A complex case of rectal neuroendocrine carcinoma with terminal delirium.

BACKGROUND: A 62-year-old white male presented to our department in December 2004 with a 1-month history of intermittent, voluminous bleedings per rectum. His medical history was unremarkable apart from a single, short-lasting syncope shortly before the first bleeding episode. INVESTIGATIONS: Physical examination, colonoscopy, rectal tumor biopsy and immunohistochemistry, pelvic MRI, abdominal and chest CT scans, ultrasound-directed puncture cytology, octreotide scintigraphy, biochemical analysis of tumor markers, and conventional laboratory tests. DIAGNOSIS: Locally advanced rectal neuroendocrine carcinoma with liver metastases. MANAGEMENT: Chemotherapy, CT-planned radiotherapy, antihypercalcemic therapy, terminal supportive care.