International journal of surgery case reports · 2025
Neuroendocrine tumor of the duodenojejunal flexure: Role of 68Ga-DOTA-NOC PET-CT and oncologic implications of nodal metastasis-A case report.
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Kumar Supreet, Bhalerao Aishwarya, Sobti Parul, Gupta Sonam, Tandon Vivek, Govil Deepak
Аннотация
INTRODUCTION AND IMPORTANCE: Neuroendocrine tumors (NETs) of the duodenojejunal (D-J) flexure are exceptionally rare and diagnostically challenging due to their anatomical obscurity and non-functional presentation. This report highlights the diagnostic value of 68Ga-DOTA-NOC PET-CT in accurately localizing a non-functional, low-grade NET at the D-J flexure, which was undetected by conventional modalities.
CASE PRESENTATION: A 52-year-old woman was referred after incidental detection of a proximal jejunal mass on CT urography during evaluation for recurrent urinary tract infections. Endoscopy and enteroscopy failed to visualize the lesion. 18F-FDG PET-CT showed no significant uptake, but 68Ga-DOTA-NOC PET-CT revealed intense somatostatin receptor avidity (SUVmax 147) at the D-J flexure. Surgical exploration confirmed a 2.3 cm G2 NET with 1 of 36 lymph nodes positive for metastasis. The patient recovered uneventfully and is under surveillance.
CLINICAL DISCUSSION: This case underscores the diagnostic blind spot posed by the D-J flexure and the limitations of standard imaging and endoscopy. Despite being small and low-grade, the tumor exhibited nodal spread, reinforcing the need for comprehensive oncologic resection. 68Ga-DOTA-NOC PET-CT proved indispensable for localization and planning.
CONCLUSION: Even small, well-differentiated NETs in rare anatomical sites such as the D-J flexure can harbour nodal metastasis. High suspicion, functional imaging, and formal surgical resection with lymphadenectomy are key to optimal management.
CASE PRESENTATION: A 52-year-old woman was referred after incidental detection of a proximal jejunal mass on CT urography during evaluation for recurrent urinary tract infections. Endoscopy and enteroscopy failed to visualize the lesion. 18F-FDG PET-CT showed no significant uptake, but 68Ga-DOTA-NOC PET-CT revealed intense somatostatin receptor avidity (SUVmax 147) at the D-J flexure. Surgical exploration confirmed a 2.3 cm G2 NET with 1 of 36 lymph nodes positive for metastasis. The patient recovered uneventfully and is under surveillance.
CLINICAL DISCUSSION: This case underscores the diagnostic blind spot posed by the D-J flexure and the limitations of standard imaging and endoscopy. Despite being small and low-grade, the tumor exhibited nodal spread, reinforcing the need for comprehensive oncologic resection. 68Ga-DOTA-NOC PET-CT proved indispensable for localization and planning.
CONCLUSION: Even small, well-differentiated NETs in rare anatomical sites such as the D-J flexure can harbour nodal metastasis. High suspicion, functional imaging, and formal surgical resection with lymphadenectomy are key to optimal management.