Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2019; 7(14): 1884-1891
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1884
Primary neuroendocrine tumor in the presacral region: A case report
Rui Zhang, Yong Zhu, Xiao-Bo Huang, Chris Deng, Min Li, Guang-Shu Shen, Shu-Liang Huang, Shao-Hua Huangfu, Yan-Ni Liu, Chun-Gen Zhou, Ling Wang, Qi Zhang, Youping Deng, Bin Jiang
Rui Zhang, Xiao-Bo Huang, Yan-Ni Liu, Chun-Gen Zhou, Ling Wang, Qi Zhang, Department of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Yong Zhu, Shao-Hua Huangfu, Bin Jiang, Department of Colorectal Surgery, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
Chris Deng, Youping Deng, Bioinformatics Core, Department of Complementary and Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96813, United States
Min Li, Department of Medical Oncology, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
Guang-Shu Shen, Department of Medical Imaging, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
Shu-Liang Huang, Department of Pathology, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 2100022, Jiangsu Province, China
Author contributions: Zhang R and Zhu Y contributed equally to this work; Huang XB, Deng C, Li M, Liu YN, Wang L, and Huangfu SH collected and analyzed the data, and drafted the manuscript; Shen GS and Zhang Q analyzed the results of diagnostic imaging; Huang SL and Zhou CG performed pathological evaluations; Deng YP, Zhu Y, and Jiang B wrote and revised the manuscript; all authors read and approved the final version of the manuscript.
Supported by Nanjing Municipal Health Bureau, No. ZKX15040; and Nanjing Medical Science and Technology Development Foundation, No. NWQR-201702.
Informed consent statement: The study was approved by the Medical Ethics Committee of The Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, and written informed consent was obtained from the patient.
Conflict-of-interest statement: All authors declare no conflict of interest.
CARE Checklist (2016) statement: This case report was written in accordance with the CARE (2016) guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bin Jiang, PhD, Chief Doctor, Professor, Department of Colorectal Surgery, the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, No. 157, Daming Road, Qinhuai District, Nanjing 210022, Jiangsu Province, China. jbfirsth@aliyun.com
Telephone: +86-18951755051
Received: March 12, 2019
Peer-review started: March 15, 2019
First decision: April 18, 2019
Revised: May 3, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: July 26, 2019
Processing time: 136 Days and 18.3 Hours
Abstract
BACKGROUND

Primary neuroendocrine tumors (NETs) in the presacral region are extremely rare, some of which are caused by other primary tumors or metastatic rectal carcinoids. Nevertheless, cases of NETs have been increasing in recent years. This report describes the first primary neuroendocrine tumor in the presacral region that was found at our hospital within the last five years.

CASE SUMMARY

The patient was identified as a 36-year-old woman with a presacral mass and pelvic floor pain. A digital rectal examination revealed a presacral mass with unclear margins and obvious tenderness. Magnetic resonance imaging (MRI) demonstrated a 57 mm × 29 mm presacral lump. An ultrasound-guided needle biopsy confirmed a well-differentiated neuroendocrine tumor. No other primary or metastatic tumors were found.

CONCLUSION

Comprehensive consideration of our case report and literature reported by others suggests that a conclusive diagnosis of NETs should be based on computed tomography/MRI and pathological examinations. The treatment of primary NETs in the presacral region mainly relies on surgical procedures with follow-up.

Keywords: Neuroendocrine tumor; Presacral; Biopsy; Case report

Core tip: This case highlights the need to include neoplastic diseases in the differential diagnosis of any potentially benign perianal abscess. A 36-year-old Asian woman was initially diagnosed with perianal abscess. Ultrasound-guided needle biopsy confirmed a well-differentiated neuroendocrine tumor, and then the patient underwent a sacrococcygeal tumor resection. A whole-body emission computed tomography scan was performed after the patient was discharged from the hospital, which revealed that she had no high expression of somatostatin receptors in the pleural cavity, abdominal cavity, or pelvis. There was no evidence of metastatic disease and no systemic symptoms or signs of carcinoid. These results confirmed that this was a primary presacral neuroendocrine tumor of level G2. The patient was advised to receive regular follow-up with her physician and magnetic resonance imaging.