Endocrine Abstracts

Introduction: Digestive neuroendocrine tumors (DNETs) represent a heterogeneous group of tumors. This heterogeneity is manifested by the variable localization of these tumors but also by a great clinical and biological diversity. Thus, they occupy an increasingly important place in digestive oncology.

NETs are very rare and represent about 1% of all digestive tumors, due to their slow evolution. The majority of them develop in the digestive tract (67.5%) (from the esophagus to the anus); the pancreas, the liver and the gallbladder are more exceptionally affected.

We report the observation of a patient with a type 1 neuroendocrine tumor to illustrate the interest of properly typing this type of tumor in order to administer an adequate treatment.

Observation: 49 year old patient with antecedents: Biermer’s anemia under treatment

Who has chronic intense epigastric pain that is resistant to analgesic treatment and for which endoscopic exploration has demonstrated: Milimetric sessile polyps in the fundus with suspected ECLomas and a histological and immunohistochemical appearance of a well differentiated DNET of grade 2+ Chronic antral gastritis.

The clinical examination was unremarkable.

A workup that could frame TNED as a possible type 1 multiple endocrine neoplasia was requested:

On the biological level:

Gastrinemia 17×N.

Chromogranin A elevated at 172 ng/ml (N: 108 ng/ml).

Insulin, C-peptide, hypophysiogam and Ph-Ca were normal at normal rate.

On the morphological level:

CT scan and Hypothalamic–pitiutary MRI without any particularities

An Otrescan for metastases was requested but did not reveal any other pathological sites

→We conclude to a neuroendocrine tumor type 1

The treatment consisted of clinical surveillance with iterative endoscopic tumorectomy every 6 months.

Conclusion: In the vast majority of cases, differentiating neuroendocrine tumors does not pose a real problem. A few simple rules can help to avoid any diagnostic doubts. The challenge is not to overtreat benign tumors (type 1) and induce surgical morbidity and mortality, or undertreat malignant tumors (type 3).