Emmanuel McDonald, DO1, Marisol Trejoss2, David Choi, DO2, Odayls Frontela, MD1, Felix Gonzalez, MD2
1Larkin Community Hospital - Palm Springs, Miami, FL; 2Larkin Community Hospital, Miami, FL
Introduction: Gastroenteropancreatic Neuroendocrine tumors (GEP-NETs) refer to a group of heterogeneous neoplasms arising from neuroendocrine cells of the embryological gut. Rectal NETs are rare and often discovered during routine colonoscopy screening. They are often incidental findings since 50% of cases present as asymptomatic. When symptomatic with rectal bleeding, bowel habits changes, weight loss, and even pain, patients often are in an advanced stage of the disease. The advances in routine endoscopic screening processes have increased the incidence and prevalence of rectal NETs over the course of the years. Rectal NETs have varied developmental processes, clinical presentations, and due to the lack of epidemiological research, risk factors are not well known. While routine screening has allowed for earlier detection of colorectal NETs, histology-specific management has not yet been established and the role of surgery has been questioned.
Case Description/Methods: We present a case of a 67 year old male with PMHx of HTN, CAD, DM, and treated prostate cancer who presents to the outpatient clinic with three months of bloody bowel movements. He reported never having blood in his stool previously, and having about two to three normal bowel movements daily. Abdominal CT scan revealed a 1.5 cm extramural mass extending into the rectal fossa. He underwent flex sigmoidoscopy that revealed a large flat ulcerated mass which pathology confirmed as a neuroendocrine neoplasm of the rectum. Patient was referred to oncology and surgery for transanal resection.
Discussion: The incidence of NETs of the rectum has increased about ten-fold over the past 30 years and represent 29% of all GEP-NETs. Despite the increase in incidental findings attributed widely to the higher endoscopy screening rates, rectal NETs continue to be rare worldwide. Studies suggest genetics may be one predisposing factor as it is more commonly found in African Americans, Hispanic, and Asian populations. Due to the rarity of rectal NETs, there is a dearth of knowledge to the risk factors for disease. While new screening guidelines have allowed for earlier incidental findings for colorectal pathologies, there is yet to be a modified screening protocol. Because rectal NET can be indolent and has potential metastasize, there is an emphasis on timing of detection. This case study highlights the potential need to further study, modify and incorporate known risk factors to improve diagnostics and screening for rectal cancer.
Citation: Emmanuel McDonald, DO; Marisol Trejoss; David Choi, DO; Odayls Frontela, MD; Felix Gonzalez, MD. P1339 - IT'S A BLOODY TUMOR: A CASE OF RARE NEUROENDOCRINE TUMOR PRESENTING AS RECTAL BLEEDING. Program No. P1339. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.