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Title: The synchronous gastrointestinal neuroendocrine tumors, colorectal adenocarcinoma and liver cavernous hemangioma-histopathological, immunohistochemical and genetic case report study
The incidence of synchronous gastrointestinal neuroendocrine tumors
(NET) and colorectal cancer is very low (Yumoto S, 2020).
NET are relatively rare tumors and located most commonly in
the gastrointestinal tract mainly in small intestine and rectum.
Generally, NETs often show hematogenous metastases, and the
most frequent site of distant spread is liver (Yumoto S, 2020).
Colorectal carcinoma is one of common malignant tumor. The
adenocarcinoma is the frequent histopathological tumor type.
(Yumoto S, 2020). The synchronous tumors usually are inherited
and are related with multiple endocrine neoplasia syndrome
(Yumoto S, 2020).
We report the case of a 70-year-old male with multiple sinchronous
tumours- primary small intestinal neuroendocrine tumor,
colorectal carcinoma and liver cavernous hemangioma. A 70
years old male was addmitted at Pauls Stradins Clinical University
Hospital with previously biopsy proved Grade 2 colorectal
carcinoma for surgical treatment.
Clinical examination was performed. CT scanning showed suspicious
liver mass, probably metastasis. In addition, in small intestine
mass lesions were observed. The surgical treatment was
performed. The histopathological, immunohistochemical and genetic
examination was performed. The comprehensive next generation
sequencing was performed (Quigen). Such genes were
analyzed-APC, AKT2, AKT3, AR, ARAF, ARID1A, BAP1, BRCA1,
BRCA2, BRAF, CDH1, CDK4, CSF1R, CDKN, CTCF, ERBB3, ESR1,
FAT1, FOXL2, GATA3, GNA11, GNAQ, H3F3A, HIST1H3 B,
HNF1A, HRAS, IDH1, IDH2, JAK2, KDR, KRAS, KEAP1, KMT2C, KMT2D, MAP2K2, MLH1, NF1, NFE2L2, PDGFRA, PIK3R1, POLE,
RAC1, RB1, RHOA, SF3B1, SMARCB 1, SRC, TSC1, TSC2, U2AF1,
VHL. Histopathological examination demonstrated multiple sinchronous
tumors. The patients has liver cavernous hemangioma,
muliple small intestinal neuroendocrine tumor Grade 2 (NET
Grade 2) measured 0.4 cm �?¸ and 0,6 cm �?¸ , pT3(m)N0M0 and
Grade 3 colorectal adenocarcinoma, pT2N1cM0. Immunohistochemical
examination confirmed NET diagnosis, the tumor was
positive for chromogranene and synaptophysine, Ki-67 index
was 5%. The Grade 3 colorectal adenocarcinoma was positive
for CKAE1/AE3. Obtained results showed that small intestine NET
had CDKN1B, DAXX and ATRX mutations, however MLH1, MSH2,
MSH6, PMS2 mutations have not been observed. Colorectal adenocarcinoma
had p53, SMAD4, PIK3CA and BRAF mutations,
however MLH1, MSH2, MSH6, PMS2 and KRAS mutations have
not been identified. To conclude, our case report rare coexistent
synchronous tumors-liver cavernous hemangioma, small intestinal
neuroendocrine tumors and colorectal adenocarcinoma. Based
on NGS analysis small intestinal NET more likely corresponded to
MEN 4 syndrome, however the genetical mutations of colorectal
carcinoma demonstrated MSI wild type tumour which did not
fulfill with MEN syndrome.
This case emphasizes that for synchronous cancer the surgical
resection and hitopathological examination is requiered before
systemic therapy regardless of the difference in prognosis between
the synchronous tumors.
Biography
Liga Sulca, MD, graduated from Faculty of Medicine, University of Latvia in 2020. Currently she is a 2 year resident at Riga East University Hospital, Centre of Pathology and University of Latvia. Interested in gastrointestinal pathology, renal pathology and neuropathology. Participated in different local and international scientific conferences. Viktorija Kregere, MD. graduated from Faculty of Medicine, University of Latvia in 2017. Currently she is a 4 year resident at Riga East University Hospital, Centre of Pathology and University of Latvia. Interested in bone and soft tissue, prostate pathology and molecular pathology. Participated in different local and international scientific conferences. Selga Savcenko, MD graduated from Faculty of Medicine, University of Latvia in 2017. She was a founder of student scientific pathology group at Faculty of Medicine, University of Latvia and its chair till 2017. Currently she is a 4 year resident at Riga East University Hospital, Centre of Pathology and University of Latvia. Interested in gynecological, gastrointestinal, breast and molecular pathology. Participated in different local and international scientific conferences. She published two PubMed peer reviewed publications in journals Virchows Archiv and Diagnostics.
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