Primary Presacral Neuroendocrine Tumors Presented by Lumbosacral Pain: a Case Report

Primary presacral neuroendocrine tumors (NETs) are exceedingly rare and often present with extensive metastases, posing significant challenges for clinical management. We report a case of a presacral neuroendocrine tumor in a 68-year-old male who presented with lumbosacral pain. Enhanced MRI revealed a soft tissue mass at the sacrococcygeal region, while whole-body enhanced 18F-PET/CT identified small intratumoral vessels and involvement of the adjacent rectal posterior wall, mesorectal fascia, presacral fascia, and sacrococcygeal bones, accompanied by multiple lymph node metastases and widespread metastases to the lungs, liver, and bones. A CT-guided biopsy confirmed the diagnosis of a grade 2 (G2) neuroendocrine tumor. Given the tumor's extensive metastasis and aggressive nature, surgical intervention was deemed unsuitable, and the patient was treated with sulfatinib. Sulfatinib shows significant potential in managing advanced neuroendocrine tumors, providing an effective therapeutic option for patients with such complex and high-risk conditions.