Introduction/Background GI neuroendocrine tumors (NETs) are rare neoplasms and are most frequently encountered in the pancreas. Only 3% of these neoplasms are found in the small intestine (SI). We present a case of synchronous SI NET and an ovarian cystadenofibroma.

Methodology A 63-year-old woman was referred to our department for a multilocular cystic tumor, with solid components and a diameter of 22 cm, in the left ovary, as shown on abdominal CT. The patient’s CA125 was normal, whereas the CA19–9 was elevated to 213 U/ml. Upper and lower GI endoscopies reported no findings. The patient underwent exploratory laparotomy with the following findings: a cystic tumor with solid elements of the left ovary (> 20 cm) and two masses on the mesenterium and the ileum, 4cm and 1cm respectively. Initially, the patient underwent a left salpingo-oophorectomy, and the result of frozen section was negative for malignancy. Hysterectomy with right salpingo-oophorectomy was then performed. Enterectomy of the ileum with synchronous removal of mesenterial mass and lymph node dissection were conducted.

Results Histology report of the ovarian tumor revealed a mucinous cystadenofibroma with local atypia (<10%). The histological examination of the ileum lesion showed a well-differentiated G1 NET (Ki67 <2%) with positive expression of chromogranin and synaptophysin. Multidisciplinary team decided that adjuvant therapy with octreotide lar was necessary. 68GA-Dodatate PET demonstrated a lesion in the pelvis (SUVmax 5.73). NSE, chromogranin A and 5-HIAA were normal. The final decision of MDT was patient’s reference to an epicenter of NET medical management.

Conclusion Surgery with lymph node dissection is the gold standard for SI NETs. Mesenteric lymph node metastases are present in more than 80% of patients at diagnosis, regardless of the size of the primary tumor. We bring into attention the possible incidental finding of NET tumors during exploratory laparotomy for gynecological conditions.

Disclosures All authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this case report.