Watch-an-wait strategy for multiple rectal neuroendocrine tumors with widespread invasion

A 57-year-old man with a history of surgical resection for subocclusive small bowel Crohn’s disease, was referred for endoscopic follow-up. Rectal neuroendocrine tumor(rNETs) was found during screening colonoscopy in the form of a centimetric polyp. A post-polypectomy endoscopy was reassuring while random biopsies performed showed low grade multiple rNETs diffusely infiltrating the mucosa and submucosa. Both abdominal-pelvic computed tomography (CT) and endoscopic ultrasonography echoendoscopy (EUS) did not identify any lymph node or distant lesion. Watch-and-wait strategy was performed by regular colonoscopy and EUS. As far as we know, this case is the unique case reported of non-progressive diffuse multiple rectal neuroendocrine tumors after a very long-term follow-up of 20 years. This case further supports that “Watch and wait” could be a safe alternative management strategy for selected rNETs, specially in patients for whom the surgical risk is increased with a potentially significant impact on the quality of life.

Keywords: Neuroendocrine neoplasm, staging, neuroendocrine carcinoma, endocrine cell micronests.