Dear Friends,
I received a letter from a surgeon in China asking for help in
diagnosing and treating a rare case of "neuroendocrine cancer".
The following is what I received. Please reply to me through
e-mail, or contact Dr. Li Faying in China directly through either
fax (011-86-791-626-2262) or snail mail:
Dr. Li Faying
Dept. of Surgery
The second Hospital
Jiangxi Medical School
Nanchang, P.R. China 330006
Thank you.
Rong
——————————————————————
Dear Friends,
I am sending out this letter to ask you for help in diagnosing
and treating a case we have not seen before. The patient happens
to be a Professor of Orthopedics of the same hospital. The following
is a summary of his medical record.
The patient is Zou Ziyun, male, 58 yr old. He was admitted because
of frequent micturition and dysuria for three years. No history of
hematuria.
Physical Exam: The prostate was found to be twice as big as normal by
digital exam via rectum. The surface of the prostate was smooth. In
additional, a mass of about 1.5 cm in diameter was found in the rectal
wall at 11-2 o’clock position at 5 cm depth from anus, with the patient
in the knee-chest posture. The mucosa covering the mass appeared normal.
Blood: ESR 50 mm/h.
The rectal mass was removed per anus under caudal anesthesia on Oct. 5,
1995. The mass was not found to be related to the prostate.
Immunohistochemistry of the removed mass showed CEA, Glu ChG-A,
and VIP positive cells. Stains for NSE, PSA, PIAP, serotomic, PP, or
Soma were negative. It was concluded that it was neuroendocrine
carcinoma. The majority of cancer cells secreted glucagon, some
secreted VIP or neutral mucus. Surrounding tissues were found to be
infiltrated by the cancer, including submucosa, smooth muscle, and
connective tissues.
On Oct, 14, 1995, a exploratory laparotomy was performed. Although
there was no sign of distant metastasis, the prostate, seminal vesicle
and
the neck of the bladder was found to be invaded the cancer. In addition,
several enlarged lymph nodes were found in the pelvic cavity. No mass
was found in the rectum. The prostate, testicles, and lymph nodes in
the
pelvic cavity were then all removed.
The cancer cells found in the prostate, bladder, and lymph nodes from the
pelvic cavity were similar to the cells in the rectal mass.
Your help in diagnosing and treating this case is greatly appreciated.
Sincerely,
Li Faying, M.D.
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