Multiple Small Intestinal Neuroendocrine Tumors With Findings of Intestinal Obstruction

Basendowah, Mohammed; Ashour, Mohammed Ali; Hassan, Ammar Y; Alshaynawi, Shahad; Alyazidi, Lujain K

doi:10.7759/cureus.17629

Cited by 5 publications

(2 citation statements)

References 11 publications

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“…NET presenting with bowel obstruction usually result from a mechanical cause. 4,5 In the present case, despite convincing symptomatology and CT findings with intestinal dilation and a transition point, extensive workup including esophagogastroduodenoscopies, colonoscopy, MRE, push enteroscopy, and video capsule enterography failed to show obstructive pathology. No obstruction was noted on surgical exploration.…”

Section: Discussionmentioning

confidence: 52%

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

et al. 2022

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A 56-year-old man presented with recurrent gastrointestinal obstruction. Computed tomography showed fluid-filled, distended stomach, small intestine, and large intestine. Extensive workup including esophagogastroduodenoscopy, colonoscopy, magnetic resonance enterography, push enteroscopy, and video capsule enteroscopy showed no mechanical obstruction. Endoscopic ultrasound-guided biopsy of peripancreatic nodes detected on 18 F-fluorodeoxyglucose positron emission tomography revealed a duodenal neuroendocrine tumor. The lesion showed intense uptake on gallium-68 DOTATOC positron emission tomographycomputed tomography scan. The patient underwent surgical resection of the tumor with resolution of bowel obstruction events. He had elevated pancreatic polypeptide levels, which are known to delay gastric emptying and could explain his symptoms.Previous computed tomography (CT) scans of the abdomen showed variable distension of the stomach, or fluid-filled small intestine with concern for transition point at the ileum, or distended large intestine. He had formerly undergone 2 esophagogastroduodenoscopies, which did not reveal gastric outlet obstruction. His current CT abdomen showed a fluid-filled stomach and duodenum, suggestive of gastric outlet obstruction (Figure 1). Magnetic resonance enterography (MRE) did not show obstruction, but demonstrated a 2.1 3 2.3-cm right mesenteric nodule with similar enhancement as the spleen, raising the possibility of ectopic splenic tissue, and a 0.7-cm nodule posterior to the uncinate process.Push enteroscopy revealed esophagitis and severe aphthous ulcerations in the small intestine, but no obstruction. Colonoscopy did not reveal any obstructive pathology. Video capsule enterography revealed erythematous mucosa with villous blunting and nonobstructive luminal narrowing in the duodenum through which the capsule passed easily.An 18 F-fluorodeoxyglucose positron emission tomography ( 18 FDG PET)/CT scan was performed to further evaluate the mesenteric lesion seen on MRE. It showed multiple mild to moderately FDG avid cervical lymph nodes (LN), the largest a 4-cm left supraclavicular LN. It redemonstrated the soft-tissue lesion anterior to the duodenum with mild to moderate FDG uptake and multiple

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Section: Discussionmentioning

confidence: 52%

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

et al. 2022

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“…Neuroendocrine tumors of the GIT include carcinoid tumors, pheochromocytomas, and various location-dependent entities. Carcinoid tumors, for example, are the second most common primary small bowel malignancy and can be detected on MRE as avidly enhancing, well-delimited submucosal masses [15] . Lymphoma accounts for a significant portion of small bowel malignancies and GIT lymphomas, with MRE revealing a variable appearance that includes preservation of adjacent fat tissue and involvement of long or multiple segments.…”

Section: Small Bowel Tumors;mentioning

confidence: 99%

Role of MR Enterography in Assessment of Small Bowels Diseases: A Review Article

2024

The Egyptian Journal of Hospital Medicine

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Background: Magnetic Resonance Enterography (MRE) has evolved as a fundamental imaging modality in the assessment of small bowel diseases, thanks to its non-invasive nature and the absence of radiation exposure. It offers detailed visualization of the small bowel's morphology and function, overcoming challenges presented by the bowel's complex anatomy and physiology. MRE's ability to provide comprehensive insights into various small bowel pathologies, including inflammatory bowel diseases, tumors, and vascular disorders, underscores its significance in clinical practice. Objective: This review aims to elucidate the role of MRE in the diagnosis and management of common small bowel diseases, highlighting its advantages over other diagnostic methods, and discussing the indications, contraindications, and techniques employed in MRE. Methods: A comprehensive review of scientific and medical journals was conducted using reputable search engines to get scientific data on the anatomy and histopathology of the small bowels and MR Enterography indications and contraindications, and its role in common small bowel diseases compared to other diagnostic methods such as CT and endoscopy. Only recent, relevant scientific papers were included. Conclusion: MRE has emerged as an essential tool in the assessment of small bowel diseases and is expected to continue playing a significant role in the future.

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Investigating Carcinoid Tumor Oncogenesis through the lens of Developmental Dynamics involved in Small Intestinal Neuroendocrine Cells

Shafi,

Yaqub

2024

Preprint

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Background: Carcinoid tumors from small intestinal Neuroendocrine Cells (SI-NECs) present clinical challenges with increasing incidence. Investigating the genetic architecture is crucial, as dysregulation in transcription factors and signaling pathways contributes to aberrant behavior, including uncontrolled proliferation and hormone secretion. Understanding these mechanisms holds promise for identifying therapeutic targets and biomarkers, not only for carcinoid tumors but also for broader applications in neuroendocrine neoplasms and gastrointestinal malignancies. Methods: Databases, including PubMed, MEDLINE, Google Scholar, and open access/subscription-based journals were searched for published articles without any date restrictions, to investigate the intricate genetic architecture and developmental dynamics underlying the development of carcinoid tumors originating from small intestinal Neuroendocrine Cells (SI-NECs). Based on the criteria mentioned in the methods section, studies were systematically reviewed to investigate carcinoid tumor oncogenesis. This study adheres to relevant PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Results: This investigation into the genetic architecture of small intestinal neuroendocrine cells (SI-NECs) reveals intricate dysregulations contributing to carcinoid tumor development. Dysfunctional expression of key transcription factors, including Neurogenin 3, Pdx1, Isl1, Foxa1/2, Hes1, and others, disrupts neuroendocrine differentiation, impacting hormone expression profiles. Chromogranin A dysregulation affects the maturation of SI-NECs, while alterations in Delta-like 1/4 and serotonin contribute to abnormal behavior. Dysfunctional Tcf4 and Gfi1b influence cell fate decisions, and NeuroD1 alterations impact maturation. Dysregulation of GATA factors, Nkx2.2, Sox factors, and Neurotrophins further complicates SI-NECs. Protein Kinase A signaling dysregulation contributes to uncontrolled proliferation. These findings advance our understanding of the complexity of carcinoid tumor development, possibly providing a framework for targeted therapeutic strategies addressing the specific aberrations identified in SI-NECs. Conclusion: The dysregulation in the genetic architecture of small intestinal Neuroendocrine Cells (SI-NECs) precipitates carcinoid tumor development. Alterations in key transcription factors, signaling pathways, and developmental processes disrupt neuroendocrine differentiation, hormone expression, and cell fate determination. Dysfunctional molecular cascades including Notch and Wnt signaling drive uncontrolled proliferation and aberrant hormone secretion characteristic of carcinoid tumors. Understanding the intricate molecular landscape of SI-NEC dysregulation is paramount for targeted therapies. Insights emerging from this research may pave the way for novel interventions aimed at mitigating carcinoid tumor progression and improving patient outcomes.

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Multiple Small Intestinal Neuroendocrine Tumors With Findings of Intestinal Obstruction

Cited by 5 publications

References 11 publications

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

Role of MR Enterography in Assessment of Small Bowels Diseases: A Review Article

Investigating Carcinoid Tumor Oncogenesis through the lens of Developmental Dynamics involved in Small Intestinal Neuroendocrine Cells

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