From pulmonary embolism to small intestinal neuroendocrine tumor - A new diagnostic perspective

Sep 23, 2026

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Pulmonary embolism is a common, potentially life-threatening acute condition in clinical practice. Neuroendocrine tumors (NETs) are heterogeneous neoplasms, and poorly differentiated or advanced NETs may increase the risk of venous thromboembolism. A 60-year-old woman developed acute chest discomfort and was diagnosed with pulmonary embolism; no lower-limb thrombosis or other identifiable causes were found. After anticoagulation, she later developed abdominal pain; colonoscopy and immunohistochemistry confirmed a grade-1 ileal NET with liver metastases on 18F-octreotide PET/CT.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Introduction

Case presentation

Initial presentation: PE

From pulmonary embolism to small intestinal neuroendocrine tumor: A new diagnostic perspective Journal of International Medical Research 2026, Vol. 54(7) 1–7 © The Author(s) 2026 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/03000605261465290](DOI: 10.1177/03000605261465290)[ ](DOI: 10.1177/03000605261465290)[journals.sagepub.com/home/imr](journals.sagepub.com/home/imr) Zhenping Wu 1, Hongwei Huang2, Angcheng Li3, Xiaojuan Zheng 1, Zhuoqun Zheng 1, Xianhui He4 and Ting Jin 1 Abstract Pulmonary embolism is a common and potentially life-threatening acute condition encountered in clinical practice. Neuroendocrine tumors are heterogeneous neoplasms characterized by diverse biological behaviors, and patients with poorly differentiated or advanced neuroendocrine tumors may have an increased risk of developing venous thromboembolism. We report the case of a 60-year-old female who experienced acute chest discomfort and was diagnosed with pulmonary embolism. Comprehensive evaluation revealed no evidence of lower limb thrombosis, autoimmune or hematologic disorders, or other identiﬁable causes. The emboli resolved following anticoagulant therapy. Seventeen months later, the patient developed upper abdominal pain and underwent a colonoscopy, which revealed alesion approximately 20 cm proximal to the terminal ileum. Histopathological and immunohistochemical analyses conﬁrmed a grade-1 neuroendocrine tumor. 18F-octreotide positron emission tomography–computed tomography demonstrated increased tracer uptake in the terminal ileum and multiple hepatic foci, consistent with an ileal neuroendocrine tumor with liver metastases. The patient received intramuscular octreotide acetate microspheres (20 mg every 4 weeks) and remained clinically stable during follow-up. This case underscores the importance of considering occult malignancy in older patients presenting with unprovoked pulmonary embolism. Small intestinal neuroendocrine tumors may remain clinically silent for extended periods and should be included in the differential diagnosis when common etiologies have been excluded. Keywords Pulmonary embolism, neuroendocrine tumor, ileum, venous thromboembolism, case report Received: 27 January 2026; revised: 2 June 2026; accepted: 8 June 2026 Introduction Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent complication in malignancies, particularly those of the gastroenteropancreatic (GEP) system. Neuroendocrine tumors (NETs) show a comparable thrombotic risk, with reported VTE incidences ranging from 7 .5% to 33% .1 The risk appears to 1 Department of Gastroenterology, Afﬁliated Jinhua Hospital, Zhejiang University School of Medicine, China 2Department of Medical Imaging, Afﬁliated Jinhua Hospital, Zhejiang University School of Medicine, China 3Department of Pathology, Afﬁliated Jinhua Hospital, Zhejiang University School of Medicine, China 4Department of Radiology, Anting Hospital, China Corresponding authors: Ting Jin, Department of Gastroenterology, Afﬁliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321001, China. Email: [784343509@qq.com](784343509@qq.com) Xianhui He, Department of Radiology, Anting Hospital, Jiading District, Shanghai 201805, China. Email: [hxhwt9999@163.com](hxhwt9999@163.com) Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as speciﬁed on the SAGE and Open Access page ([https://us](https://us). [sagepub.com/en-us/nam/open-access-at-sage](sagepub.com/en-us/nam/open

FAQs

Why was small intestinal neuroendocrine tumor considered after the pulmonary embolism?

The case showed an unprovoked pulmonary embolism with no evidence of common causes, and later imaging and pathology identified an ileal neuroendocrine tumor with liver metastases.

What diagnostic tests confirmed the neuroendocrine tumor?

Colonoscopy identified a lesion, histopathology and immunohistochemistry confirmed a grade-1 neuroendocrine tumor, and 18F-octreotide PET/CT demonstrated terminal ileum uptake with multiple hepatic foci.

How was the patient treated and what was the clinical course?

The patient received anticoagulant therapy for pulmonary embolism, followed by intramuscular octreotide acetate microspheres (20 mg every 4 weeks). Follow-up showed clinical stability after treatment.

Sep 23, 2026

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