was made based on biopsy specimens taken from the lesion. Since no apparent distant metastasis other than the ileocolic lymph nodes was noted, laparoscopy-assisted ileocecal resection with regional lymph node dissection was performed. In the resected material, NET(G2)limited to the subserosa layer was present. The NET tested positive for synaptophysin, chromogranin A, and CD56. Metastases in the paraileal lymph nodes was detected. NET metastasis to the ileum is frequent, even if the tumor is small in diameter; therefore, it is necessary to resect the tumor entirely and to dissect the regional lymph nodes.

Ileo-colic intussusception by ileo-cecal valve lipoma - an infrequent ultrasonographic occurrence. A case report

We present a rare cause of intestinal obstruction in an adult, due to ileo-colic intussusception by a lipoma of the ileo-cecal valve and its ultrasonographic presentation. The case presented in emergency for spontaneously appearing and disappearing palpable elastic mass in the right iliac fossa. The ultrasonographic examination raised the suspicion of an ileo-colic intussusception due to a polypoid tumor. The contrast-enhanced computed tomography confirmed the finding and suggested that the polypoid tumor was more likely a lipoma. Right hemicolectomy and cholecystectomy were performed and the pathological examination confirmed the lipoma. The evolution of the patient was favourable and uneventful.

Hepatoid adenocarcinoma arising from heterotopic pancreas of the ileum: A case report

INTRODUCTION

Hepatoid adenocarcinoma (HAC) is a rare neoplasm with a striking morphologic similarity to hepatocellular carcinoma. The most common sites of HAC are the stomach, lung, and pancreas.

CASE REPORT

Here we report a rare case of HAC arising from the heterotopic pancreas (Heinrich type II) in the ileum with lymph node metastasis. A 56-year-old man was admitted to our hospital presenting with bloody stools under no obvious predisposing causes. The colonoscopy and the gastroscopy showed no pathological findings. A computed tomography scan showed an intussusception of ileum. Then partial resection of ileum was performed with end-to-end anastomosis and appendectomy. Histopathological examination showed a malignant transformation of heterotopic pancreas (Heinrich type II) in the ileum. We made the diagnosis of HAC based on clinical pathological features and immunochemical staining. The patient received chemotherapy and died 9 months later.

CONCLUSION

To our best knowledge, this is the first reported case of HAC originated from a heterotopic pancreas in the ileum. The clinical pathological features and immunochemical staining are important for correct diagnosis of HAC.

Small bowel mesenchymal tumors: description of two unusual cases

We present two cases of intestinal ileal GIST who developed complications of nonspecific signs and required to be operated urgently, providing unusual images of tumors because of its characteristics.

Successful management of adult lymphoma-associated intussusception by laparoscopic reduction and appendectomy

Although primary gastrointestinal lymphoma is a rare malignancy, it can cause an intussusception in adults and can be a clinically challenging condition to manage. Intussusception could progress to life-threatening complications if left untreated or could delay chemotherapy if inappropriate surgical management is used. We report a 31-year-old man diagnosed with human immunodeficiency virus who was being treated with antiretroviral therapy. He presented with nausea, vomiting, poor appetite, and intermittent, cramping abdominal pain for over 1 wk. Abdominal computed tomography revealed a well-defined homogeneous mass in the mesenteric root region, together with a long segmental wall thickening in the ileum with ileocolic-type intussusception, which was suspected to be caused by a lymphoma. The intussusception was successfully laparoscopically reduced, and the tumor involvement of the appendix was confirmed by appendectomy with intraoperative frozen section. Systemic chemotherapy was immediately initiated after surgery without the need for bowel resection.

Comb sign in intestinal obstruction secondary to desmoplastic reaction due to an ileal neuroendocrine tumor

This article report the case of an intestinal obstruction secondary to desmoplastic reaction of an ileum neuroendocrine tumor (NET), that was radiologically diagnosed by the comb sign. This is an infrequent clinical manifestation of NETs, often underdiagnosed, related to local overproduction of serotonin.

[Role of multislice computed tomography in the differential diagnosis of right iliac tumors and inflammatory diseases]

OBJECTIVE

To determine the capabilities of multislice computed tomography (MSCT) in the differential diagnosis of tumors and inflammatory diseases of the cecum, appendix, and ascending colon.

MATERIAL AND METHODS

The investigation analyzed the complete data of medical records and the results of diagnosis in the patients admitted in 2009 to 2013 to the Treatment and Rehabilitation Center for right iliac pains. The results of MSCT were compared with those of histological verification.

RESULTS

The sensitivity and specificity of MSCT for diagnosing right iliac tumors were 97.6 and 97.8%, respectively. Those of MSCT for diagnosing right iliac inflammatory diseases were 95.1 and 97.3%, respectively. The investigation showed that the accuracy of MSCT for diagnosing right iliac tumors and inflammatory diseases was 94.1%.

CONCLUSION

MSCT is the method of choice in the diagnosis and differential diagnosis of right iliac tumors and inflammatory diseases.

Metastatic carcinoid tumor--atypical presentation

Carcinoid tumor is a slow-growing type of neuroendocrine tumor, originating in the enterochromaffin cells and secreting mainly serotonin. Neuroendocrine tumors (NETs) are found throughout the intestinal tract, the appendix and terminal ileum being the most common locations, and are classified by site of origin and by degree of differentiation, with well-differentiated lesions representing those tumors formerly referred to as carcinoid tumors. The clinical symptoms are characterized by flushing, diarrhea, abdominal pain, and/or bronchial constriction and occur almost exclusively in patients with liver metastases due to the release of bioactive peptides and amines directly into the systemic circulation. We report the clinical, serological and histological diagnosis of a 67-years-old male patient with congestive heart failure secondary to carcinoid heart disease in the context of liver metastases of an ileum carcinoid tumor.

⁶⁸Ga-DOTA-TOC-PET/CT detects heart metastases from ileal neuroendocrine tumors

Metastases from ileal neuroendocrine tumors (NETs) to the myocardium are rare and generally seen in patients with widespread metastatic NET disease. The objectives of this investigation were to describe the frequency of intracardiac metastases in ileal NET patients examined by (68)Ga-DOTA-TOC-PET/CT and to describe the cases in detail. All (68)Ga-DOTA-TOC-PET/CT examinations performed at the Karolinska University Hospital since 2010 until April 2012 were reviewed. In all, 128 out of 337 examinations were in patients with ileal NETs. Four patients had seven myocardiac metastases, yielding a frequency of 4.3 % in patients with ileal NETs. One patient had cardiac surgery while three were treated with somatostatin analogs. The cardiac metastases did not affect the patients' activity of daily life. (68)Ga-DOTA-TOC-PET/CT is an established imaging modality in identifying cardiac metastases in ileal NETs. Prospective studies are needed to confirm the true clinical value of (68)Ga-DOTA-TOC-PET/CT in detecting cardiac metastases in both ileal and non-ileal NETs.

Ileocolic intussusception secondary to gastrointestinal stromal tumor in a 61-year-old

Intussusception is a common emergency in patients age of 3 months to 5 years. In adults, the diagnosis is infrequent but must be considered in the clinical setting of abdominal pain and vomiting. We present a case of a 61-year-old woman presenting with epigastric abdominal pain and vomiting, diagnosed with intussusception secondary to gastrointestinal stromal tumor. Serial bedside ultrasound examinations uncovered the diagnosis of intussusception, confirmed by computed tomographic scan during a paroxysm of pain. Intussusception has a much higher predilection for neoplasms in adults, with a high morbidity and mortality, so early recognition is critical in improving patient outcomes.

Renal cell carcinoma presenting as small bowel obstruction secondary to a metastatic ileal intussusception

We report a rare clinical presentation of renal cell carcinoma in the form of small bowel obstruction which was secondary to a metastatic ileal intussusception. Intussusception in the elderly is most commonly due to an underlying neoplasm, however metastases from a renal cell carcinoma is very uncommon. We present clinical details, radiological and pathological findings of the case followed by a discussion of the diagnosis and management of intussusception in the adult population.

Treatment with octreotide in patients with well-differentiated neuroendocrine tumors of the ileum: prognostic stratification with Ga-68-DOTA-TATE positron emission tomography

We investigated the use of Ga-68-DOTA-Tyr3-octreotate (Ga-68-DOTA-TATE) positron emission tomography (PET) and standardized uptake values (SUVs) to predict the effectiveness of treatment with the somatostatin analogue octreotide acetate (Sandostatin LAR) in patients with neuroendocrine tumors (NETs). Thirty patients with well-differentiated NETs of the ileum (grades G1 and G2) were studied with Ga-68-DOTA-TATE. The average SUV of a 50% isocontour volume of interest covering the lesion with maximum uptake (SUV mean) and the maximum SUV (SUV max) were determined. Patients were followed up, and the time to progression was recorded. Twenty-one patients showed progressive disease at the end of the study; nine patients had stable disease. The median progression-free survival (PFS) was 51.0 weeks (95% confidence interval [CI] 26.4-75.6). A cutoff for the SUV max of 29.4 and for the SUV mean of 20.3 could separate between patients with a long PFS (69.0 weeks; 95% CI 9.8-128.2) and a short PFS (26.0 weeks; 95% CI 8.7-43.3) response to octreotide acetate therapy. Patients with high radiotracer uptake had significantly higher PFS with a 2.9-fold higher chance for stable disease after 45 weeks; however, the prognostic performance of SUV max on an individual basis was poor, with a sensitivity of 75% and a specificity of 64%. SUV max and SUV mean of NET tumor lesions in Ga-68-DOTA-TATE PET are important prognostic indices for predicting the response to therapy with octreotide acetate.

Presentation of ileal Burkitt lymphoma in children

Burkitt lymphoma is a highly aggressive form of Non-Hodgkin lymphoma that responds favorably if diagnosed accurately and treated early. Recognition of the various radiologic manifestations of Burkitt lymphoma can help guide the clinician to expedite appropriate chemotherapy. We present two cases that illustrate different radiologic presentations of this aggressive gastrointestinal malignancy in children. Case 1 features a 7-year-old boy who presented to our hospital with recurrent ileocecal intussusception. Case 2 describes a 16-year-old male with history of blood-streaked stools. Ileocectomy was performed in both cases and histologic analysis showed the "starry sky pattern" and t(8;14) translocation, classic for Burkitt lymphoma. Both patients remain disease-free following surgical excision and chemotherapy.

Carcinoid syndrome from small bowel endocrine carcinoma in the absence of hepatic metastasis

An 80-year-old male patient presented with abdominal pain, paroxysmal diaphoresis, diarrhoea and vomiting. CT scan revealed a small bowel endocrine carcinoma (or 'carcinoid' tumour), but the absence of hepatic disease. The lesion was excised 'en-bloc'. Intra-operatively, there was wide fluctuation in blood pressure associated with tumour manipulation, with hyper- and hypotension. Carcinoid syndrome usually occurs from gastrointestinal tumours when hepatic metastases occur, causing flushing, diarrhoea, bronchoconstriction and murmurs from cardiac valvular lesions. This patient did not have radiological evidence of hepatic metastasis, but the syndrome could still occur with midgut tumours via local invasion of the retroperitoneal circulation, or by action of substances other than serotonin that do not undergo hepatic metabolism.

Ascaris Lumbricoides infestation and intestinal MZBCL: a surgical and radiological perspective

Ascaris Lumbricoides is the most common worm found in human beings and it is the largest of the intestinal nematodes parasitizing humanity. The most common complication of Ascariasis is mechanical bowel obstruction caused by a large number of worms. Bowel obstruction can also be caused by various toxins released by the worms. A large worm bolus can also cause volvulus or intussusception. We report a case of Intestinal Obstruction due to an Ileal MZBCL in an Ascaris. Lumbricoides infestation setting.

Advanced adenocarcinoma of terminal ileum: an unusual neoplasm revealed by an unusual diagnostic tool

BACKGROUND AND AIM

Terminal ileum adenocarcinoma is a rare tumour. Its incidence or prevalence among the other sites of gastro-intestinal tract is unknown, since it has been only sporadically described. Since contrast enhanced ultrasonography has been recently used to study bowel alterations in the course of neoplastic or inflammatory disorders, we report here a case of a rare tumour (terminal ileum poorly differentiated adenocarcinoma) in which the investigation played a pivotal role to obtain a defined diagnosis. MATERIALS AND METHODS (CASE REPORT): Here we report the case of a 62 year old male patient. Due to intestinal occlusive symptoms and body weight decrease of about 8 Kg, he performed an abdominal computed tomography, intestinal magnetic resonance with double contrast medium, colonoscopy and contrast enhanced ultrasonography using a second generation medium.

RESULTS

In our case the peculiar aspect is that no arterial enhancement was observed and the finding remained unchanged for about 2.48 minutes as well as after a further administration of 1.5 ml of contrast medium. This aspect was not suggestive of an active inflammation such as Crohn's disease, where a marked contrast medium enhancement should be expected.

CONCLUSIONS

At present it is too speculative to emphasize contrast enhanced ultrasonography as usefulness tool in the diagnosis of terminal ileum tumors. Nevertheless, our preliminary experience strongly encourages the diffusion of the method.

Primary aldosteronism due to adrenocortical adenoma with concurrent ileum carcinoid tumor: case report

Primary aldosteronism (PA) with synchronous carcinoid syndrome is extremely rare occurrence. In this article, we describe a case of PA due to adrenocortical adenoma ("aldosteronoma") and concurrent malignant carcinoid tumor of ileum. The patient was treated with synchronous right adrenalectomy and resection of the ileum. This case is an example of concomitant presence of two types of tumors, effectively managed surgically. We report a case of a nonclassical form of multiple endocrine neoplasia type 1 (MEN 1) syndrome.

Ileal neuroendocrine tumor - ultrasonographic and capsule endoscopy appearance: a case report

We present the case of a female patient admitted for an abdominal tumoral mass corresponding to large liver metastases. The abdominal ultrasonography detected a solid intestinal tumor. The capsule endoscopy showed a vegetative tumor on the terminal ileum. After intestinal and partial liver resection, the histologic examination identified a neuroendocrine tumor. The patient responded incompletely to standard chemotherapy. In the presence of large hypoechoic liver metastases, a neuroendocrine tumor should be suspected.

Ileocolocolic intussusception secondary to a submucosal lipoma: an unusual cause of intermittent abdominal pain in a 62-year-old woman

We present a case of subacute nonobstructing ileocolocolic intussusception secondary to a submucosal lipoma and a mobile cecum diagnosed sonographically in a 62-year-old woman. The patient was seen following a 2-month history of nonspecific intermittent pain in the right and middle abdomen and weight loss. Sonography revealed ongoing intussusception involving distal ascending and transverse colon. Analysis of the distal intussusception end demonstrated a 3.0 x 2.5 cm echogenic polypoid lesion consistent with a lipoma serving as a lead point. The sonographic diagnosis was confirmed at surgery.

Mesenteric cavernous hemangioma involving small bowel and appendix: a rare presentation of a vascular tumor

We report on a case of cavernous hemangioma of the small bowel mesentery. Fewer than five cases of large mesenteric cavernous hemangioma have been reported in the English literature. Cavernous hemangioma of the small bowel mesentery is extremely rare. A 32-year-old black male presented with 1 week of abdominal pain, nausea, vomiting, and anorexia. He had recently undergone computed tomographic guided biopsy of a pelvic mass at another facility. Repeat CT guided biopsy was nondiagnostic, mesenteric angiography was inconclusive, and magnetic resonance imaging was performed as well. Complete workup was performed to localize primary source of abdominal mass and eventual open biopsy was planned resulting in en bloc resection of the mass, which had invaded the terminal ileum and appendix. Final pathologic diagnosis was cavernous mesenteric hemangioma. The patient experienced a prolonged postoperative ileus and was eventually discharged in stable condition, tolerating a regular diet with adequate bowel and urinary function. Diagnosis of cavernous mesenteric hemangioma is difficult and multiple imaging modalities can prove inconclusive. Adequate biopsy can be difficult to obtain even in patients with small body habitus. Standard of care is resection of entire mass en bloc.

[Intestinal neuroendocrine tumor. Case report and review of the literature]

Gastroenteropancreatic (GEP) neuroendocrine tumors are rare neoplasm and have proved to be slow growing malignancies which involve many organs and most frequently the gastrointestinal tract. They have a peculiary biological behaviour: most of them have endocrine function (carcinoid syndrome); many are clinically silent until late presentation. Symptoms are non specific; the most common are abdominal pain, nausea and vomiting, weight loss and gastrointestinal (GI) blood loss. Incidental carcinoid, discovered at the time of another procedure, occurred in 40% of patients, and in multiple site throughout the GI tract. Here we report a case of a 73-year-old male with an adenomatous colonic polyp, not suitable of endoscopic treatment, and a synchronous carcinoid of small intestine discovered during surgical procedure. Therefore we performed a review of literature with particular attention to diagnosis and strategy of the treatment.

Impact of fluorodihydroxyphenylalanine-18F positron emission tomography on management of adult patients with documented or occult digestive endocrine tumors

CONTEXT AND OBJECTIVES

Fluorodihydroxyphenylalanine-(18F) (FDOPA) positron emission tomography (PET) is a recent imaging modality used to localize endocrine tumors. This study was conducted to evaluate the impact of FDOPA-PET on the management of patients referred for carcinoid or noncarcinoid digestive tumors and the clinical relevance of the treatment decisions based on this examination.

METHODS AND PATIENTS

Between March 2002 and December 2006, 101 FDOPA-PET examinations were performed in 78 adult patients for follow-up of histologically documented carcinoid tumor of the ileum (23 patients) or noncarcinoid digestive tumor (26 patients) or to screen for occult digestive endocrine tumors (29 patients). More than one FDOPA-PET examination was performed in 12 patients. The impact of FDOPA PET was evaluated on a per-patient basis by means of a questionnaire completed by the referring physician, and the relevance of the treatment decision was assessed on the basis of follow-up data.

RESULTS

The survey response rate was 91% (71 of 78). The overall impact rate of FDOPA-PET on patient management was 25% (18 of 71). The greatest impact was observed for carcinoid tumors (50%: 11 of 22) and was clinically relevant in every case, followed by occult endocrine tumors (16%: four of 25), and was clinically relevant in three of the four cases, and noncarcinoid tumors (13%: 3 of 22), clinically relevant in only one case.

CONCLUSION

FDOPA-PET appears to be a major tool for the management of carcinoid tumors with excellent diagnostic performances and induced relevant changes in patient management. FDOPA-PET was less sensitive and less useful for the management of noncarcinoid tumors.

[Detection of neuroendocrine tumors by positron emission tomography-computed tomography with 68Ga-DOTATATE: report of one case]

We report a 74-year-old male with liver metastases from a neuroendocrine tumor (NET) of unknown origin. Conventional imaging studies with ultrasound, computed tomography colonoscopy and Positron emission tomography-computed tomography (PET/CT) with 18Fluor odeoxyglucose did not identify the site of origin of the primary tumor. The patient was submitted for a PET/CT scan with a new radiopharmaceuticai, the somatostatin analogue 68Ga-DOTATATE. This new technique demonstrated increased focal uptake at the ileocecal valve. This lesion and other two liver metastases were surgically removed. The histopathology and immunohistochemistry analysis confirmed the diagnosis of NET (carcinoid). This case illustrates the advantages of the PET/CT scan with 68Ga-DOTATATE.