Rektum Mezenterinde Gelişen Nöroendokrin Tümör: 13 Yıl Önce Apendiks Nöroendokrin Tümörü Nedeniyle Ameliyat olan bir Olgu

Öz

Gastrointestinal sistemde Nöroendokrin Tümörler (NET) en sık apendikste görülür. Bu çalışmanın amacı, 51 yaşında rektum mezenterinde NET tanısı koyulan erkek hastayı sunmaktır. 2009 yılında apendektomi sonrası apendiks NET tanısı koyulmuş. Ardından total mezokolonik sağ hemikolektomi uygulanmış. 2022 yılına kadar rutin takiplerinde patolojiye rastlanmayan hastanın 2022 Haziran ayında yapılan tetkiklerinde pelvisin sağ tarafında, seminal vezikülün posteriorunda ve rektumun anterolateralinde, rektum mezenteri içerisinde kitle lezyon tespit edildi. Yapılan transabdominal biyopside NET tanısı koyuldu ve operasyon kararı verildi. Periopreatif frozen section incelemede kitle lezyonun temiz cerrahi sınırlar ile rezeke edilmiş NET olduğu doğrulandı. Büyük tümör boyutuna sahip ya da yüksek dereceli NET'de ameliyat sonrası tedaviye kemoterapi veya kemoradyoterapi ile devam edilmektedir. Hastaya cerrahi sonrası kemoterapi tedavisi verildi ve poliklinik takibine alındı.

Anahtar Kelimeler

• Apendiks
• nöroendokrin tümör
• rektum mezenteri

Neuroendocrine Tumor Developing in the Rectal Mesentery: A Case Who Had Surgery Due to Appendiceal Neuroendocrine Tumor 13 Years Ago

Abstract

In the gastrointestinal tract, Neuroendocrine Tumors (NETs) are most observed in the appendix. This study aims to present a 51-year-old male patient diagnosed with NET in rectal mesentery. In 2009, appendiceal NET was diagnosed after appendectomy. Then, a total mesocolonic right hemicolectomy was performed. In the examination conducted in June 2022, a mass lesion was detected on the right side of the pelvis, posterior to the seminal vesicle and anterolateral to the rectum, within the rectal mesentery. Diagnosis of NET was made with a transabdominal biopsy, and then an operation decision was made. The perioperative frozen section confirmed that the mass lesion was a NET with clean surgical margins. In patients with large tumor sizes or high-grade NET, postoperative treatment is continued with chemotherapy or chemoradiotherapy. The patient was administered chemotherapy after surgery and was followed up in the outpatient clinic.

Keywords

• Appendix
• neuroendocrine tumor
• rectal mesentery

Kaynakça

1. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumors of the digestive system. Histopathology. 2020;76(2):182-188. doi:10.1111/his.13975
2. Volante M, Daniele L, Asioli S, et al. Tumor staging but not grading is associated with adverse clinical outcome in neuroendocrine tumors of the appendix: A retrospective clinical pathologic analysis of 138 cases. Am J Surg Pathol. 2013;37(4):606-612. doi:10.1097/PAS.0b013e318275d1d7
3. Groth SS, Virnig BA, Al-Refaie WB, Jarosek SL, Jensen EH, Tuttle TM. Appendiceal carcinoid tumors: Predictors of lymph node metastasis and the impact of right hemicolectomy on survival. J Surg Oncol. 2011;103(1):39-45. doi:10.1002/jso.21764
4. Rault-Petit B, Do Cao C, Guyétant S, et al. Current management and predictive factors of lymph node metastasis of appendix neuroendocrine tumors: A national study from the French group of endocrine tumors (GTE). Ann Surg. 2019;270(1):165-171. doi:10.1097/SLA.0000000000002736
5. Fields AC, Lu P, Vierra BM, et al. Survival in patients with high-grade colorectal neuroendocrine carcinomas: The role of surgery and chemotherapy. Ann Surg Oncol. 2019;26(4):1127-1133. doi:10.1245/s10434-019-07203-3
6. Brighi N, La Rosa S, Rossi G, et al. Morphological factors related to nodal metastases in neuroendocrine tumors of the appendix: A multicentric retrospective study. Ann Surg. 2020;271(3):527-533. doi:10.1097/SLA.0000000000002939
7. Hrabe J. Neuroendocrine tumors of the appendix, colon, and rectum. Surg Oncol Clin N Am. 2020;29(2):267-279. doi:10.1016/j.soc.2019.11.010
8. Tchana-Sato V, Detry O, Polus M, et al. Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies. World J Gastroenterol. 2006;12(41):6699-6701. doi:10.3748/wjg.v12.i41.6699

9. Badak B, Yilmaz AS, Salis M. Should we be afraid of neuroendocrine appendix tumors? Special Issue of Health Sciences, 2020;(78):36-40. doi:10.7176/JHMN/78 05
10. Zhang P, Li YL, Qiu XD, et al. Clinicopathological characteristics and risk factors for recurrence of well-differentiated pancreatic neuroendocrine tumors after radical surgery: a case-control study. World J Surg Oncol. 2019;17(1):66. doi:10.1186/s12957-019-1606-8