A Rare Case of Poorly Differentiated Neuroendocrine Carcinoma of the Descending Colon with Regional Lymph Node Involvement Presenting in a Young Adult Nigerian Male: A Case Report
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Keywords
Poorly Differentiated Neuroendocrine Carcinoma, Descending Colon, Intestinal Obstruction, Etoposide, Carboplatin, Colostomy
Abstract
Malignant colonic neuroendocrine tumours are rare. Even more uncommon is their occurrence in the left colon. They also infrequently occur in males and young adults. We describe a rare case of poorly differentiated neuroendocrine carcinoma of the descending colon in a 32-year-old male who presented with signs of intestinal obstruction. He later had exploratory laparotomy and tumour resection with 5 cm gross tumour margins and Hartman-type colostomy and completed six cycles of Etoposide and Carboplatin combination. He has been tumour- and symptom-free for 36 months. Even though rare, neuroendocrine tumours should be an important differential of all colonic tumours, irrespective of the patient's age and sex, and surgeons should have a high index of suspicion for them. Although they most commonly occur in the right colon (cecum), they can also be found in the descending colon, where they can present with intestinal obstruction. Tumour resection with 5 cm gross tumour margins and Hartman-type colostomy can be handy. Etoposide and Carboplatin combination can improve overall survival in complicated World Health Organization (WHO) stage 3 neuroendocrine carcinoma with regional lymph node involvement, and generally poor prognosis, but without evidence of distant metastasis, and relatively fair performance index. Younger patients with neuroendocrine carcinomas may benefit better from platinum-based chemotherapy.
References
2. Israel AK, Cracolici V, Griffith CC. Challenging differential diagnoses in small biopsies from the sinonasal tract. InSeminars in Diagnostic Pathology 2023 Sep 1 (Vol. 40, No. 5, pp. 321-332). WB Saunders.
3. Ahmed M. Gastrointestinal neuroendocrine tumours in 2020. World J Gastrointest Oncol 2020; 12(8): 791-807
4. Waisberg DR, Fava AS, Martins LC, Matos LL, Franco MI, Waisberg J. Colonic carcinoid tumours: a clinicopathologic study of 23 patients from a single institution. Arquivos de Gastroenterologia. 2009;46:288-93.
5. Maggard MA, O'Connell JB, Ko CY. Updated population-based review of carcinoid tumours. Annals of surgery. 2004 Jul 1;240(1):117-22.
6. Hrabe J. Neuroendocrine tumours of the appendix, colon, and rectum. Surgical Oncology Clinics. 2020 Apr 1;29(2):267-79.
7. Maggard MA, O'Connell JB, Ko CY. Updated population-based review of carcinoid tumours. Ann Surg 2004; 240: 117-122
8. Capdevila J, Meeker A, García-Carbonero R, Pietras K, Astudillo A, Casanovas O, Scarpa A. Molecular biology of neuroendocrine tumours: from pathways to biomarkers and targets. Cancer Metastasis Rev 2014; 33: 345-351
9. Aldera AP, Govender D, Locketz ML. Neuroendocrine neoplasms of the digestive tract: incorporating the 2019 WHO grading schema in the South African context. South African Journal of Surgery. 2021;59(1):27a-e.
10. Masui T, Ito T, Komoto I, Uemoto S, JNETS Project Study Group. Recent epidemiology of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN) in Japan: a population-based study. BMC cancer. 2020 Dec;20:1-7.
11. Ahmed M. Gastrointestinal neuroendocrine tumours in 2020. World journal of gastrointestinal oncology. 2020 Aug 8;12(8):791.
12. Anthony LB, Strosberg JR, Klimstra DS, Maples WJ, O'Dorisio TM, Warner RR, Wiseman GA, Benson AB 3rd, Pommier RF; North American Neuroendocrine Tumor Society (NANETS). The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumours (nets): well-differentiated nets of the distal colon and rectum. Pancreas 2010; 39: 767-774
13. Jiang M, Tan Y, Li X, Fu J, Hu H, Ye X, et al. Clinicopathological Features and Prognostic Factors of Colorectal Neuroendocrine Neoplasms. Gastroenterol Res Pract. 2017;2017:4206172
14. Agada H, Grimah V, Emmanuel O. Skin Involvement of Metastatic Neuroendocrine Tumour in a Black African: A Rare Occurrence. Nigerian Journal Of Dermatology. 2023;13(1).
15. Okebalama VC, Nwadiokwu JI, Osaze E, Ayodeji AA, Chinatu-Nwankwo OM. Poorly differentiated carcinoma with neuroendocrine features in two patients with sinonasal tumours: a report of two cases. Pan African Medical Journal. 2022 May 16;42(1).
16. Kumar K, Tariq H, Ahmed R, Chukwunonso C, Niazi M, Ihimoyan A. Small‐Cell Type, Poorly Differentiated Neuroendocrine Carcinoma of the Gallbladder: A Case Report and Review of the Literature. Case Reports in Oncological Medicine. 2019;2019(1):8968034.
17. Obateru OA, Taiwo JA, Oladejo S, Awelimobor DA, Fadaunsi OO, Olokoba AB. Cecal carcinoid tumor in a Nigerian man: a case report and review of literature. Nigerian Journal of Clinical Practice. 2017 May 24;20(5):634-6.
18. Umana IO, Obaseki DE, Ekanem VJ. The clinicopathological features of lower gastrointestinal tract endoscopic biopsies in Benin City, Nigeria. Saudi Surgical Journal. 2017 Jan 1;5(1):9-20.
19. Uchendu OJ, Akpo EE. Primary gastrointestinal tract cancers in Nigeria, epidemiological and histopathological study. Asian Pacific Journal of Cancer Care. 2021 Mar 26;6(1):3-7.
20. Kapoor R, Bhattacharyya T, Gupta R, Mitta BR, Kalra N. A systematic review of management of neuroendocrine tumours: An experience from a tertiary care centre from India. Clin Cancer Investig J. 2014;3:363–72
21. Gonzalez RS. Staging-neuroendocrine. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colontumourstagingneuroendocrine.html. Accessed November 21st, 2024.
22. Yu YJ, Li YW, Shi Y, Zhang Z, Zheng MY, Zhang SW. Clinical and pathological characteristics and prognosis of 132 cases of rectal neuroendocrine tumours. World journal of gastrointestinal oncology. 2020 Aug 8;12(8):893.
23. Chi Y, Du F, Zhao H, Wang JW, Cai JQ. Characteristics and long-term prognosis of patients with rectal neuroendocrine tumours. World Journal of Gastroenterology: WJG. 2014 Nov 11;20(43):16252
24. Shen C, Yin Y, Chen H, Tang S, Yin X, Zhou Z, Zhang B, Chen Z. Neuroendocrine tumours of colon and rectum: validation of clinical and prognostic values of the World Health Organization 2010 grading classifications and European Neuroendocrine Tumor Society staging systems. Oncotarget. 2017 Mar 3;8(13):22123.
25. Azam F, Latif MF, Farooq A, Tirmazy SH, AlShahrani S, Bashir S, Bukhari N. Performance status assessment by using ECOG (Eastern Cooperative Oncology Group) score for cancer patients by oncology healthcare professionals. Case reports in oncology. 2020 Sep
25;12(3):728-36.
26. Neychev V, Steinberg SM, Cottle-Delisle C, Merkel R, Nilubol N, Yao J, et al. Mutation-targeted therapy with sunitinib or everolimus in patients with advanced low-grade or intermediate-grade neuroendocrine tumours of the gastrointestinal tract and pancreas with or without cytoreductive surgery: protocol for a phase II clinical trial. BMJ Open 2015;5:e008248.
27. Komarnicki P, Musiałkiewicz J, Stańska A, Maciejewski A, Gut P, Mastorakos G, Ruchała M. Circulating Neuroendocrine Tumor Biomarkers: Past, Present and Future. J Clin Med. 2022 Sep 21;11(19):5542. doi: 10.3390/jcm11195542.
28. Cavalcanti MS, Gönen M, Klimstra DS. The ENETS/WHO grading system for neuroendocrine neoplasms of the gastroenteropancreatic system: a review of the current state, limitations and proposals for modifications. International journal of endocrine oncology. 2016 Aug 1;3(3):203-19.
29. Mertz AT, Ojemuyiwa MA. A case of poorly differentiated large-cell neuroendocrine carcinoma of the cecum: a rare malignancy, with review of the literature. Case Reports in Oncology. 2017 Jan 6;9(3):847-53.
30. Lakhe, R. R., Swami, R. M., Kulkarni, P., Doshi, P. R., & Mani, N. S. (2020). Immunophenotyping in incidental gastrointestinal neuroendocrine tumours: study at tertiary care centre. Journal of Pathology of Nepal, 10(2), 1751–1755.
31. Chen JX, Lin Y, Meng YL, Zhao AX, Huang XJ, Liang R, Li YQ, Liu ZH. Predicting the Survival Probability of Neuroendocrine Tumor Populations: Developing and Evaluating a New Predictive Nomogram. Biomed Res Int. 2021 Jan 28;2021:9126351
32. Freis P, Graillot E, Rousset P, Hervieu V, Chardon L, Lombard-Bohas C, Walter T. Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers. Scientific Reports. 2017 Jan 11;7(1):40609.
33. Freis P, Graillot E, Rousset P, Hervieu V, Chardon L, Lombard-Bohas C, Walter T. Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers. Scientific Reports. 2017 Jan 11;7(1):40609.
34. Frizziero M, Spada F, Lamarca A, Kordatou Z, Barriuso J, Nuttall C, McNamara MG, Hubner RA, Mansoor W, Manoharan P, Fazio N. Carboplatin in combination with oral or intravenous etoposide for extra-pulmonary, poorly-differentiated neuroendocrine carcinomas. Neuroendocrinology. 2019 Jan 21;109(2):100-12.
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