Clinics and Research in Hepatology and Gastroenterology (2014) 38, 1—2
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IMAGE OF THE MONTH
Neuroendocrine tumor of the small intestine Antoune Arbache, Mona Kara, Sanaâ El Mouhadi, Lionel Arrivé ∗ Department of Radiology, Saint-Antoine Hospital, AP—HP, Université Pierre-et-Marie-Curie, Paris-VI, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France Available online 28 October 2013
A 68-year-old woman with a metastatic neuroendocrine tumor of the small intestine presented to a follow up examination with recurrent abdominal pain and vomiting. Clinical examination was unremarkable as were laboratory tests. Computed tomography (CT) demonstrated a dilatation and wall thickening of several ileal loops around a calcified mesenteric lymph node mass. This finding was associated with an intense enhancement of the mucosa and was responsible for a chronic sub-occlusive syndrome. Primary ileal tumor was also demonstrated.
Figure 1 Coronal CT scan: primary neuroendocrine tumor (T) is demonstrated as well as a calcified lymph node mass (arrow). Heterogeneous thickening (arrowheads) of adjacent intestinal loops is well seen. ∗
Corresponding author. E-mail address: [email protected] (L. Arrivé).
2210-7401/$ – see front matter © 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.clinre.2013.09.001
2 Neuroendocrine tumors are the second most common small-bowel malignancy, accounting for 1.2%—1.5% of all gastrointestinal neoplasms [1]. Primary small bowel lesion is often small and difficult to detect at CT. The most common CT feature is mesenteric involvement secondary to direct extension or lymphatic spread. The dominant imaging feature is an enhancing soft-tissue mass with linear bands, radiating in the mesenteric fat, representing a tumoral proliferation and/or desmoplastic reaction. Calcifications may be seen in up to 70% of the neuroendocrine tumors of the intestine [2]. In some cases, adjacent intestinal loops can be thickened. This can be related to the desmoplastic reaction that may kink the bowel and cause obstruction or obstruct vascular supply, causing ischemia or infarction of the involved segment. The involvement of adjacent vessels may be also caused by the release of serotonin and other hormones from the primary tumor.
A. Arbache et al. The combinations of these CT features, which allow a definite diagnosis, are well demonstrated in the present case.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References [1] Thomas RM, Sobin LH. Gastrointestinal cancer. Cancer 1995;75:154—70. [2] Chang S, Choi D, Lee SJ, et al. Neuroendocrine neoplasms of the gastrointestinal tract. Classification, pathologic basis and imaging features. Radiographics 2007;27:1667—79.
Available online at
ScienceDirect www.sciencedirect.com
IMAGE OF THE MONTH
Neuroendocrine tumor of the small intestine Antoune Arbache, Mona Kara, Sanaâ El Mouhadi, Lionel Arrivé ∗ Department of Radiology, Saint-Antoine Hospital, AP—HP, Université Pierre-et-Marie-Curie, Paris-VI, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France Available online 28 October 2013
A 68-year-old woman with a metastatic neuroendocrine tumor of the small intestine presented to a follow up examination with recurrent abdominal pain and vomiting. Clinical examination was unremarkable as were laboratory tests. Computed tomography (CT) demonstrated a dilatation and wall thickening of several ileal loops around a calcified mesenteric lymph node mass. This finding was associated with an intense enhancement of the mucosa and was responsible for a chronic sub-occlusive syndrome. Primary ileal tumor was also demonstrated.
Figure 1 Coronal CT scan: primary neuroendocrine tumor (T) is demonstrated as well as a calcified lymph node mass (arrow). Heterogeneous thickening (arrowheads) of adjacent intestinal loops is well seen. ∗
Corresponding author. E-mail address: [email protected] (L. Arrivé).
2210-7401/$ – see front matter © 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.clinre.2013.09.001
2 Neuroendocrine tumors are the second most common small-bowel malignancy, accounting for 1.2%—1.5% of all gastrointestinal neoplasms [1]. Primary small bowel lesion is often small and difficult to detect at CT. The most common CT feature is mesenteric involvement secondary to direct extension or lymphatic spread. The dominant imaging feature is an enhancing soft-tissue mass with linear bands, radiating in the mesenteric fat, representing a tumoral proliferation and/or desmoplastic reaction. Calcifications may be seen in up to 70% of the neuroendocrine tumors of the intestine [2]. In some cases, adjacent intestinal loops can be thickened. This can be related to the desmoplastic reaction that may kink the bowel and cause obstruction or obstruct vascular supply, causing ischemia or infarction of the involved segment. The involvement of adjacent vessels may be also caused by the release of serotonin and other hormones from the primary tumor.
A. Arbache et al. The combinations of these CT features, which allow a definite diagnosis, are well demonstrated in the present case.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References [1] Thomas RM, Sobin LH. Gastrointestinal cancer. Cancer 1995;75:154—70. [2] Chang S, Choi D, Lee SJ, et al. Neuroendocrine neoplasms of the gastrointestinal tract. Classification, pathologic basis and imaging features. Radiographics 2007;27:1667—79.
