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Abstract Disclosure: K. Saleh Anaraki: None. H. Tsou: None. E. Ahmed: None. T.N. Birhane: None. X. Wang: None. Neuroendocrine neoplasms (NEN) is an umbrella term characterizing cancers of both neural and endocrine cells. In addition, depending on the speed of proliferation; Ki-67 levels, they are then classed as either low grade; neuroendocrine tumor (NET), or high grade; neuroendocrine carcinoma (NEC). With more than 12,000 new occurrences detected in the United States year, Neuroendocrine tumors make up approximately 0.5% of all newly diagnosed malignancies with approximately 175,000 people concurrently with this condition hinting at an increase in both prevalence, incidence, but most importantly, survival outcomes. Here we present a case of a well differentiated NET in a 59 year old female with an PMH of HTN, HLD, Osteoarthritis, vitamin D deficiency, who presented to the ED with left sided atypical chest pain lasting for 20 hours. She reports a 5/10 dull to sharp chest pain lasting 5 to 10 seconds localizing to the sternal area with no radiation and episodes of complete pain resolution. She also reports no aggravating or relieving factors or other accompanying symptoms. Workup for cardiac causes was negative but a CT scan to rule out PE revealed incidental findings of liver masses and spine lesions suggestive of metastasis. Liver core biopsy discovered a low grade metastatic well differentiated neuroendocrine tumor with immunohistochemical staining favoring colorectal as the primary origin. In addition, tumor cells were positive for chromogranin, synaptophysin, AE1/AE3 and CDX2, with Ki-67 showing a low proliferative index. CEA and AFP were negative. FDG-PET showed multiple hypodense lesions throughout the liver in both lobes, with a few hypermetabolic soft tissue masses in the root of the mesentery which was consistent with the suggestive finding of metastatic disease. NETs from either the gastroenteropancreatic or respiratory structures account for approximately 65% and 25% of total NETs respectively and are usually the most common sites of origin. It is also important to note the differing incidences of origins among different races as well; such as caucasian patients having more midgut NETs, whereas rectal NETs occur more commonly in other races. It is also important to distinguish that most NENs are NETs which have a slower progression rate, whereas NECs; which have a rapid disease progression, make up approximately 15% of all cases. With most neuroendocrine tumors being asymptomatic, it is often hard to come to a clinical diagnosis at time of presentation due to the various hormone secretions that these tumors produce which can result in unique clinical syndromes. Therefore it is important for clinicians to be aware of the diverse manifestations of this disease as the key step to the management of these rare tumors as well as safeguarding patients who may have a more sinister pathology. Presentation: 6/2/2024
Anaraki et al. (Tue,) studied this question.