A Novel Approach for a Metastatic Gut-Derived Neuroendocrine Tumour: Simultaenous Intestinal and Vascularised Sentinel Forearm Flap Transplantation

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Introduction: Non-resectable tumours involving the mesenteric root are an indication for intestinal and multivisceral transplantation (MVT). Vascularised sentinel forearm flaps (VSFF) offer possibilities for monitoring graft rejection and tailoring immunosuppression (IS) regimens.

Aim(s): We present the first documented case of using MVT for a metastatic neuroendocrine tumour (NET) whilst implementing a VSFF.

Materials and methods: A 44year old male was diagnosed with a well-differentiated Grade 1 (Ki67 <1%) NET. Serum chromogranin A was 395pmol/L (reference range 0-60), chromogranin B was 349pmol/L (reference range 0-150), and 5-hydroxyindoleacetic acid in 24hr urine was 643μmol/L (reference range 0-40). 68Ga-DOTATATE PET/CT showed significant uptake in mesenteric tumour bulk and in an aorto-caval lymph node. At laparotomy, stage IV tumour bulk encasing the mesenteric root, numerous enlarged lymph nodes near the small bowel loops, and 7 sub-centimetre tumours scattered over the ileum were observed.

Conference: 12th Annual ENETSConcerence (2015)

Presenting Author: Frilling A

Authors: Clift A, Giele H, Vrakas G, Reddy S, Macedo R,

Keywords: neuroendocrine, tumor, transplantation,