Case Study: What would you do? – Dr. Ravinder Singh
Original Case Query:
A 16 year old female with history of obesity presented with several day history of abdominal pain. CT showed acute appendicitis. She was taken to the OR and she had significant inflammation in the RLQ with sigmoid and ileum adhered to what was presumed to be the area of the appendix. She had a small abscess that was drained but further dissection was impossible. A JP drain was placed and she was kept on ABX. Folllow-up CT revealed a decrease in inflammation and no abscess; the drain was removed and she was booked for an interval appendectomy. Intra-operatively, she had less inflammation but had dense adhesions. The appendix was removed. Pathology revealed a T4N0 NET (NeuroEndocrine Tumour) at the tip 8mm in size. Of course she was M0 based on 2 CT scans. What would you do next?
1. PET scan
2. NET Metabolic work-up
3. Refer to Neuroendocrine Specialty Clinic
4. Right Hemicolectomy
Actual Case Outcome:
16 Female with T4N0M0 NET of the appendix. Post-operatively, the initial step taken was doing a Chromogranin A serology, and 5-HIAA. These were normal. Given the T4 nature of the NET, a PET scan was ordered after discussing the case at tumour board rounds. The PET was negative. An opinion from the NET Specialty Clinic advised nothing further needed to be done.
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