Two synchronous primary mesenteric neuroendocrine tumors in a patient: a case report

TL;DR

A 40-year-old woman had two rare mesenteric neuroendocrine tumors successfully removed via laparoscopic surgery, with no further treatment needed.

Contribution

This case report highlights the successful use of laparoscopic surgery and 68-Gallium DOTATATE for diagnosing and treating two synchronous primary mesenteric neuroendocrine tumors.

Findings

68-Gallium DOTATATE imaging accurately identified two primary mesenteric neuroendocrine tumors.

Laparoscopic resection was effective for both tumors with no postoperative complications.

The patient remained disease-free six months after the second surgery.

Abstract

Primary mesenteric neuroendocrine tumors represent a rare clinical entity, challenging to manage, while a combination of imaging is demanded in order to differentiate it from metastatic disease, and set the diagnosis. If the tumor is resectable, surgery is the fundament of the therapeutic approach. The appearance of a second primary mesenteric tumor suggests an unacquainted scenario. The current article presents a case of a 40-year-old woman, who underwent laparoscopic excision of a mesenteric tumor located close to the left pararenal space. Pathology with immunohistochemistry examination reported neuroendocrine tumor grade 2. No further treatment was necessary. Seven months later, 68-Gallium DOTATATE detected another primary neuroendocrine tumor located at the right retroperitoneal space without other lesions. The second tumor was also resected laparoscopically, and the pathology confirmed the diagnosis of another neuroendocrine tumor G2. The postoperative course was uneventful, and six months later the patient is disease-free. The adequacy of 68-Gallium DOTATATE for the preoperative diagnosis of primary mesenteric tumors, the role of the laparoscopic approach, and the extent of lymph node resection are matters addressed in this article.

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