Neuroendocrine Carcinoma of the Lower Rectum: A Case Report
Woramin Riansuwan MD, FRCST*, Siriluck Prapasrivorakul MD, FRCST*
Affiliation : * Colorectal Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Rectal neuroendocrine carcinoma is a rare disease with a prognosis worse than rectal adenocarcinoma. The
authors report a case of successful ultra-low anterior resection in well-differentiated neuroendocrine carcinoma of the lower
rectum.
Case Report : A 38-year-old man presented with chronic constipation for six years. Digital rectal examination, colonoscopy
and pelvic MRI demonstrated a 5-cm. intramural mass with a smooth mucosa at the posterior aspect of the lower rectum; 4
cm above the anal verge. No liver metastasis was demonstrated by an abdominal CT scan. The patient underwent an
uneventful ultra-low anterior resection. The operative time was 195 minutes and blood loss was 310 milliliters. The pathology
report showed well-differentiated neuroendocrine carcinoma, presence of angio-lymphatic invasion and metastatic carcinoma
in one out of twenty-six regional lymph nodes. The patient received postoperative adjuvant radiation and chemotherapy. No
recurrent tumor was detected after 14 months of follow-up.
Conclusion : Although high recurrence rates are noted, radical oncologic resection followed by adjuvant chemo-radiation is
a standard treatment in lower rectal neuroendocrine carcinoma. Long-term follow-up of this patient is still needed.
Keywords : Neuroendocrine carcinoma, Neuroendocrine tumor, NETs, Surgery, Rectum
