Neuroendocrine tumors of the gastrointestinal tract: Case reports and literature review

Table 1 Clinical data of patients with neuroendocrine tumors

Patient (age, yr/sex)	Initial evaluation	Site	Diagnostic studies	Outcome
65/F	Hematochezia, IBD epigastric pain	Duodenal bulb	12 21 05 EGD duodenal bulb polyp; path: neuroendocrine tumor 12 30 05 repeat EGD, no residual, path: neuroendocrine tumor 11 24 08 repeat EGD no recurrence, COL mucosal prolapse syndrome	Alive and well
59/M	GERD with break-through symptoms	Duodenal bulb	11 11 08 EGD duodenal bulb polyp, path: neuroendocrine tumor 12 22 08 EGD, no residual tumor 12 30 08 PET scan negative	Alive and well
50/F	2nd opinion for liver metastatic disease	Liver	02 09 04 EGD chronic esophagitis, HH, fundic nodularity, path: benign lymphoid aggregates 03 16 04 PET/CT innumberable larg hepatic lesions replacing R and L lobes consistent with neuroendocrine tumor	Expired 12 04
70/M	Epigastric pain and 15 lb weight loss	Intra-abdominal	04 15 08 EGD chronic esophagitis, HH, acute and chronic gastritis; path: reactive gastropathy; COL: 1 adenomatous/2 hyperplastic polyps 04 16 08 CT Abd/Pelvis mesen-teric mass 04 24 08 CT guided bx: path: neuroendocrine tumor	05 08 treated with sandostatin
46/F	Nausea, vomiting, abdominal pain	Intra-abdominal	01 02 10 CT Abd/Pelvis ascites small bowel and colonic obstruction 01 04 10 Gastrografin emema sigmoid Obstruction 01 04 10 exploratory laparotomy desmoplastic reaction, sigmoid colon with liver metastases and intraperitoneal implants; bx of implants positive for chromogranin and synapotophysin 01 19 10 COL 3 cm stenosis at 30 cm due to extrinsic pressure; stent placed 01 26 10 serum CGA, 27 nmole/L	Discharge To hospice
40/M	Recurrent perianal abscess r/o IBD	Terminal ileum	12 05 06 COL 10 mm sessile polyp in terminal ileum, path: neuroendocrine tumor	Lost to follow-up
50/F	GERD and CRCS	Sigmoid	04 04 08 EGD chronic esophagitis, HH, path: mild reactive gastropathy, COL 4 mm sigmoid neuroendocrine tumor resected 04 30 08 normal octreotide scan 03 30 09 COL negative bx at prior polypectomy site	Alive and well
75/F	Breast cancer and CRCS	Sigmoid	02 06 08 COL 7 mm sigmoid submucosal nodule resected; cells positive for synaptophysin, but negative for chromogranin 03 11 08 Urinary 5-HIAA negative 04 22 08 Repeat COL with resection of remaining neuroendocrine tumor 05 19 09 COL negative for recurrence	Alive and well
55/M	LLQ tenderness, CRCS	Rectum	08 22 06 COL sigmoid tubulovillous adenoma and 6 mm rectal neuro-endocrine tumor 09 01 09 COL hyperplastic polyp, no recurrence of neuroendocrine tumor	Alive and well
55/F	CRCS	Rectum	05 01 09 COL 8 mm neuroendocrine tumor COL 1 yr later no recurrence	Alive and well
60/F	CRCS	Rectum	11 29 07 COL submucosal nodule neuroendocrine tumor 01 28 08 COL no recurrence	Alive and well

IBD: Inflammatory bowel disease; CGA: Chromogranin A; EGD: Esophagoduodenoscopy; COL: Colonoscopy; GERD: Gastroesophageal reflux disease; HH: Hiatal hernia; R: Right; L: Left; bx: Biopsy; CRCS: Colorectal cancer screening; F: Female; M: Male; 5-HIAA: 5-hydroxyindoleacetic acid; PET/CT: Positron emission tomography/computed tomography; LLQ: Left lower quadrant.

Table 2 Hormone production by tumor location[15,9,31,43]

Location	Hormones
Stomach	Histamine, Gastrin, Serotonin, Somatostatin, Gastrin Releasing Peptide
Duodenum/Upper Jejunum	Gastrin, Serotonin, Somatostatin, Gastrin Releasing Peptide
Ileum/Cecum	Enteroglucagon, Serotonin, Substance P, Tachykinins
Appendix	Enteroglucagon, Peptide YY, Serotonin, Somatostatin
Colon/Rectum	Enteroglucagon, Serotonin, Somatostatin
Pancreas	ACTH, Calcitonin, Cholecystokinin, Corticotropin-Releasing Hormone, Gastrin, Glucagon, Growth Hormone-Releasing Hormone, Growth Hormone-Releasing Factor, Insulin, Neurotensin, Pancreatic Polypeptide, Parathyroid Hormone-Related Peptide, Prolactin, Somatostatin, Vasoactive Intestinal Peptide