SHM Converge Scientific Abstract ePoster Gallery-The Meticulous Scope: A Rare Case of Duodenal Neuroendocrine Tumor

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This case describes a 73-year-old man with multiple chronic illnesses, including hypertension, atrial fibrillation, coronary artery disease, heart failure, end-stage renal disease on hemodialysis, and hypothyroidism, who presented with three weeks of persistent nausea, vomiting, and inability to tolerate food. He had no abdominal pain, diarrhea, fevers, or chills, and dialysis did not improve his symptoms. Initial labs showed mild hyponatremia, hyperkalemia, and chronic anemia, while imaging was largely unrevealing aside from cholelithiasis without cholecystitis.<br /><br />Because his symptoms were intractable, he underwent esophagogastroduodenoscopy (EGD), which showed non-erosive gastritis, a medium hiatal hernia, and a non-obstructing nodule in the duodenal bulb. Biopsy of the duodenal lesion revealed tumor cells positive for synaptophysin and chromogranin, consistent with a well-differentiated duodenal neuroendocrine tumor (DNET). Serum gastrin was normal, while chromogranin A was markedly elevated. CT imaging of the chest, abdomen, and pelvis showed no metastatic disease.<br /><br />The report highlights that DNETs are rare gastrointestinal tumors, representing only a small fraction of GI neuroendocrine tumors. Most are non-functional, though they can occasionally produce hormonal syndromes. Common presentations include abdominal pain, GI bleeding, jaundice, vomiting, and diarrhea. Diagnostic evaluation may include EUS with cytology, CT, and somatostatin receptor imaging. Treatment depends on tumor size, location, differentiation, and stage, and often involves resection with surveillance.<br /><br />The key teaching point is that DNET should remain in the differential diagnosis for patients with unexplained or refractory nausea and vomiting, even when other findings such as gastritis seem sufficient to explain symptoms. Careful, complete endoscopic evaluation can uncover additional clinically important pathology.

Asset Subtitle

Benjamin Ascherman

Meta Tag

Author List Benjamin Ascherman, Victoria Garland, Yingheng Liu

Category Clinical Vignettes

Concept Duodenal Neuroendocrine Tumor

Concept Nonspecific Gastrointestinal Symptoms

Concept Intractable Nausea

Concept Vomiting

Concept Diagnostic Workup

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Benjamin Ascherman

Track Adult

Keywords

duodenal neuroendocrine tumor

refractory nausea

vomiting

esophagogastroduodenoscopy

chromogranin A

synaptophysin

chromogranin

gastritis

duodenal bulb nodule

hemodialysis

Duodenal Neuroendocrine Tumor

Nonspecific Gastrointestinal Symptoms

Intractable Nausea

Vomiting

Diagnostic Workup