Duodenal Neuroendocrine Tumour: A Report of Two Cases with Rare Presentations

Abstract

Duodenal Neuroendocrine Tumours (D-NETs) are extremely rare tumours with a propensity to be solitary and limited to the first and second parts of the duodenum, the periampullary area contributing to only about 20% of such cases. They can be discovered incidentally at imaging or at Upper Gastrointestinal Endoscopy (UGIE) for vague Gastrointestinal (GI) symptoms. The authors encountered two successive cases (55-year-old female; 50-year-old male) of D-NETs within a couple of months in which one presented with acute upper GI bleeding and another with vague upper GI symptoms. The first case was located at the second part of the duodenum with nodal metastasis, whilst the second case had multiple D-NETs at the second and third parts of the duodenum. Sub-centimetric growths may be treated by endoscopic mucosal resections but larger ones require surgery. Both cases were more than 20 mm in size and were successfully managed by classical Whipple’s procedure. Diagnoses were confirmed and graded with histopathology and Immunohistochemistry (IHC) using chromogranin, synaptophysin, and Kiel 67 (Ki67). Normally these are mucosal and submucosal lesions, however, in the first case, the tumour invaded muscularis propria and extended upto subserosa. The authors present these two cases because of their rarity, singular presentations, and successful management in a rural set-up with logistical constraints.

Keywords

• histopathology
• immunohistochemistry
• whipple’s procedure