Small Intestinal Neuroendocrine Tumour Incidentally Diagnosed Along with Large Mesenteric Lymph Node Metastasis: A Case Report

Small intestinal neuroendocrine tumours (NETs) are rare malignancies that occur in the small intestine. The incidence of small intestinal NETs has increased substantially in recent decades. Similar to that of general NETs, the diagnosis rate of small intestinal NETs is increasing continuously. Small intestinal NETs often metastasize to the lymph nodes, even when the lesions are small. Surgical resection of the primary tumour and associated mesenteric lymph nodes is recommended. We present a case of a NET in the ileum that was incidentally diagnosed along with large mesenteric lymph node metastasis. Abdominal computed tomography for examination of urinary frequency revealed an intra-abdominal mass, measuring 80 mm in diameter. The patient was intraoperatively diagnosed with an ileocaecal mesenteric mass, and ileocaecal resection with lymph node dissection was performed. The resected specimen incidentally showed a NET measuring 14 mm in diameter in the ileum, located 90 cm from the ileocaecal valve. The ileocaecal mesenteric mass was histopathologically diagnosed as lymph node metastasis of the NET. This case confirms the importance of making an immediate intraoperative pathological diagnosis and performing a thorough examination of small intestinal lesions when a large mesenteric tumour is suspected

Efficacy and safety of lenvatinib–transcatheter arterial chemoembolisation sequential therapy followed by surgical resection for intermediate-stage hepatocellular carcinoma beyond Up-to-7 criteria: a study protocol for a multicentre, single-arm, prospective study

Introduction The feasibility and efficacy of surgical resection following systemic therapy for intermediate-stage hepatocellular carcinoma (HCC) beyond the Up-to-7 criteria is unclear. The combination of lenvatinib (LEN) and transcatheter arterial chemoembolisation (TACE), termed LEN–TACE sequential therapy, has shown a high response rate and survival benefit in patients with intermediate-stage HCC. This trial aims to evaluate the efficacy and safety of LEN–TACE sequential therapy and the feasibility of surgical resection for intermediate-stage HCC beyond the Up-to-7 criteria.Methods and analysis This is a multicentre, single-arm, prospective clinical trial. Thirty patients with intermediate-stage HCC beyond the Up-to-7 criteria will be enrolled. Patients eligible for this study will undergo LEN–TACE sequential therapy in which LEN is administered for 4 weeks, followed by TACE, and then further LEN for another 4 weeks. Patients will be assessed for efficacy of LEN–TACE sequential therapy and resectability, and surgical resection will be performed if the HCC is considered radically resectable. The primary outcome of this study is the resection rate after LEN–TACE sequential therapy. The secondary outcomes are the objective response rate of LEN–TACE sequential therapy, safety, curative resection rate, overall survival and recurrence-free survival.Ethics and dissemination This trial was approved by the Institutional Review Board of Hiroshima University, Japan (approval no. CRB210003), and has been registered with the Japan Registry of Clinical Trials (jRCTs061220007). The results of this study will be submitted for publication in a peer-reviewed journal and shared with the scientific community at international conferences.Trial registration number jRCTs061220007 (https://jrct.niph.go.jp/latest-detail/jRCTs061220007)