Neuroendocrine Tumor of Unknown Origin Leading to the Diagnosis of Advanced Celiac Disease: A Case Report Exploring a Possible Association.

Authors

Hussam Almasri, Maram Albandak, Shahem Abbarh, Adnan Humam Hajjar, Ashraf I Ahmed, Abdelrahman A Karen, Yusuf Hallak, Bisher Sawaf, Mohammed Elbadri

Published in

Case reports in gastroenterology. Volume 20. Issue 1. Pages 304-310. Epub Jul 10, 2026.

Abstract

Celiac disease (CD), if left untreated, can predispose a wide range of intestinal malignancies including enteric lymphoma and adenocarcinoma. On rare occasions, intestinal neuroendocrine tumors (NETs) were reported. We present a case of metastatic NET that led to the diagnosis of CD.
A 58-year-old woman presented with a lump in the left axilla without fever or weight loss. Physical examination showed a single tender and rubbery lymph node (LN) of 2.5 cm in size in the left axilla. Laboratories showed mild iron-deficiency anemia. An excisional LN biopsy showed well-differentiated NET, grade 3. A gallium Ga-68 DOTATATE-integrated positron emission tomography (PET)-computed tomography scan showed nonspecific homogenous duodenal and small bowel uptake without apparent signs of fluorodeoxyglucose (FDG)-avid malignancy. Upper endoscopy with push enteroscopy with small bowel biopsies were consistent with CD. The serum tissue transglutaminase-immunoglobulin test was positive. The patient was started on a gluten-free diet and managed with clinical observation. A follow-up FDG-PET scan after 6 months showed no abnormal uptake, and the patient continued to be asymptomatic beyond 1 year of follow-up.
This case highlights the possible rare coexistence of CD with an atypical neoplastic process, particularly in patients presenting with unexplained iron-deficiency anemia. While CD is associated with an increased risk of certain rare gastrointestinal malignancies, its relationship with NETs remains poorly defined. Larger studies are needed to further explore any potential association between CD and NETs.

PMID:
42603073
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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