Neuroendocrine Tumor Case Study

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INTRODUCTION
Neuroendocrine tumors (NETs) encompass diverse types of tumors arising from neuroendocrine (enterochromaffin) cells found throughout the body. While NETs often have a relatively indolent course, there is a propensity for metastasis to the liver producing the classic carcinoid syndrome of diarrhea and flushing. Metastasis to other sites such as the peritoneum and mesentery is also common {Woodside 2004; Akerstrom 2005} however primary mesenteric NET is rare. We present a 64 year-old man with mesenteric NET without any other primary site.

CASE PRESENTATION
A 64 year-old man with a past medical history of mechanical aortic valve replacement on Coumadin, coronary artery disease with a history of coronary artery bypass graft, permanent
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Broadly, NETs are classified based on tumor differentiation into well differentiated (low and intermediate grade) and poorly differentiated (high grade) NET. Grading addresses aggressiveness of the tumor with Grade 1, 2 and 3 representing low, intermediate and poorly differentiated tumors respectively {Rindi 2007}. Well differentiated NETs are generally rare {Klimstra 2010}. Carcinoid tumors are well differentiated NETs arising from the digestive tract, commonly the small intestine {Modlin 2003}. Other carcinoid tumor origins include the lungs, thymus, ovaries and kidneys.
Primary mesenteric carcinoid tumors are extremely rare {Karahan 2006}. Park et al. reported a case of a solitary 8 cm mesenteric carcinoid tumor in a 73 year-old woman after a meticulous search for tumors at other sites {Park 2013}. Yamanuha reported mesenteric tumor in a 52 year old with a partially calcified lobulated mass in the mesentery with smaller nodes in adjacent mesentery also without tumor activity elsewhere after imaging, colonoscopy and direct visualization at surgery {Yamanuha 2009}. Karahan et al. also reported a 2 cm primary mesenteric tumor with an area of calcification {Karahan

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