Searchable abstracts of presentations at key conferences in endocrinology
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UKI NETS 14th National Conference

ea0046p1 | (1) | UKINETS2016

MicroRNAs associated with small bowel neuroendocrine tumours and their metastases

Miller Helen C , Frampton Adam E , Malczewska Anna , Ottaviani Silvia , Stronach Euan A , Flora Rashpal , Kaemmerer Daniel , Schwach Gert , Pfragner Roswitha , Faiz Omar , Kos-Kudla Beata , Hanna George B , Stebbing Justin , Castellano Leandro , Frilling Andrea

Introduction: Novel molecular analytes are needed in small bowel neuroendocrine tumours (SBNETs) to better determine disease aggressiveness and predict treatment response.Aim of the study: To profile the global miRNome of SBNETs, and identify microRNAs (miRNAs) involved in tumour progression for use as potential biomarkers.Material and methods: Two independent miRNA profiling experiments were performed (n=90), including pr...

ea0046p2 | (1) | UKINETS2016

68Gallium-DOTANOC (68Ga-DOTANOC) positron emission tomography (PET) imaging in Bronchial Carcinoids (BC): multicentre evaluation of its role in clinical practice

Lamarca Angela , Pritchard D. Mark , Westwood Thomas , Papaxoinis George , Vinjamuri Sobhan , Valle Juan W , Manoharan Prakash , Mansoor Wasat

Background: New nuclear medicine imaging techniques have improved diagnosis, staging and treatment planning for BC. 68Ga-DOTA PET is preferable to standard somatostatin receptor scintigraphy where available (ENETS guidelines); however, its role in the management of BC remains unclear.Methods: All consecutive patients diagnosed with BC from two ENETS Centres of Excellence were identified retrospectively; patients with high grade tumours or lack...

ea0046p3 | (1) | UKINETS2016

Health-related quality of life (HRQoL), anxiety, depression and impulsivity in patients with advanced Gastroenteropancreatic Neuroendocrine Tumours (GEPNETs)

Lewis Alexandra , Wang Xin , Magdalani Laurice , Bashir Colsom , Mansoor Wasat , Hubner Richard A , Valle Juan W , McNamara Mairead G

Background: In patients with advanced GEPNETs, psychological symptoms may result due to potential disturbances in biogenic amines, particularly serotonin. This study compared HRQoL, anxiety, depression, and impulsivity in patients with and without carcinoid syndrome (CS) and correlated with serum 5-HIAA.Methods: Consecutive patients with advanced GEPNETs (with liver metastases) receiving treatment, with and without CS completed (single time-point) HRQoL ...

ea0046p4 | (1) | UKINETS2016

Measurement of urinary 5-hydroxyindole acetic acid: correlation between spot versus 24-hour urine collection

Calanchini Matilde , Tadman Michael , Krogh Jesper , Fabbri Andrea , Grossman Ashley , Shine Brian

Introduction: In neuroendocrine tumours (NETs), the urinary concentration of the serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) is used to monitor disease progression or treatment response. The sensitivity and specificity in the presence of the carcinoid syndrome are approximately 70 and 90%, respectively. Collecting a 24 hour urine specimen is difficult and inconvenient for patients and increases analytical variability. In addition, serotonin-containing foods may i...

ea0046p5 | (1) | UKINETS2016

Incidence and characteristics of Ileo-colonic neuroendocrine tumours identified in the UK bowel cancer screening programme

Basuroy Ron , Srirajaskanthan Rajaventhan , O'Donnell Katie , Brooks Corrine , Ramage John

Background: Colorectal cancer is the third most common cancer in the UK this had led to development of the bowel cancer screening programmes (BCSPs). It is known that ileo-colonic NETs are increasing in incidence in part thought to be related to increased endoscopy. There are few epidemiological data on rectal or ileal NETs diagnosed in BCSPs. This study aims to identify the number of NETs diagnosed through the UK BCSP.Methods: UK bowel cancer colonoscop...

ea0046p6 | (1) | UKINETS2016

Whole-exome next generation sequencing of sporadic adrenocortical carcinomas - evidence for a proposed adenoma-carcinoma carcinogenesis sequence

Walls Gerard , Salatino Silvia , Wright Benjamin , Mihai Radu

Limited survival of patients with adrenocortical carcinoma (ACC) makes it imperative to understand the genetic basis of disease and support development of new therapies.Between 2010–2015, tissues from nine adrenalectomy patients (5M:4F, age 30–68 years) were snap frozen in liquid nitrogen and DNA extracted. Adjacent normal adrenal tissue (n=3) excised at adrenalectomy was collected as matched ‘normal’ controls. Whole-exome se...

ea0046p7 | (1) | UKINETS2016

Evaluation of quality of life after each cycle in patients treated with Peptide Receptor Radionuclide Therapy (PRRT)

Mateo-Vito Ivy , Amlani Ashik , Leshen Rebelidad , Mcmeekin Helena , Davis Neil , Navalkissoor Shaunak

Background: NET-related symptoms such as flushing and diarrhoeas as well as disease related worries reduce quality of life in patients with neuroendocrine tumours (NETs). Peptide receptor radionuclide therapy (PRRT) is an established treatment in NETs and has been shown to prolong survival. However quality of life data post PRRT is lacking.Aim: To evaluate the symptoms prevalence, intensity and their relation to quality of life in patients receiving PRRT...

ea0046p8 | (1) | UKINETS2016

Blood measurement of neuroendocrine gene transcripts defines the effectiveness of operative resection and ablation strategies

Modlin Irvin M , Frilling Andrea , Salem Ronald R , Alaimo Daniele , Drymousis Panagiotis , Wasan Harpreet S , Callahan Stephen , Faiz Omar , Weng Lei , Teixeira Nancy , Bodei Lisa , Drozdov Ignat , Kidd Mark

Background: Surgery is the only curative treatment for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), but the prediction of residual disease/recurrence is limited in the absence of optimal biomarkers. We examined whether a blood-based multianalyte neuroendocrine gene transcript assay (NETest) would define tumor cytoreduction and therapeutic efficacy.Methods: The NETest is a polymerase chain reaction–based analysis of 51 genes. Disease acti...

ea0046p9 | (1) | UKINETS2016

Whole-exome sequencing (WES) of samples from patients with advanced pancreatic neuroendocrine tumours (pNETs) with exceptional responses vs. poor responders to targeted therapies; a TransNET study

Barriuso Jorge , Lamarca Angela , McNamara Mairead , Burgis Timothy , Manoharan Prakash , Hayes Andrew , Mansoor Wasat , Hubner Richard , Valle Juan

Background: Despite encouraging advances in the systemic therapy options for patients with pNETs (sunitinib and everolimus), no predictive biomarkers have been established for these drugs. We aimed to identify distinctive genomic alterations associated with benefit from treatment in patients with pNETs, by comparing exceptional-responders (ER) to poor-responders (PO).Methods: Patients who achieved an objective radiological response (complete or partial) ...

ea0046p10 | (1) | UKINETS2016

Biomarkers for carcinoid heart disease

Basuroy Ron , Ramage John , Sherwood Roy , Srirajaskanthan Rajaventhan

Introduction: Carcinoid heart disease (CHD) develops in patients with small bowel NETs with carcinoid syndrome. Currently NT-proBNP (NTP) is suggested as the best current biomarker to screen for CHD and monitor heart failure. A number of other markers have been investigated for heart failure, however, none of these have been explored in NET patients with CHD or carcinoid syndrome. Galectin-3 (GAL3) promotes fibroblast proliferation and correlates with worse outcomes in heart f...

ea0046p11 | (1) | UKINETS2016

Assessing treatment benefit of telotristat etiprate in patients with carcinoid syndrome: Patient exit interviews

Anthony Lowell , Horsch Dieter , Ervin Claire , Kulke Matthew H. , Pavel Marianne , Bergsland Emily , Caplin Martyn , Oberg Kjell , Warner Richard , Kunz Pamela , Metz David C. , Pasieka Janice , Pavlakis Nick , DiBenedetti Dana , Haydysch Emily , Yang Qi Melissa , Jackson Shanna , Arnold Karie , Law Linda , Lapuerta Pablo

Background: Telotristat etiprate (TE), an oral tryptophan hydroxylase inhibitor, is intended to treat carcinoid syndrome (CS) by reducing serotonin production. TE was evaluated in TELESTAR, a phase 3 study; the primary endpoint showed significant reductions in bowel movement (BM) frequency for 2 TE dosages + standard of care (SOC) vs. SOC. TELESTAR patients had CS inadequately controlled on somatostatin analog therapy with ≥4 BMs per day. They were interviewed about base...

ea0046p12 | (1) | UKINETS2016

Evaluation of a novel microfluidic device for epitope-independent enrichment of circulating tumour cells (CTCs) in patients with neuroendocrine tumours (NET)

Childs Alexa , Kularatne Bihani , Vesely Clare , Ensell Leah , Hartley John , Meyer Tim

Background: The identification and characterization of CTCs as part of a minimally invasive “liquid biopsy” has potential as a real-time biomarker in cancer patients. Using blood samples from NET patients, we evaluate the epitope-independent Parsortix, which enriches CTCs based on size and rigidity, and compare to the EpCAM-dependent CellSearch platform.Methods: About 10 patients with histologically confirmed metastatic NET had synchronous 7.5 ...

ea0046p13 | (1) | UKINETS2016

Role of palliative resection of the primary tumour in advanced pancreatic and small intestinal neuroendocrine tumours: A systematic review and meta-analysis

Almond Max , Hodson James , Ford Samuel , Gourevitch David , Roberts Keith , Shah Tahir , Desai Anant

Introduction: The role of surgery to resect the primary lesion in incurable metastatic small intestinal (SI-NET) and pancreatic neuroendocrine tumours (P-NET) remains controversial. Recent evidence suggests that palliative surgery may increase survival even in asymptomatic patients with non-functioning tumours. The present study investigated the value of palliative resection of the primary tumour in SI-NET and P-NET by systematic literature review and meta-analysis.<p clas...

ea0046p14 | (1) | UKINETS2016

Perioperative carcinoid crisis during surgery-who benefits from octreotide?

ElGendy Khalil , Johnnson Sarah , French Jeremy , White Steven , Charnley Richard , Manas Derek , Wilson Colin

Introduction: Carcinoid crisis, as an entity is poorly defined, but can be seen in patients with small bowel NET tumours after open bowel surgery or tumour unrelated procedures as cardiovascular instability (CI). Recent evidence suggests that cardiovascular instability (CI) during NET surgery is more common than previously considered.Aims and methods: We audited the incidence of CI during procedures and determined the relationship to perioperative octreo...

ea0046p15 | (1) | UKINETS2016

Low rate of psychological ill health in patients with GEP NETS attending an ENETS Centre of Excellence

Liyanarachchi Kamani , Amarawardena Maheshi , Smith Eleanor , Newell-Price John , Munir Alia

Background: Assessment of psychological burden of disease forms one criterion for accreditation of a cancer specialist center. Patient Health Questionnaire-4 (PHQ-4), a validated self-report ultra-short questionnaire was used to assess anxiety and depression level in patients with GEP NETs, attending the clinics at an ENETS Centre of Excellence.Methods: PHQ-4 was completed during routine outpatient visits over a three month period by 48 patients, who wer...

ea0046p16 | (1) | UKINETS2016

Knockdown of Gα15 in BON cell line enhances pancreastatin inhibitory effect on neoplastic proliferation

Zanini Sara , Barron Gemma , Ahmed Irfan , Bermano Giovanna , Giovinazzo Francesco

Although initially considered rare, the incidence of pancreatic neuroendocrine tumours (P-NETs) has progressively increased. A population-based study conducted in England and Wales (1986–1999) found that 5-year survival was 29% for non-functioning and 41% for functioning tumours when considering well-differentiated P-NETs. Traditional treatments show very limited effectiveness; novel targeted therapies are, therefore, required and identification of key molecules driving n...

ea0046p17 | (1) | UKINETS2016

UK Phase IV, Observational study to assess Quality of Life in patients (pts) with pancreatic neuroendocrine tumours (pNETs) receiving treatment with Everolimus: The “Real-World” OBLIQUE Study

Ramage John , Punia Pankaj , Olusola Faluyi , Frilling Andrea , Meyer Tim , Kapur Gaurav , Cave Judith , Wadsley Johnathan , Cummins Sebastian , Farrugia David , Starling Naureen , Wall Lucy , Saharan Ruby , Valle Juan

Background: Everolimus, a mammalian target of rapamycin inhibitor, is licensed for use in adult pts with advanced well-differentiated pNETs in the UK. Limited Health-Related Quality-of-Life (HrQOL) data are available for everolimus therapy in these pts.Methods: This prospective study assessed changes in HrQoL (by monthly patient-reported EORTC QLQ-C30, -G.I.NET21 and EQ-5D questionnaires), in pts with pNETs during the first 6 months (mo) of treatment wit...

ea0046p18 | (1) | UKINETS2016

High-grade neuroendocrine tumours of the oesophagus: a single centre experience

Salih Zena , Patrao Ana , Kordatou Zoe , Papaxoinis George , Mansoor Was

Background: High-grade neuroendocrine tumours (HGNETs) of the oesophagus are extremely rare and few cases have been reported worldwide. Here we aim to understand clinical profile, treatment strategy and outcomes for oesophageal HGNETs.Methods: We report a single-centre retrospective review of 21 patients with oesophageal HGNETs treated between 2011–2016. Data on incidence, tumour location, stage at presentation, histopathology, treatment protocol an...

ea0046p19 | (1) | UKINETS2016

Patient outcomes after cardiac surgery for carcinoid heart disease are dependant upon successful cytoreductive multimodal treatment and control of metastatic neuroendocrine disease

Jaber Basher , Ramsey Emma , Cowburn Peter , Tsang Geoff , Pearce Neil , Knight John

Introduction: Carcinoid Heart Disease (CHD) can occur in up to 50% of patients with long standing carcinoid syndrome as a result of metastatic neuroendocrine tumour (NET). It is associated with poor prognosis due to the development of right side heart failure. High circulating levels of serotonin cause cardiac fibrosis leading to tricuspid and pulmonary valve regurgitation and poor ventricular function. Cardiac surgery with valve replacement in combination with cytoreductive s...

ea0046p20 | (1) | UKINETS2016

Initial experience of a novel technique for endoscopic full thickness resection of rectal neuroendocrine tumours

Fong Michelle , Ramsey Emma , Boger Philip , Patel Praful , Ellis Richard , Knight John

Introduction: Standard endoscopic resection of rectal neuroendocrine tumours (NETs) is often associated with histological incomplete excision due to the submucosal position of the tumour within the bowel. This can lead to multiple attempts to achieve a complete excision or uncertainty leading to ongoing endoscopic surveillance. Endoscopic full thickness resection may allow early definitive management. We report a simple definitive technique for the full thickness excision of r...

ea0046p21 | (1) | UKINETS2016

Efficacy of the combination of Capecitabine and Temozolamide in patients with advanced Pulmonary Carcinoid Tumors: A single institution experience

Kordatou Zoe , Papaxoinis George , McCallum Lynn , Salih Zena , Nasralla Magdy , Nonaka Daisuke , Mansoor Wasat

Background: Pulmonary carcinoids (PC) are rare neuroendocrine tumors (NETs). The course of PCs is considered to be indolent, but patients with advanced disease have low survival rates and their treatment options are limited. As PCs are under-represented in trials, therapeutic decisions are based on evidence extrapolated from other types of NETS. Capecitabine-Temozolamide (CAPTEM) has demonstrated significant efficacy in pancreatic NETs. However, its role in PCs is still unexpl...

ea0046p22 | (1) | UKINETS2016

Multivisceral transplantation and vascularised sentinel forearm flap for a metastatic small bowel neuroendocrine tumour: Update on follow-up

Frilling A , Giele H , Vrakas G , Reddy S , Macedo R , Al-Nahhas A , Wasan H , Clift AK , Gondolesi GE , Vianna RM , Friend P , Vaidya A

Introduction: We previously reported the first documented case of a novel approach in a patient with extensive mesenteric metastases from a small bowel (SB) NET: this combined multivisceral transplantation (MVT) and a vascularised sentinel forearm flap (VSFF) from the same donor.Aim(s): We re-present this case after 38-month follow-up post-MVT/VSFF.Materials and methods: A 44-year old male patient was diagnosed with a well-differen...

ea0046p23 | (1) | UKINETS2016

Evaluation of faecal elastase 1 in symptomatic patients with neuroendocrine tumours

Chaudhry Rayhan , Newbould Rachel , Williams Megan , Reid Kieran , Donnelly Lauren , Lewis Janet , Khan Mohid

Monitoring patients with NETs reveals a significant prevalence of gastrointestinal symptoms, often unrelated directly to the tumour1. Exocrine pancreatic insufficiency exemplifies a common treatable cause of gastrointestinal symptoms in NET patients undergoing therapy with somatostatin analogues. There is a paucity of data regarding this important issue which affects quality of life in NETs. We explored the value of faecal elastase (FE) as a marker of exocrine pancr...

ea0046p24 | (1) | UKINETS2016

Improving outcomes for patients with resectable small bowel NET tumours; 5 year experience from a tertiary centre

ElGendy Khalil , Johnson Sarah , French Jeremy , White Steven , Charnley Richard , Manas Derek , Wilson Colin

Introduction: There remains controversy about which patients benefit from removal of their primary small bowel tumour and whether this should be performed in a specialist tertiary referral hospital as an elective procedure. Part of the decision making and consenting process in patients with metastases will be a shared decision about surgery with the patient in light of symptoms, morbidity from surgery and survival. The aim of this study was to elucidate important institution s...

ea0046p25 | (1) | UKINETS2016

Prognostic factors that mandate long term follow up following surgery for appendix neuroendocrine tumours (aNETs)

Alabraba Edward , Joshi Heman , Tufo Andrea , Malik Hassan , Banks Melissa , Fenwick Stephen , Cuthbertson Daniel , Poston Graeme

Background: Appendiceal neuroendocrine tumours (aNETs) are usually diagnosed incidentally at appendicectomy, are indolent and rarely recur. Current ENETS guidelines inform aNETs management and highlight areas of uncertainty. We aimed to identify risk factors that predict lymph node metastasis, residual disease at completion surgery, or disease recurrence and also assessed survival according to ENETS stage.Methods: We retrospectively analysed a prospectiv...

ea0046p26 | (1) | UKINETS2016

The use of continuous glucose monitoring to investigate and manage a rare cause of spontaneous hypoglycaemia

Walkinshaw Emma , Jones Hugh , Munir Alia

Insulin autoimmune syndrome (Hirata syndrome) is a rare cause of hypoglycaemia. It was described by Hirata in 1970 and characterised as spontaneous hypoglycaemia, with elevated insulin levels, and associated high titres of insulin autoantibodies. It is most commonly reported in Japan and is associated with autoimmune disease or exposure to sulfhydryl-containing drugs.Continuous glucose monitoring (CGM) devices measure interstitial glucose and were initia...

ea0046p27 | (1) | UKINETS2016

Modality to detect pancreatic NETS in MEN1: EUS or MRI?

Joshi Mamta , McGowan Barbara , Powrie Jake , Breen Louise , Jacques Audrey , Izatt Louise , Carroll Paul

Background: Pancreatic neuroendocrine tumours (pNETs) are commonly reported in patients with MEN1. The estimated incidence is reported as 40–80% of adults with MEN1 and pNETs are frequently multifocal. Guidelines recommend that CT, MRI and endoscopic ultrasound (EUS) can be used for detection and surveillance of pNETs in MEN1. MRI has been the most commonly used modality, but EUS may be more sensitive in detecting pNETs.Objective: To compare the sen...

ea0046p28 | (1) | UKINETS2016

Outcome of Surgical Resection after Neoadjuvant Peptide Receptor Radionuclide Therapy (PRRT) for Pancreatic Neuroendocrine Neoplasms: a case-matched analysis

Partelli Stefano , Bertani Emilio , Bartolomei Mirco , Muffatti Francesca , Grana Chiara Maria , Doglioni Claudio , Fazio Nicola , Falconi Massimo

Background: Peptide receptor radionuclide therapy (PRRT) can be an option for advanced pancreatic neuroendocrine neoplasms (PNENs) to allow patients undergo resection. Whether or not neoadjuvant PRRT increases postoperative morbidity remains unclear.Methods: Patients with initially metastatic and/or locally advanced PNEN who underwent neoadjuvant PRRT (neoadjuvant group) were compared with a group of patients who underwent upfront surgery (control group)...

ea0046p29 | (1) | UKINETS2016

Succinate dehydrogenase subunit-B mutation with associated prolactinoma and typical carcinoids

Calanchini Matilde , Shine Brian , Wang Lai Mun , Fabbri Andrea , Grossman Ashley

Case Report: A 42 year-old male, with a family history of phaeochromocytomas and paragangliomas, was diagnosed as a carrier of the succinate dehydrogenase subunit-B (SDHB) mutation. He was also diagnosed with macroprolactinoma and treated with cabergoline (currently 250 mcg weekly). A contrast CT chest scan, performed as part of the surveillance program for SDHB-associated tumours, revealed a small right lung lesion, which was found to be OctreoScanTM positive. The ...

ea0046p30 | (1) | UKINETS2016

Evaluating the impact of the Specialist Nurse

Wotherspoon Irene

The Beatson West of Scotland Cancer Centre (BWoSCC) is a Regional Service for the West of Scotland and beyond. It is considered to be a Centre of Excellence in the delivery of 21st century cancer care.Whilst the role of site specific specialist nurses has been integral to many cancer teams for in excess of 20 years, this has not been the case for neuroendocrine tumours in Scotland until May 2016.An international study ca...

ea0046p31 | (1) | UKINETS2016

A single centre analysis of the management of appendiceal neuroendocrine neoplasms (NENs) including goblet cell carcinoids (GCC)

Sagar Vandana , Coldham Christopher , Shah Tahir , Setty Shishir , Ayuk John , Elshafie Mona , Taniere Phillipe , Gourevitch David , Desai Anant , Ford Samuel , Karkhanis Salil , Geh Ian

Introduction: Appendiceal NENs are usually diagnosed incidentally on histology following an appendicectomy. They include carcinoid tumours (appendiceal neuroendocrine tumours, NETs) and GCC. GCC neoplasms are able to transform to an adenocarcinoma phenotype. There are several important criteria to review when deciding on the treatment and follow up for appendiceal NENs, in particular when to offer further surgery to patients.Aim: To assess whether the ma...

ea0046p32 | (1) | UKINETS2016

Orbital neuroendocrine tumor metastases: diversity of presentation

Amaraward Maheshi , Liyanarachchi Kamani , Wadsley Jon , Newell-Price John , Munir Alia

Introduction: Orbital metastases from Neuroendocrine tumours (NET) are reported to be very rare, and can be the primary presentation or become evident up to 20 years after diagnosis. We report a series presented in the NET MDT, where ocular metastasis occurred.Case series: A 69-yr-old woman presented with blurred vision, pain and perception of a lump around the left eye. MRI showed a lacrimal gland mass within the orbit. Excision biopsy revealed a TTF1-p...

ea0046p33 | (1) | UKINETS2016

A case report of bicaval stents and inferior vena cava valve implantation to control carcinoid symptoms in order to safely allow surgical valve replacement

Sagar Vandana , Steeds Rick , Doshi Sagar , Shetty Shishir , Shah Tahir

Severe tricuspid regurgitation (TR) leads to a reduction in cardiac output and an increase in the central venous pressure, resulting in secondary organ dysfunction. Surgery for severe TR is a high-risk procedure, particularly in the presence of uncontrolled carcinoid syndrome (CS) symptoms. Replacement of leaking tricuspid valves can lead to reduction in tumour markers and improvement in carcinoid symptoms. Transcatheter valve implantation into the vena cava may be an alternat...

ea0046p34 | (1) | UKINETS2016

An exploration of psychological symptoms in vasoactive hormone-secreting neuroendocrine tumours (carcinoid syndrome)

Friend Elizabeth

Introduction: Psychological symptoms such as aggression, confusion, irritation, anxiety and depression have been observed clinically in patients with carcinoid syndrome. It has been suggested that vasoactive-hormone secretion are involved in provoking psychological symptoms. The objective of this qualitative study is to explore the presence and experience of specific psychological symptoms in vasoactive hormone-secreting NET (carcinoid syndrome).Methods:...

ea0046p35 | (1) | UKINETS2016

Cardiac metastases from ileal NETs

Liyanarachchi Kamani , Amarawardena Maheshi , Lorenz Eleanor , Newell-Price John , Munir Alia

Background: Intracardiac metastasis of carcinoid tumours are rare (incidence 2–4%). Their presence without carcinoid valvulopathy or carcinoid syndrome is unusual.Case Discussions: A 70 year old male presented with abdominal pain. CT imaging revealed a small intestinal tumor with liver and mesenteric metastasis. Biopsy showed a neuroendocrine tumour (NET). Clinical and biochemical evidence of functionality was absent. He underwent definitive small b...