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Ileal Neuroendocrine Tumor in a Patient with Sclerosing Mesenteritis: Which Came First?

Unusual clinical course, Challenging differential diagnosis, Patient complains / malpractice, Rare disease

Cristine Pathirannehalage Don, Daniele Sforza, Leandro Siragusa, Bruno Sensi, Matteo Ciancio Manuelli, Rossana Telesca, Luca Savino, Valentina Ferrazzoli, Simona Grande, Massimo Villa, Michele Grande

Italy Department of Surgery, Policlinico Tor Vergata, Rome, Italy

Am J Case Rep 2021; 22:e931372

DOI: 10.12659/AJCR.931372

Available online: 2021-04-30

Published: 2021-06-06


#931372

BACKGROUND: Jejunoileal neuroendocrine tumors (JI-NETs) are rare tumors that can be associated with mesenteric fibrosis. This case report is of an incidental finding of a JI-NET in a patient who was previously misdiagnosed with sclerosing mesenteritis.
CASE REPORT: A 42-year-old man was admitted to our institution with diffuse abdominal pain and clinical and radiographic signs of bowel obstruction. He had a previous diagnosis of sclerosing mesenteritis, which had been histologically diagnosed after an exploratory laparoscopy performed in 2009 for recurrent acute abdominal pain. He was also annually monitored through computed tomography scans for an incidentally discovered, gradually enlarging mesenteric mass for which a “wait and watch” management approach was adopted. After a period of fasting and observation, the patient underwent an urgent exploratory laparotomy because of his worsening condition. Intraoperatively, an ileocecal resection was performed, along with excision of the known mesenteric mass. The pathology report revealed an ileal NET with nodal metastases within the mesentery and mesenteric tumor deposits (pT3N1).
CONCLUSIONS: JI-NETs are rare entities, which are usually encountered as incidental findings or in patients with unspecific abdominal pain. Our case represents a probable delayed diagnosis of JI-NET in the context of sclerosing mesenteritis; therefore, a possible association between these 2 conditions should be investigated.

Keywords: Fibrosis, Gastrointestinal Neoplasms, neuroendocrine tumors, Panniculitis, Peritoneal



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