HIGH GRADE NEUROENDOCRINE TUMOUR A CASE REPORT ANNA

HIGH GRADE NEUROENDOCRINE TUMOUR. A CASE REPORT ANNA KOUMARIANOU ATTIKON UNIVERSITY HOSPITAL ATHENS GREECE

• 25 years old male university student, never smoker, healthy life style, unremarkable personal and family history • 2 weeks earlier presented to his family doctor • • Acute onset Profound asthenia Diffuse abdominal pain, mainly right side On Clinical examination anemia and hepatomegaly

• Day 2 • FBC Hgb 9, WBC 21. 000, PLT 245. 000 • Biochemistry Cr. 2, K+6, SGOT 1291, SGPT 742, γGT 466, ALP 370, total Bil 3, direct bil 2 • Abdominal Ultrasound 99% Metastatic Liver disease, ascites

Day 4 • CT- guided liver biopsy • Histology: High Grade Neuroendocrine Neoplasm most probable GI origin • Ki 67 35%, grade 3 • Positive immunohistochemistry for chromogranuin, synaptophysin, CAM 5. 2, CD 56, CDX 2. • Negative calcitonin and TTF 1

Days 7 -12 • MRI abdomen: liver 25 cm diameter, diffusely infiltrated by tumour metastases, ascites • CT scan thorax: negative • 99 Tc-octreotide: intense uptake from the liver metastases, lower intensity in a region between liver and spleen • PET CT scan: hypermetabolic region in the small bowel (SUV 11. 2) and multiple liver secondaries (SUV 7) • NSE 210 (nv<16)

Day 14 • Patient in the Emergency Outpatient Department • Rapid Deterioration of his Mental State, confusion • Blood gases: p. H 7. 17, Lac 17. 2, K 8, HCO 3: 11 • Uric Acid 22, Cr 7, P 12, Ca 5, Na 110 • EF 55%, normal rhythm • Intensice Care Unit -Renal dialysis • Cardiac Arrest

Επιπλοκές συνδρόμου Annemans et al. Leyk. Lymphoma 2003