Korean J Gastroenterol.  2014 Aug;64(2):103-109. 10.4166/kjg.2014.64.2.103.

Multiple Rectal Neuroendocrine Tumors: Report of Five Cases

• Park CS
• Lee SH
• Kim SB
• Kim KO
• Jang BI

• KMID: 2164421
• DOI: http://doi.org/10.4166/kjg.2014.64.2.103

Abstract

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.

Keyword

Multicentricity; Rectum; Neuroendocrine tumors

MeSH Terms

Adult
Aged
Colonoscopy
Female
Humans
Male
Middle Aged
Neuroendocrine Tumors/*diagnosis/pathology/surgery
Positron-Emission Tomography
Rectal Neoplasms/*diagnosis/pathology/surgery
Sigmoidoscopy
Tomography, X-Ray Computed

Figure

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  Fig. 1. Endoscopic views. (A) A small subepithelial nodule at the rectum was observed. (B) The small nodule was removed by biopsy. (C) Two other subepithelial nodules distal to the lesion (A) were observed. (D) Two subepithelial nodules were removed by endoscopic submucosal resection using a ligation device.

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  Fig. 2. Pathologic findings. (A) Carcinoid tumor is arising from lamina propria and infiltrating to the upper portion of submucosa (H&E, ×40).(B) Tumor cells forming a mostly glandular and trabecular pattern (H&E, ×100). (C) CD56 immunohistochemical staining is positive along the tumor cell membrane (×200). (D) Few Ki-67 nuclear stain positive cells are observed in the tumor (×200).

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  Fig. 3. Endoscopic submucosal resection using a ligation device (ESMR-L) technique. (A) Yellowish triple subepithelial lesions at the rectum were noted. (B) Lifting of lesions by hypertonic saline injection and band ligation are noted. (C) Triple rectal carcinoids were removed by ESMR-L.

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  Fig. 4. Endoscopic views. (A) Bleeding related to the endoscopic submucosal resection using a ligation device was noted. (B) Bleeding was controlled by endoscopic hemoclipping.

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  Fig. 5. Pathologic findings. (A) Carcinoid tumor is arising from lamina propria and infiltrating to submucosa (H&E, ×40). (B) Tumor cells forming the nesting pattern of growth (H&E, ×100).

Reference

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