Rectal neuroendocrine tumor developing lateral lymph node metastasis after curative resection: a case report

Area of Science:

• Gastroenterology
• Surgical Oncology
• Oncology

Background:

• Rectal neuroendocrine tumors (NETs) represent a significant portion of gastrointestinal NETs.
• While lateral lymph node metastasis can occur, recurrence is infrequent, particularly after curative resection.
• This report details an exceptionally rare instance of lateral lymph node recurrence in a patient with a previously resected rectal NET.

Observation:

• A 55-year-old male presented with symptoms of a rectal mass, diagnosed as a Grade 2, T1b, N0 rectal NET.
• The patient underwent successful laparoscopic intersphincteric resection and D2 lymph node dissection.
• At 54 months post-surgery, recurrence was detected in a left lateral lymph node, confirmed pathologically after dissection.

Findings:

• The patient had a Stage I rectal NET with no initial lymphovascular invasion or metastasis.
• Despite curative intent surgery, lateral lymph node metastasis recurred 54 months post-operation.
• This represents a unique case, as no prior English reports document lateral lymph node recurrence in such a specific rectal NET profile.

Implications:

• Lateral lymph node metastasis is associated with poorer survival outcomes in rectal cancer.
• Complete surgical resection of recurrent lateral lymph node metastasis may offer a viable treatment strategy.
• This case underscores the need for vigilance and potential surgical intervention for rare recurrences in rectal NET management.