Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2023; 29(34): 5082-5090
Published online Sep 14, 2023. doi: 10.3748/wjg.v29.i34.5082
Simultaneous rectal neuroendocrine tumors and pituitary adenoma: A case report and review of literature
Jing-Yi Li, Jie Chen, Jun Liu, Su-Zhen Zhang
Jing-Yi Li, Su-Zhen Zhang, Department of Gastroenterology, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
Jie Chen, Department of Neuroendocrine Tumor, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Jun Liu, Department of Gastroenterology, Shanxi Bethune Hospital, Taiyuan 030032, Shanxi Province, China
Author contributions: Li JY drafted the manuscript and collected the data; Chen J and Liu J analyzed and collated the data; Zhang SZ guided the operation and revised the manuscript.
Informed consent statement: Informed written consent was obtained from the patient and her parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su-Zhen Zhang, MM, Chief Physician, Department of Gastroenterology, Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Gongxin Street, Xinghualing District, Taiyuan 030000, Shanxi Province, China. zhangsuzhen209@163.com
Received: April 19, 2023
Peer-review started: April 19, 2023
First decision: May 27, 2023
Revised: June 9, 2023
Accepted: August 18, 2023
Article in press: August 18, 2023
Published online: September 14, 2023
Processing time: 142 Days and 5 Hours
Abstract
BACKGROUND

Neuroendocrine tumors (NET) are rare heterogeneous tumors that arise from neuroendocrine cells throughout the body. Acromegaly, a rare and slowly progressive disorder, usually results from a growth hormone (GH)-secreting pituitary adenoma.

CASE SUMMARY

We herein describe a 38-year-old patient who was initially diagnosed with diabetes. During colonoscopy, two bulges were identified and subsequently removed through endoscopic submucosal dissection. Following the surgical intervention, the excised tissue samples were examined and confirmed to be grade 2 NET. 18F-ALF-NOTATATE positron emission tomography-computed tomography (PET/CT) and 68Ga-DOTANOC PET/CT revealed metastases in the peri-intestinal lymph nodes, prompting laparoscopic low anterior resection with total mesorectal excision. The patient later returned to the hospital because of hyperglycemia and was found to have facial changes, namely a larger nose, thicker lips, and mandibular prognathism. Laboratory tests and magnetic resonance imaging (MRI) suggested a GH-secreting pituitary adenoma. The pituitary adenoma shrunk after treatment with octreotide and was neuroendoscopically resected via a trans-sphenoidal approach. Whole-exome sequencing analysis revealed no genetic abnormalities. The patient recovered well with no evidence of recurrence during follow-up.

CONCLUSION

18F-ALF-NOTATE PET/CT and MRI with pathological analysis can effectively diagnose rare cases of pituitary adenomas complicated with rectal NET.

Keywords: Neuroendocrine neoplasm; Pituitary adenoma; Rectum; Diagnosis; Case report

Core Tip: We herein present a rare case of rectal dual-source grade 2 neuroendocrine tumors with a pituitary growth hormone-secreting tumor that caused acromegaly and diabetes. The rarity of this combination makes an accurate diagnosis difficult to achieve. The correct diagnosis can be obtained by using 18F-ALF-NOTATATE-positron emission tomography–computed tomography and magnetic resonance imaging combined with pathological analysis.