title: [Neuroendocrine tumor of the terminal ileum observed by magnifying endoscopy with narrow-band imaging: a case report].
abstract: We report the case of an 88-year-old woman with localized intestinal obstruction caused by a midgut neuroendocrine tumor (NET) without endocrine symptoms. She was referred to our hospital for lower abdominal pain. Abdominal enhanced computed tomography revealed a thickened wall in the terminal ileum with dilated small bowel and multiple hepatic metastases upstream. Although the presenting symptoms resolved with short-term fasting and defecation, we performed further investigation. Colonoscopy confirmed the presence of submucosal tumors in the terminal ileum with a yellow-discolored surface but without ulceration or erosion. Magnifying endoscopy with narrow-band imaging clearly showed extended and dilated vessels, with the existing vessels maintained under the epithelium. Biopsies from these lesions were immunohistochemically positive for all neuroendocrine markers, and the Ki-67 index was 10%. Therefore, the patient was diagnosed with NET, and she underwent laparoscopic surgery to relieve the intestinal obstruction. Pathological examination of the resected specimen confirmed grade 2 NET with intramural metastasis and dissemination. After follow-up for a month, octreotide long-acting repeatable therapy was initiated and the patient was free of symptoms at the 6-month follow-up. This is the first report of midgut NET observed by magnifying endoscopy with narrow-band imaging.
authors.affiliation: Department of Gastroenterology, Seirei Yokohama General Hospital.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Yosho
authors.initials: Y
authors.lastname: Fukita
authors.forename: Michifumi
authors.initials: M
authors.lastname: Toyomizu
authors.forename: Tsutoshi
authors.initials: T
authors.lastname: Asaki
authors.forename: Seitaro
authors.initials: S
authors.lastname: Adachi
authors.forename: Ikuma
authors.initials: I
authors.lastname: Yasuda
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Katakura
authors.forename: Toru
authors.initials: T
authors.lastname: Saito
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nozawa
authors.forename: Naomi
authors.initials: N
authors.lastname: Suematsu
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography