Endocrine Abstracts

Introduction: Neuroendocrine tumour of the kidney makeup less than 1% of all renal tumours. They pose a diagnostic challenge therefore pathological and immunohistological analysis are considered extremely important for attaining accurate diagnosis.

Case report: 29-year-old male presented with sudden onset of severe abdominal pain and vomiting. He had no past medical history, his mother had gallstone pancreatitis. On examination there was mild tenderness in the left umbilical region and the biochemical workup revealed increased inflammatory markers. He underwent a CT scan of the abdomen and pelvis which revealed a mass arising from the lower pole of the left kidney measuring 66 X 59 X 80 mm. The lesion is of soft tissue and was less than 20 Hounsfield units. There were multiple lesions in the left para-aortic region. CT neck and thorax did not reveal any new lesions. His care was initially discussed at the urology MDT, the consensus was retroperitoneal lymphadenopathy with a left renal mass may present an atypical renal neoplasm or lymphoma. He underwent a CT-guided core biopsy of para-aortic lymph nodes. Histology revealed a well to moderately differentiated neuroendocrine tumour with Ki-67 of around 20%. Immuno histochemistry revealed positive staining for synaptophysin CD 56, AE1/3, negative for CK7, P504S, OCT3/4, PLAP, chromogranin A, WT1, Melan A, Serotinin. He underwent a nuclear medicine gallium 68 DOTATATE PET-CT, this revealed avid left renal mass associated with left renal hilar, para-aortic, aortocaval lymph nodes. There were numerous scattered avid bone metastasis throughout the visualised skeleton. MRI liver revealed a small cyst. These findings were discussed at the neuroendocrine (NET) tumour multidisciplinary team meeting; as there were widespread metastasis, the renal lesion was deemed not amenable for surgical resection. He has been commenced on long-acting somatostatin analogues and reviewed by the oncologist. Oncologist have commenced him on CAPTEM (Capecitabine and Temozolomide) chemotherapy.

Discussion: Common presenting symptoms of renal NETs are back pain flank pain and haematuria. Immuno histochemistry and pathological examination or key players in diagnosis of the renal neuroendocrine tumours.