Navigating the uncommon: a comprehensive case study of multiple gastroduodenal neuroendocrine tumor

Abstract

Neuroendocrine tumors (NETs) have varied pathophysiological characteristics, location, clinical presentation, management & outcome. Unfortunately, most NETs are non-functional and therefore, either remain asymptomatic until incidentally detected or present very late with pressure symptoms, adding up to the associated morbidity and mortality. Here we presented a case of a 43-year gentleman, who presented to gastroenterology OPD with chief complaints of heartburn and pain in the upper abdomen for one year. He had an equivocal clinical examination and laboratory parameters. Upper GI endoscopy and computed tomography revealed multiple nodular growths in the D1 segment and pylorus of the stomach. He was successfully managed by wide local excision of D1 and distal stomach (pylorus) followed by Polya gastrojejunostomy reconstruction. Histopathology confirmed well-differentiated NETs, low Ki67, and positive for chromogranin and synaptophysin. This case draws attention to the early age of presentation of multifocal NETs with vague symptoms and equivocal clinical examination. Coexisting gastric NETs with duodenal NETs in itself is very rare, never the less non-functional status and pre-operative diagnostic dilemma. Here, we have also drawn attention to the pros and cons of various diagnostic tools and how their utility can sometimes limit the approach of clinicians, apart from a high index of suspicion.