Neuroendocrine Tumor of Unknown Origin Leading to the Diagnosis of Advanced Celiac Disease: A Case Report Exploring a Possible Association
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Abstract Introduction Celiac disease (CD), if left untreated, can predispose a wide range of intestinal malignancies including enteric lymphoma and adenocarcinoma. On rare occasions, intestinal neuroendocrine tumors (NETs) were reported. We present a case of metastatic NET that led to the diagnosis of CD. Case Presentation A 58-year-old woman presented with a lump in the left axilla without fever or weight loss. Physical examination showed a single tender and rubbery lymph node (LN) of 2.5 cm in size in the left axilla. Laboratories showed mild iron-deficiency anemia. An excisional LN biopsy showed well-differentiated NET, grade 3. A gallium Ga-68 DOTATATE-integrated positron emission tomography (PET)-computed tomography scan showed nonspecific homogenous duodenal and small bowel uptake without apparent signs of fluorodeoxyglucose (FDG)-avid malignancy. Upper endoscopy with push enteroscopy with small bowel biopsies were consistent with CD. The serum tissue transglutaminase-immunoglobulin test was positive. The patient was started on a gluten-free diet and managed with clinical observation. A follow-up FDG-PET scan after 6 months showed no abnormal uptake, and the patient continued to be asymptomatic beyond 1 year of follow-up. Conclusion This case highlights the possible rare coexistence of CD with an atypical neoplastic process, particularly in patients presenting with unexplained iron-deficiency anemia. While CD is associated with an increased risk of certain rare gastroin
Abstract
Abstract Introduction Celiac disease (CD), if left untreated, can predispose a wide range of intestinal malignancies including enteric lymphoma and adenocarcinoma. On rare occasions, intestinal neuroendocrine tumors (NETs) were reported. We present a case of metastatic NET that led to the diagnosis of CD. Case Presentation A 58-year-old woman presented with a lump in the left axilla without fever or weight loss. Physical examination showed a single tender and rubbery lymph node (LN) of 2.5 cm in size in the left axilla. Laboratories showed mild iron-deficiency anemia. An excisional LN biopsy showed well-differentiated NET, grade 3. A gallium Ga-68 DOTATATE-integrated positron emission tomography (PET)-computed tomography scan showed nonspecific homogenous duodenal and small bowel uptake without apparent signs of fluorodeoxyglucose (FDG)-avid malignancy. Upper endoscopy with push enteroscopy with small bowel biopsies were consistent with CD. The serum tissue transglutaminase-immunoglobulin test was positive. The patient was started on a gluten-free diet and managed with clinical observation. A follow-up FDG-PET scan after 6 months showed no abnormal uptake, and the patient continued to be asymptomatic beyond 1 year of follow-up. Conclusion This case highlights the possible rare coexistence of CD with an atypical neoplastic process, particularly in patients presenting with unexplained iron-deficiency anemia. While CD is associated with an increased risk of certain rare gastrointestinal malignancies, its relationship with NETs remains poorly defined. Larger studies are needed to further explore any potential association between CD and NETs.