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A complex case of rectal neuroendocrine carcinoma with terminal delirium

Abstract

Background A 62-year-old white male presented to our department in December 2004 with a 1-month history of intermittent, voluminous bleedings per rectum. His medical history was unremarkable apart from a single, short-lasting syncope shortly before the first bleeding episode.

Investigations Physical examination, colonoscopy, rectal tumor biopsy and immunohistochemistry, pelvic MRI, abdominal and chest CT scans, ultrasound-directed puncture cytology, octreotide scintigraphy, biochemical analysis of tumor markers, and conventional laboratory tests.

Diagnosis Locally advanced rectal neuroendocrine carcinoma with liver metastases.

Management Chemotherapy, CT-planned radiotherapy, antihypercalcemic therapy, terminal supportive care.

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Figure 1: Biopsies obtained from the rectal tumor of a 62-year-old white male at the time of diagnosis.
Figure 2: Pelvic MRI scans of a 62-year-old white male with rectal neuroendocrine carcinoma, taken at the time of diagnosis.
Figure 3: Abdominal CT scans of a 62-year-old white male with rectal neuroendocrine carcinoma.
Figure 4: 111In–DTPA-octreotide scintigraphy scans by single-photon-emission CT of a 62-year-old white male at the time of diagnosis of a rectal neuroendocrine carcinoma.
Figure 5: Pelvic, digitally reconstructed images with target volume definitions for radiotherapy of a 62-year-old white male with rectal neuroendocrine carcinoma.

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Acknowledgements

The author thanks Drs K Kotanska-Grøholt, K Knutstad, TV Bogsrud, JP Berg, and T Skaali for their assistance with the histologic, radiologic, radionuclear, biochemical, and psychiatric diagnostics, respectively, and particularly Dr TT Steen for his collaboration in treating this patient.

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Correspondence to Anne Hansen Ree.

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The author declares no competing financial interests.

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Ree, A. A complex case of rectal neuroendocrine carcinoma with terminal delirium. Nat Rev Gastroenterol Hepatol 3, 408–413 (2006). https://doi.org/10.1038/ncpgasthep0525

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  • DOI: https://doi.org/10.1038/ncpgasthep0525

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