Introduction/Background NETs are rare tumours most commonly occurring in the pancreas, and represent about 2% of female genital cancers. The cervix and ovaries are the most common locations. They can vary in their behaviour though many require surgery/chemotherapy. Encountering 4 cases in a year is unusual and we present them here:

Methodology Case series of 4 cases over one year.

Results Our 4 cases, presented as suspected ovarian cancer. Ages raged from 55–71. In two cases, the primary was in the appendix or in small bowel. Our 3rd case, presented as stage IIIc extensive peritoneal disease and diagnosed as metastatic well differentiated G3 NET Ki 67 index of 25%, which was inoperable. Our 4th case, was a well differentiated G1 NET (carcinoid) arising within a mature teratoma, with Ki 67 proliferation index < 1%. All tumours stained positively for chromogranin, synaptophysin, CDX2, CK 8/18, and negatively for CK 20, CK7.

Treatment strategies varied 1st case metastasizing from small bowel ( G2 well differentiated NET, KI 67 9% ) had debulking surgery and bowel resection-with residual retroperitoneal and mesenteric nodes - followed by somatostatin analogue injections. Her last follow up (1y ) gallium scan showed overall stable disease. 2nd case metastasizing from appendix had debulking surgery, followed by lung lobectomy for carcinoid tumor and awaiting further plan. Our 3rd case ( inoperable ) had chemotherapy in form of capecitabine and temozolomide for 6 cycles. Her scan ( 9months ) showed good treatment response. 4th case, had BSO and recommended for interval scans.

Follow up period was short (1m-1y), but all cases are still alive.

Conclusion NET though rare can present in many ways. There is no specific optiumum therapy due to the paucity of case. In Oxford the approach varied and management was joint with NET specialized team.

Disclosures no conflict of interest/no funding