A small, low-grade rectal neuroendocrine tumor with lateral pelvic lymph node metastasis: a case report

Shin, Seon Hui; Maeng, Young-In; Jung, Seyun; Yang, Chun‐Seok

doi:10.3393/ac.2021.00899.0128

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Both short-and long-term outcomes in patients who undergo curative resection for rectal NETs are largely unknown, and even less is known about LPLN metastasis in rectal NETs [18]. Although there are a few reports on LPLN metastasis in rectal NETs [12,14,18,19], no studies have addressed the clinical features and prognosis of LPLN metastasis in patients with rectal NETs. LPLN metastasis in rectal NETs is a rare occurrence; currently, there are no de nite criteria for diagnosing LPLN metastasis and no exact indication for LPLN dissection in patients with rectal NETs [4].…”

Section: Discussionmentioning

confidence: 99%

“…One is along the superior rectal artery and inferior mesenteric artery, draining into the LNs around the abdominal aorta; the other is along the middle rectal artery, entering the obturator and internal and external iliac LNs, i.e., the lateral pelvic lymph nodes (LPLNs). LPLN metastasis of rectal NETs is rare, and only a few corresponding case reports have been published [12][13][14]. Among cases of rectal cancer, the survival of patients with LPLN metastasis was poorer than that of patients without LPLN metastasis [15][16][17], suggesting that LPLN metastasis can also be a poor prognostic factor in rectal NETs.…”

Section: Sohn Et Al Have Reported That Ln Metastasis Affects Survival...mentioning

confidence: 99%

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Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: A single-center retrospective analysis of 214 cases with radial resection

Sakurai,

Hiyoshi,

Daitoku

et al. 2023

Preprint

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Background Lateral pelvic lymph node (LPLN) metastasis of rectal neuroendocrine tumors (NETs) is rare, and its oncologic features are unknown. We aimed to investigate the oncologic impact of LPLN metastasis in patients with rectal NETs. Methods This study included 214 patients with rectal NETs who underwent curative surgery. Clinicopathological characteristics and short- and long-term outcomes were also evaluated. Results LPLN dissection was performed in 15 patients with LPLN swelling of ≥ 7 mm on preoperative imaging. Among them, 12 patients had LPLN metastases, and six of the 12 patients had LPLN metastases without mesorectal lymph node metastases (skip metastasis). Short-term outcomes were similar between the groups with and without LPLN dissection. The median follow-up time was 54.8 months, and patients with LPLN metastasis showed significantly shorter disease-free and overall survival. Among 199 patients who did not undergo LPLN dissection, only one had LPLN recurrence. In the univariate analysis, tumor depth, tumor grade, and LPLN metastasis were associated with worse overall survival. In the multivariate analysis, only LPLN metastasis was an independent predictor of overall survival. Conclusions LPLN metastasis is a poor prognostic factor in patients with rectal NETs. LPLN enlargement can be considered an indication for dissection owing to its high rate of metastasis and associated poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Sohn Et Al Have Reported That Ln Metastasis Affects Survival...mentioning

confidence: 99%

Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: A single-center retrospective analysis of 214 cases with radial resection

Sakurai,

Hiyoshi,

Daitoku

et al. 2023

Preprint

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“…The likelihood of lymph node metastasis increases with tumor size. In tumors smaller than 10mm, lymph node metastasis is a rare result, with an incidence of 1% ~ 10% ( 31 – 33 ). The rectal NEN with a maximum diameter of 1-2 cm has a lymph node metastasis rate of about 30% at the time of diagnosis, and about 40% in those ≥20 mm ( 27 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Multiple rectal neuroendocrine tumors: An analysis of 15 cases and literature review

et al. 2022

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Multiple neuroendocrine tumors (M-NETs) are rare in the rectum and there is no consensus on their characteristics and treatments. Here, we report 15 cases of rectal M-NETs and review the previous literature. We discuss the clinical characteristics, endoscopic features and pathological features of rectal M-NETs, aiming to analyze the treatments and follow-up strategies in combination with these characteristics. We retrospectively reviewed and analyzed the data of 15 patients with rectal M-NETs who were diagnosed and treated at Beijing Friendship Hospital, Capital Medical University. Their clinical data, endoscopic findings, pathological features and treatments were analyzed. Follow-up evaluations and literature review were performed. In all, 14 male (93.3%) and 1 female (6.7%) were recruited. The average age at diagnosis was 55.7 years. The clinical manifestations include asymptomatic in 9 patients (60.0%), defecation habits changes in 2 patients (13.3%), anal distension in 2 patients (13.3%), and abdominal distension in 2 patient (13.3%). The largest tumor diameter ≤10mm was found in 13 patients (86.7%) and >10mm in 2 patients (13.3%). All of the lesions originated from the mucous or submucosa layer. WHO grades were all NET G1. The number of tumors diagnosed by pathology in 13 patients was consistent with that observed by endoscopy, while more lesions were observed by pathology than endoscopy in two patients. Lymph node metastasis occurred in 1 patient (6.7%), and vascular or lymphatic invasion occurred in 9 patients (60.0%). Among the 13 patients with the largest tumor diameter being ≤10mm, lymphovascular invasion occurred in 8 patients (61.5%). And among the 2 patients with the largest tumor diameter of >10mm, lymphovascular invasion occurred in 1 patient (50.0%). 14 patients underwent endoscopic resection and 1 underwent surgical excision. Postoperative follow-up was achieved in 13 patients and no recurrence or metastasis was found. The true number of rectal M-NETs may be more than seen under endoscopy. Rectal M-NETs is associated with a high risk of metastasis; therefore, treatment and surveillance strategies should be more radical than single lesion.

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“…In general, rNENs are well differentiated small tumors with a fairly good prognosis, but they also show variations of larger tumor size, metastasis, and severe prognosis (11). A case report found that radiology of a lowgrade rNEN in a 36-year-old male revealed a suspected 2.6 cm mesenteric lymph node metastasis and multiple left internal iliac lymph node metastases (12).…”

Section: Introductionmentioning

confidence: 99%

Comparison of characteristics between true rectal neuroendocrine tumors and rectal hyperplastic polyps among patients with endoscope-diagnosed rectal neuroendocrine tumors

Weng¹,

Ran²,

Peng³

et al. 2022

J Gastrointest Oncol

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Background: To explore the white light endoscopy and endoscopic ultrasonography (EUS) features of rectal hyperplastic polyps (rHP) misdiagnosed as rectal neuroendocrine neoplasms (rNENs). In rNENs with a diameter of 5-10 mm, the endoscopic findings are not typical and some of them are similar to rHP, so it is not uncommon to misdiagnose rNENs as rHP. However, misdiagnosis of rHP as rNENs has not been reported in the literature, which can alert clinicians to the existence of this possibility and avoid overtreatment.Methods: We collected 245 cases of rectal submucosal tumor (SMT) diagnosed by endoscopy in our hospital from January 2015 to December 2020 and 103 patients with suspected rNENs identified through endoscopy. A retrospective analysis was conducted of the shape, color, vascular dilatation, and boundary on the surface of the lesion under white light endoscope, and the source, boundary, and echo characteristics of EUS. We also analyzed the endoscopic features of rHP misdiagnosed as rNENs. Endoscopic diagnosis and pathological diagnosis were reviewed by a senior endoscopic expert and pathologist respectively. The counting data were tested and analyzed by χ 2 test and Fisher exact probability method.Results: A total of 103 cases of rNENs were diagnosed by endoscope, among whom 75 cases were confirmed as rNENs (72.8%) and 8 cases as rHP (7.8%) by histopathology. There was no significant difference between rNENs and rHP in terms of gender, age, clinical manifestation, shape and color of lesions, dilatation of blood vessels on the surface, and location of lesions. Meanwhile, there were significant differences in whether the boundary of the lesion was clear under white light endoscopy, and the source, echo, and boundary of the lesion under EUS. Conclusions:The morphology of some rHP is similar to rNENs under endoscopy. The boundary is clear under white light endoscopy and the source, echo, and boundary under EUS are helpful for the diagnosis of rNENs and rHP.

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A small, low-grade rectal neuroendocrine tumor with lateral pelvic lymph node metastasis: a case report

Cited by 4 publications

References 14 publications

Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: A single-center retrospective analysis of 214 cases with radial resection

Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: A single-center retrospective analysis of 214 cases with radial resection

Multiple rectal neuroendocrine tumors: An analysis of 15 cases and literature review

Comparison of characteristics between true rectal neuroendocrine tumors and rectal hyperplastic polyps among patients with endoscope-diagnosed rectal neuroendocrine tumors

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