Ovarian metastasis from neuroendocrine tumor presenting as hot flashes: A case report and literature review

Abstract

Neuroendocrine metastases to the ovaries are extremely rare, with approximately 100 cases reported in the English literature. The most frequent primary source is a small bowel neuroendocrine tumor (NET), particularly of ileal origin, and patients often present with widespread metastases and carcinoid syndrome. We report the case of a 46-year-old North African woman who presented with hot flashes, motility diarrhea, and a cutaneous rash of the neckline persisting for 3 months, initially misattributed to perimenopause. Imaging revealed bilateral ovarian masses classified as ORADS 4. Surgical exploration found bilateral adnexal tumors and multiple peritoneal nodules; a total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and nodule resection were performed. Histology revealed bilateral ovarian involvement by a well-differentiated NET, also affecting peritoneal nodules. The primary origin was unclear, prompting comprehensive staging, including an octreoscan, computed tomography scan, and enteric magnetic resonance imaging, which revealed retractile mesenteritis and a 4-cm mass involving the cecum and terminal ileum, along with mesenteric lymphadenopathy. A right hemicolectomy with resection of 1 m of small bowel and mesenteric nodes confirmed a well-differentiated NET of the cecum and ileum with negative surgical margins. The patient was started on long-acting repeatable octreotide. This case underlines the importance of considering a neuroendocrine origin in perimenopausal women presenting with symptoms suggestive of carcinoid syndrome, as these may be mistaken for menopausal changes.