Laparoscopic Resection of a Neuroendocrine Tumor Arising from the Mesentery—A Case Report—

Abstract

A 56-year-old woman presented to our hospital because of a pancreatic tumor detected by an abdominal ultrasonography at a health exam. The hypoechoic tumor was 17mm in size, and closely contacted to the pancreas and small intestine. On a contrast-enhanced CT scan, it was revealed as a hypervascular tumor adjacent to the bowel wall and pancreas parenchyma. Primary mesenteric tumor, especially, gastrointestinal stromal tumor or neuroendocrine tumor (NET) was suspected. Laparoscopic tumor resection was performed (the operative time was 174 min and the operative blood loss was 10mL).

At least in laparoscopic findings, the tumor was adjacent to the ligament of Treitz and had no anatomical continuity with the surrounding organs. The resected specimen showed the character of primary mesenteric NET. On immunostaining, tumor cells were positive for chromogranin A, synaptophysin, and CD56, and the MIB-1 index was 8.4%. These findings were compatible with NET G2.

Primary mesenteric NET is extremely rare. Several case reports are known and most of them were treated by open surgery. So far, there is no case of primary mesenteric NET resected by pure laparoscopic procedure. Considering the advantage of laparoscopic surgery, it might be a suitable way to treat.