title: Multiple, persistent gastropancreato-neuroendocrine tumours accompanying sigmoid bowel adenocarcinoma: A rare case report.
abstract: BACKGROUND
  Gastropancreato-neuroendocrine tumours (GETs) are rare, especially when they occur alongside colorectal adenocarcinoma. Furthermore, multiple GETs occurring within the small bowel are less frequent with only two cases described within the literature.
  
  
  METHODS
  A healthy 58-year old woman presented with severe gastrointestinal pain and faecal incontinence. Family history revealed consanguineous parents and a brother who had recently died of a gastric GET. First biopsy showed a sigmoid adenocarcinoma. Histology of the resected sigmoid revealed both adenocarcinoma and GET. After this, she presented with small bowel obstruction secondary to multiple ileal and jejunal GETs, also treated with resection. All imaging modalities gave no evidence of extra-intestinal metastasis. The patient received multiple operations and chemotherapy but died 18 months after the original presentation.
  
  
  CONCLUSIONS
  A case of such persistent and multiple small bowel GET without extra-intestinal metastasis has yet to be reported within the literature. GETs are rare and typically asymptomatic with a small proportion giving the classical carcinoid syndrome. Surgery is usually reserved for smaller GETs with high five-year survival. Despite this, surgery and chemotherapy were performed and both proved to be ineffective. Furthermore, a genetic basis for GETs is supported in this case with her brother suffering a similar fatal tumour.
  
  
  CONCLUSIONS
  This case highlights a rare GET that has a likely underlying familial origin. It illustrates the non-specific presentation of these tumours and the importance of taking a thorough family history. It also demonstrates that these tumours can be fatal even in the absence of extra-intestinal metastasis.
authors.affiliation: Department of Surgery, Milton Keynes General Hospital, Milton Keynes MK65LD, UK.
authors.forename: Andrew James
authors.initials: AJ
authors.lastname: Hotchen
authors.affiliation: Department of Medicine, Milton Keynes General Hospital, Milton Keynes MK65LD, UK.
authors.forename: Khimara
authors.initials: K
authors.lastname: Naidoo
authors.affiliation: Department of Medicine, Milton Keynes General Hospital, Milton Keynes MK65LD, UK.
authors.forename: Sandro
authors.initials: S
authors.lastname: Lanzon-Miller
keywords: Carcinoid syndrome; Neuroendocrine tumour; Oncology