Perm Medical JournalPerm Medical Journal0136-14492687-1408Eco-Vector11249410.17816/pmj395144-149Research ArticleDiagnostic difficulties of small intestinal neuroendocrine tumors: clinical caseKotelnikovaL. P.<p>MD PhD, Professor, Head of the Department of Surgery with Course of Cardiovascular Surgery and Invasive Cardiology</p>splaksin@mail.ruShatrovaN. A.<p>surgeon, 1<sup>st</sup> Surgical Unit</p>splaksin@mail.ruTrukhachevaE. A.<p>radiologist, Department of Computer Diagnostics</p>splaksin@mail.ruE.A. Vagner Perm State Medical UniversityPerm Krai Clinical Hospital101120223951441491011202210112022Copyright © 2022, Eco-Vector2022<p>The objective of the study was to demonstrate the difficulties of diagnosing the neuroendocrine tumor (NET) of the small intestine at the example of a concrete clinical case. In the case presented, clinical manifestations of the disease were nonspecific and the examination began from a low-informative method multispiral computed tomography (MSCT) without a bolus contrast study that was the reason of wrong diagnosis for 7 months. The detection of the swollen lymph node in the mesentery was interpreted incorrectly; additionally, only endoscopic investigation of the stomach and large intestine was used. By means of MSCT-angiography we succeeded to diagnose not only the lymph node conglomerate in the mesentery, but to reveal a tumor sized 915 cm in the ileac wall. Laparoscopy with lymph node biopsy after its morphological study permitted to verify the diagnosis before the surgery.</p>
<p>To reduce the period of diagnostics of small intestinal NET, general practitioners should be informed on specific features of clinical manifestations of the disease and rational diagnostic methods. MSCT-angiography showed its efficiency in detection of small-sized small intestinal NET, and laparoscopy with biopsy of the mesentery lymph node will permit to verify the diagnosis before surgery.</p>small intestinal neuroendocrine tumorMSCT-angiographylaparoscopyнейроэндокринная опухоль тонкой кишкиМСКТ-ангиографиялапароскопия[Durleshter V.M., Henrikh S.R., Avakimyan A.V., Dryyaeva L.H., Kirakosyan D.S. Experience of diagnosis and treatment of patients with intestinal neuroendocrine tumor. Nauchnyj vestnik zdravoohraneniya Kubani 2018; 2: 39–50.][Lysanyuk M.V., Maistrenko N.A., Romashenko P.N. The difficulties of diagnosis and choice of treatment tactics of neuroendocrine tumors. Grekov’s Bulletin of Surgery 2018; 177 (1): 76–80.][Lisanyuk M.V., Romashenko P.N., Maistrenko N.A. Features of diagnostics and treatment of patients with neuroendocrine tumors of the small intestine. Tavricheskiy Mediko-Biologicheskiy Vestnik. 2020; 23 (2): 100–109.][Beltsevich D.G., Melnichenko G.A. Management of patients with differentiated neuroendocrine tumors of jejunum and ileum (according to international guidelines). Endocrine Surgery 2011; 2: 5–17.][Watzka F.M., Fotter C., Miederer M., Weber M.M., Schad A., Lang H., Musholt T.J. Surgical treatment of NEN og small bowel: a retrospective analysis. Wold J. Surg. 2016; 40 (3): 749–758.][Fata C.R., Gonzalez R.S., Liu E., Cates J.M., Shi C. Mesenteric tumor in Endomidgut small intestinal neuroendocrine tumors are a stronger indicator than lymph node metastasis for liver metastasis and poor prognosis. Am. J. Surg. Pathol. 2017; 41 (1): 128–133.][Clift A.K., Kidd M., Bodei L., Toumpanakis C., Baum R.P., Oberg K., Modlin I.N., Frilling A. Neuroendocrine neoplasms of the small bowel and pancreas. Neuroendocrinology 2020; 110: 444–476.][Sundin A., Arnold R., Baudin E., Cwikla J.B., Eriksson B., Fanti S., Fazio N., Giammarile F., Hicks R.J., Kjaer A., Krenning E., Kwekkeboom D., Lombard-Bohas C., O’Connor J.M., O’Toole D., Rockall A., Wiedenmann B., Valle J.W., Vullierme M. ENETS Consensus guidelines for the standards of care in neuroendocrine tumors: radiological, nuclear medicine&hybrid imaging. Neuroendocrinology 2017; 105 (3): 121–244.]