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Dhaliwal AJS, Strosberg JR, Centeno BA, Vignesh S. Diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration for cystic and non-cystic pancreatic neuroendocrine tumors. Endosc Int Open 2019; 7:E854-E859. [PMID: 31286055 PMCID: PMC6611730 DOI: 10.1055/a-0915-9496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Pancreatic neuroendocrine tumors (P-NENs) are rare tumors with malignant potential. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been shown to be superior to other imaging methods in preoperative localization and diagnosis of P-NENs. The objective of this study was to describe the EUS features of non-metastatic cystic and non-cystic P-NENs seen at a referral center and to evaluate the performance of EUS-FNA in diagnosis of P-NENs. Patients and methods All patients with histologically confirmed, non-metastatic P-NENs, which underwent EUS-FNA prior to surgical resection at the Moffitt Cancer Center between Jan 2005 and Dec 2012 were included. Clinical, endoscopic and pathologic information was abstracted from electronic medical records. Results Thirty-nine patients, all with non-functional P-NENs, were included in this study. Thirteen tumors were cystic and 26 were solid. Among the cystic tumors, 50 % were partly cystic and partly solid, and 50 % were fully cystic. The cystic tumors were more commonly seen at the body/tail, and the solid tumors were more uniformly distributed. Fluid could be aspirated from 50 % of the cystic tumors, all with a carcinoembryonic antigen level < 192 ng/mL. With surgical pathology as the gold standard, overall sensitivity of EUS-FNA in diagnosing cystic tumors was 62.5 %, and for solid tumors, 95 % ( P < 0.03). Conclusions EUS-FNA is much more sensitive in diagnosing solid P-NENs than cystic PNETs. Our results indicate that EUS-FNA may have higher sensitivity for diagnosis of cystic P-NENs than the reported sensitivity of EUS-FNA for all pancreatic cystic tumors.
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Affiliation(s)
- Amaninder Jeet Singh Dhaliwal
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States,Corresponding author Amaninder Jeet Singh Dhaliwal MD Department of Gastroenterology and HepatologyUniversity of Nebraska Medical Center982000 Nebraska Medical CenterOmaha, NE 68198-2000+1-402-559-9004
| | - Jonathan R. Strosberg
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida College of Medicine, Tampa, Florida, United States
| | - Barbara A. Centeno
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida College of Medicine, Tampa, Florida, United States
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, SUNY Health Sciences Center at Brooklyn, Brooklyn, New York, United States
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Hurtado-Pardo L, A Cienfuegos J, Ruiz-Canela M, Panadero P, Benito A, Hernández Lizoain JL. Cystic pancreatic neuroendocrine tumors (cPNETs): a systematic review and meta-analysis of case series. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:778-787. [PMID: 29072081 DOI: 10.17235/reed.2017.5044/2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cystic pancreatic neuroendocrine tumors represent 13% of all neuroendocrine tumors. The aim of this study is to analyze the phenotype and biologic behavior of resected cystic neuroendocrine tumors. A systematic review and meta-analysis were conducted until September 2016 using a search in Medline, Scopus, and EMBASE with the terms "cystic pancreatic endocrine neoplasm", "cystic islets tumors" and "cystic islets neoplasms". From the 795 citations recovered 80 studies reporting on 431 patients were selected. 87.1% (n = 387) were sporadic tumors and 10.3% (n = 40) corresponded to multiple endocrine neoplasia endocrine type 1. Were diagnosed incidentally 44.6% (n = 135). Cytology was found to have a sensitivity of 78.5%. Were non-functional tumors 85% (n = 338), and among the functional tumors, insulinoma was the most frequent. According to the European Neuroendocrine Tumor Society staging, 87.8% were limited to the pancreas (I-IIb), and 12.2% were advanced (III-IV). Disease-free survival at 5 years in stages (I-IIIa) and (IIIb-IV) was 91.5% and 54.2%, respectively; and was significantly lower (p = 0.0001) in functional tumors. In patients with multiple endocrine neoplasia there was a higher incidence of functional (62.5%) and multifocal (28.1%) tumors. Disease-free survival at 5 and 10 years was 60%. Cystic pancreatic neuroendocrine tumors exhibit phenotypical characteristics which are different to those of solid neuroendocrine tumors.
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Affiliation(s)
| | | | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Healt, Medical School. University of Navarra, España
| | - Pablo Panadero
- Anatomía Patológica, Clínica Universidad de Navarra, España
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Pancreatic Cystic Lesions: Pathogenesis and Malignant Potential. Diseases 2018; 6:diseases6020050. [PMID: 29899320 PMCID: PMC6023528 DOI: 10.3390/diseases6020050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/17/2023] Open
Abstract
Pancreatic cancer remains one of the most lethal cancers despite extensive research. Further understanding of precursor lesions may enhance the ability to treat and prevent pancreatic cancer. Pancreatic cystic lesions (PCLs) with malignant potential include: mucinous PCLs (intraductal papillary mucinous neoplasms and mucinous cystic neoplasm), solid pseudopapillary tumors and cystic neuroendocrine tumors. This review summarizes the latest literature describing what is known about the pathogenesis and malignant potential of these PCLs, including unique epidemiological, radiological, histological, genetic and molecular characteristics.
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Kaosombatwattana U, Hirooka Y, Kawashima H, Ohno E, Ishikawa T, Suhara H, Goto H. Neuroendocrine neoplasm of pancreas with cystic degeneration mimicking mucinous cystic neoplasm. Clin J Gastroenterol 2018. [PMID: 29536430 DOI: 10.1007/s12328-018-0846-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Endoscopic ultrasound is increasingly being used for evaluation of pancreatic diseases and pancreatic tumors. Among various pancreatic cystic lesions, cystic degeneration of pancreatic neuroendocrine neoplasm is of the challenge in making diagnosis. Although unique characteristic of each type of pancreatic cystic lesions has been proposed abundantly, typical morphology of cystic degeneration of pancreatic neuroendocrine neoplasm is still unclear. We, herein, reported a case of 66-year-old woman who was incidentally found to have a cystic lesion in the tail of pancreas upon screening transabdominal ultrasonography. A well-defined cystic lesion with rim calcification was noted on subsequent abdominal computed tomography. Endoscopic ultrasound revealed a markedly thick-wall cystic lesion containing solid nodule inside which was not enhanced following contrast-enhanced study. A mucinous cystic neoplasm was suspected and the patient was proceeded with distal pancreatectomy. A definite diagnosis of neuroendocrine neoplasm was confirmed after staining with synaptophysin and chromogranin A. We performed a meticulous review on current literatures focusing on endoscopic characteristics of pancreatic neuroendocrine neoplasms with cystic degeneration.
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Affiliation(s)
- Uayporn Kaosombatwattana
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan.,Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroki Suhara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Yasumoto M, Okabe Y, Sugiyama G, Naito Y, Nakayama M, Hisaka T, Ishikawa H, Horiuchi H, Kunou Y, Ushijima T, Ishida Y, Tsuruta O, Torimura T. A case of pancreatic neuroendocrine tumor with multiple cystic components of various sizes. Clin J Gastroenterol 2017; 11:87-91. [PMID: 29270782 DOI: 10.1007/s12328-017-0798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
The patient was a 51-year-old woman who, while undergoing a thorough health checkup, was found to have a tumor (measuring 60 mm in diameter) in the tail of the pancreas by abdominal ultrasonography. Contrast-enhanced computed tomography revealed delayed contrast enhancement; the tumor also contained numerous low-absorption areas showing poor contrast enhancement. On magnetic resonance imaging, the tumor was visualized as having high signal intensity areas inside the tumor on T2-weighted images. Positron emission tomography revealed an abnormal accumulation in the area corresponding to the tumor. Endoscopic ultrasonography (EUS) revealed a relatively hyperechoic solid area, with a number of echo-free areas of various sizes that assumed a honeycomb appearance. EUS-guided fine needle aspiration was carried out targeting the solid area within the tumor, which led to a diagnosis of pancreatic neuroendocrine tumor (PNET). Histopathological examination of the resected specimen revealed that the tumor was composed of numerous cysts of various sizes and solid components. The cysts contained no evidence of necrosis or bleeding. Immunohistochemically, the cystic as well as solid components were CD56 (+), synaptophysin (+) and chromogranin A (+) with MIB1 labeling index of 5%. On the basis of these findings, the final diagnosis was PNET (G2).
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Affiliation(s)
- Makiko Yasumoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Gen Sugiyama
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshiki Naito
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masamichi Nakayama
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroto Ishikawa
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Horiuchi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yukiko Kunou
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoyuki Ushijima
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yusuke Ishida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Osamu Tsuruta
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Izumi H, Yazawa N, Furukawa D, Masuoka Y, Yamada M, Mashiko T, Kawashima Y, Ogawa M, Kawaguchi Y, Mine T, Hirabayashi K, Nakagohri T. Laparoscopic splenopancreatectomy for an endocrine tumor with cystic changes: a case report. Clin Case Rep 2017; 5:328-332. [PMID: 28265400 PMCID: PMC5331262 DOI: 10.1002/ccr3.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 11/19/2016] [Accepted: 01/09/2017] [Indexed: 11/25/2022] Open
Abstract
The biological behavior of a cystic pancreatic endocrine neoplasm is less aggressive than that of pancreatic neuroendocrine neoplasms, and its prognosis is better. Limited surgery should be considered for cystic pancreatic endocrine neoplasms that are not accompanied preoperatively by lymph node or distant metastasis.
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Affiliation(s)
- Hideki Izumi
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Naoki Yazawa
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Daisuke Furukawa
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Yoshihito Masuoka
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Misuzu Yamada
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Taro Mashiko
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Yohei Kawashima
- Department of Internal Medicine Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Masami Ogawa
- Department of Internal Medicine Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Yoshiaki Kawaguchi
- Department of Internal Medicine Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Tetsuya Mine
- Department of Internal Medicine Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Kenichi Hirabayashi
- Department of Pathology Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
| | - Toshio Nakagohri
- Department of Gastrointestinal Surgery Tokai University School of Medicine 143 Shimokasuya Isehara Kanagawa 259-1193 Japan
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Barnes J, Johnson SJ, French JJ. Correlation of Ki-67 indices from biopsy and resection specimens of neuroendocrine tumours. Ann R Coll Surg Engl 2017; 99:193-197. [PMID: 27490982 PMCID: PMC5450268 DOI: 10.1308/rcsann.2016.0225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Neuroendocrine tumours (NETs) are a heterogeneous group of tumours with a highly variable presentation and prognosis. Management decisions are complex. Ki-67 levels in tissue samples are a key indicator used to grade tumours and guide treatment. This study assessed whether the Ki-67 index and tumour grade generated from tissue samples correlated with that assessed in resection specimens. METHODS This was a retrospective cohort analysis of all patients who had both a tissue sample and a resection specimen analysed in our trust, a tertiary referral centre, during 2012 and 2013. RESULTS Data from 36 patients were reviewed. Ki-67 indices from tissue samples and resection specimens showed strong correlation (r=0.95, p<0.001). Tumour grading was the same in the tissue sample and resection specimens for 22 patients (61.1%). In four patients (11.1%), the tissue sample overestimated the grade while in ten (27.8%), the sample underestimated the grade. CONCLUSIONS In most cases, the Ki-67 index and tumour grade from the tissue sample matched that of the resection specimen. However, in nearly 40% of cases, the tissue sample grading did not match the resection tumour grading. In the majority of these, the tissue sample underestimated disease activity. A low Ki-67 index in a tissue sample should therefore be taken as provisional and should not, in isolation, persuade clinicians to choose a more conservative treatment approach if there is clinical, biochemical or radiological evidence suggestive of a more aggressive disease pathology.
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Affiliation(s)
- J Barnes
- Newcastle upon Tyne Hospitals NHS Foundation Trust , UK
| | - S J Johnson
- Newcastle upon Tyne Hospitals NHS Foundation Trust , UK
| | - J J French
- Newcastle upon Tyne Hospitals NHS Foundation Trust , UK
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Cystic neuroendocrine tumor in the pancreas detected by endoscopic ultrasound and fine-needle aspiration: a case report. BMC Res Notes 2014; 7:510. [PMID: 25106541 PMCID: PMC4127522 DOI: 10.1186/1756-0500-7-510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 08/01/2014] [Indexed: 01/27/2023] Open
Abstract
Background Pancreatic neuroendocrine tumors are typically solid neoplasms but in very rare cases present as cystic lesions. The diagnosis of cystic tumors in the pancreas is extremely difficult and the use of endoscopic ultrasound and fine-needle aspiration might be helpful in the work-up of patients with cystic neuroendocrine tumors in the pancreas. Case presentation A 78-year-old Caucasian man was admitted with a history of epigastric pain. Laboratory tests were normal. The patient underwent transabdominal ultrasound, computed tomography and magnetic resonance cholangiopancreatography demonstrating an unclear cystic mass in the head of the pancreas. The patient was referred for endoscopic ultrasound. Endoscopic ultrasound showed a hypoechoic lesion (42 × 47 mm) in the head of the pancreas with regular borders and large cystic components. The main pancreatic duct was normal without any connection to the cystic process. The lesion underwent fine-needle aspiration (22 Gauge). Cytological examination demonstrated cohesive groups of plasmacytoid cells staining positively for synaptophysin and chromogranin A, which is suggestive of a neuroendocrine tumor. Conclusions Differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology, such as computed tomography and magnetic resonance imaging. This unusual case with a pancreatic cystic neuroendocrine tumor highlights the clinical importance of endoscopic ultrasound in the work-up of patients with unclear lesions in the pancreas.
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Colaiacovo R, de Castro ACF, Ganc RL, Shiang C, Filippi RZ, Ferrari Junior AP. Cystic carcinoid tumor of the pancreas diagnosed by endoscopic ultrasound-guided fine needle aspiration of the cystic wall: an unusual presentation and diagnosis. ACTA ACUST UNITED AC 2014; 12:254-5. [PMID: 25003937 PMCID: PMC4891174 DOI: 10.1590/s1679-45082014ai2516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/01/2013] [Indexed: 01/04/2023]
Affiliation(s)
- Rogério Colaiacovo
- Department of Endoscopy, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Ricardo Leite Ganc
- Department of Endoscopy, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Christina Shiang
- Department of Endoscopy, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Renée Zon Filippi
- Department of Endoscopy, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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