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Zeer ZMM, Noman M, Zeer AMM, Mahamid YH, Arafat H, Abomoch M, Abu Aqeel B. A Rare Case of Concurrent Chromophobe Renal Cell Cancer with Lung Neuroendocrine Tumor: A Case Report and Literature Review. Ann Med Surg (Lond) 2024; 86:2230-2235. [PMID: 38576925 PMCID: PMC10990380 DOI: 10.1097/ms9.0000000000001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/25/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Multiple primary malignancies (MPM) may be in one organ or in multiple separate organs. They are categorized into synchronous and metachronous according to the time interval between the two malignancies. Multiple risk factors could be attributed to the development of second primary malignancy. Case presentation The authors report a case of a 51-year-old male patient with renal cell carcinoma. During his evaluation, he seemed to have a lung mass which revealed to be a carcinoid tumour. As the patient had two primary malignancies, he was managed according to the treatment options for each tumour. Discussion Although MPMs have been reported increasingly in the past decade, overall incidence is still very rare. Appropriate management and survival depend on distinguishing between dual primary tumours from metastatic disease. Conclusion Multidisciplinary approach is very crucial for diagnosis and management such rare cases.
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Affiliation(s)
| | | | | | | | - Hasan Arafat
- Medical Resident at Augusta Victoria Hospital, Jerusalem, Palestine
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Mangioris G, Halfdanarson TR, Lennon VA, Chang BK, Dubey D, Dyck PJB, Flanagan EP, McKeon A, Mills JR, Pittock SJ, Zekeridou A. Neurological autoimmunity in patients with non-pulmonary neuroendocrine neoplasms: clinical manifestations and neural autoantibody profiles. Eur J Neurol 2024:e16273. [PMID: 38466015 DOI: 10.1111/ene.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND PURPOSE Paraneoplastic neurological autoimmunity is well described with small-cell lung cancer, but information is limited for other neuroendocrine neoplasms (NENs). METHODS Adult patients with histopathologically confirmed non-pulmonary NENs, neurological autoimmunity within 5 years of NEN diagnosis, and neural antibody testing performed at the Mayo Clinic Neuroimmunology Laboratory (January 2008 to March 2023) were retrospectively identified. Control sera were available from patients with NENs without neurological autoimmunity (116). RESULTS Thirty-four patients were identified (median age 68 years, range 31-87). The most common primary tumor sites were pancreas (nine), skin (Merkel cell, eight), small bowel/duodenum (seven), and unknown (seven). Five patients received immune checkpoint inhibitor (ICI) therapy before symptom onset; symptoms preceded cancer diagnosis in 62.1% of non-ICI-treated patients. The most frequent neurological phenotypes (non-ICI-treated) were movement disorders (12; cerebellar ataxia in 10), dysautonomia (six), peripheral neuropathy (eight), encephalitis (four), and neuromuscular junction disorders (four). Neural antibodies were detected in 55.9% of patients studied (most common specificities: P/Q-type voltage-gated calcium channel [seven], muscle-type acetylcholine receptor [three], anti-neuronal nuclear antibody type 1 [three], and neuronal intermediate filaments [two]), but in only 6.9% of controls. Amongst patients receiving cancer or immunosuppressive therapy, 51.6% had partial or complete recovery. Outcomes were unfavorable in 48.3% (non-ICI-treated) and neural autoantibody positivity was associated with poor neurological outcome. DISCUSSION Neurological autoimmunity associated with non-pulmonary NENs is often multifocal and can be treatment responsive, underscoring the importance of rapid recognition and early treatment.
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Affiliation(s)
- Georgios Mangioris
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryce K Chang
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Shokei S, Nagase M, Araki A, Nakajima H, Wada K, Niino D. A Case Report of Carcinoid With Teratoma Arising From the Renal Hilum. Int J Surg Pathol 2024:10668969241228299. [PMID: 38332632 DOI: 10.1177/10668969241228299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Teratoma is a germ cell tumor composed of 2 or 3 germ cell layers, and it can occur in various parts of the human body. However, teratomas of the renal hilum are particularly rare, and those complicated by carcinoids are even more uncommon. Herein, we report the example of an asymptomatic 49-year-old woman in whom a tumor in the right renal hilum was unexpectedly discovered on imaging. Histological examination revealed a carcinoid tumor arising from a simple cyst composed of teratomatous tissue. Although the tumor was located in the renal hilum and touched the renal parenchyma, it appeared independent of the kidney and urinary tract. This report highlights the rare occurrence of teratomas with carcinoids and provides insights into their origins.
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Affiliation(s)
- Sachiko Shokei
- Pathology Division, Shimane University Hospital, Shimane, Japan
| | - Mamiko Nagase
- Department of Organ Pathology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Asuka Araki
- Pathology Division, Shimane University Hospital, Shimane, Japan
| | - Hirochika Nakajima
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Koichiro Wada
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Daisuke Niino
- Department of Functional Pathology, Shimane University Faculty of Medicine, Shimane, Japan
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Phillips WJ, Pradier M, Goodwin R, Vickers M, Asmis T. Virtual Care for Patients with Advanced Well Differentiated Gastroenteropancreatic Neuroendocrine Tumor (GEP-NET). Curr Oncol 2024; 31:952-961. [PMID: 38392065 PMCID: PMC10887493 DOI: 10.3390/curroncol31020071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in an unprecedent shift towards virtual cancer care, including the care of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). The aim of this study was to evaluate the use of virtual care for GEP-NETs during the COVID-19 pandemic at a high-volume academic cancer center. METHODS This retrospective, observational study performed at the Ottawa Hospital Cancer Center in Canada evaluated adult patients with GEP-NETs seen in consultation by medical oncology between 1 June 2019 and 31 December 2022. Demographic, clinicopathologic, cancer treatment and visit data were collected. Univariable and multivariable analyses assessed the relationship between patient characteristics and virtual care use. RESULTS A total of 103 patients with well-differentiated GEP-NETS were included. Overall, 18/103 (17.5%) consults and 594/781 (76.1%) follow-ups were performed virtually. All consultation visits returned to in-person assessment by 2022, while 67.0% and 41.4% follow-ups remained virtual in 2022 and 2023, respectively. The year of follow-up, sex, employment and Charlston comorbidity index were associated with virtual follow-up use in the multivariable analysis. DISCUSSION Virtual care remained a predominant method of GEP-NET patient assessment in the peri-pandemic period. These results highlight an opportunity to improve access to subspecialty neuroendocrine cancer care through the continued use of virtual care.
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Affiliation(s)
- William J. Phillips
- Division of Medical Oncology, The University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Michelle Pradier
- Faculty of Medicine, The University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Rachel Goodwin
- Division of Medical Oncology, The University of Ottawa, The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
| | - Michael Vickers
- Division of Medical Oncology, The University of Ottawa, The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
| | - Tim Asmis
- Division of Medical Oncology, The University of Ottawa, The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
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Alhamar M, Sethi S, Reuter VE, Fine SW. Primary Well-Differentiated Neuroendocrine Tumor/ Carcinoid of the Prostate: Case Report and Review of Literature. Int J Surg Pathol 2024:10668969241228297. [PMID: 38303155 DOI: 10.1177/10668969241228297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Primary well-differentiated neuroendocrine tumor (WDNT)/carcinoid of the genitourinary tract is rare. Many WDNT reported in the prostate gland have been seen in close association with conventional prostatic adenocarcinoma and/or label for prostate-specific immunohistochemical markers and are best considered prostatic adenocarcinomas with "carcinoid-like" features. We present a case of primary WDNT/carcinoid incidentally detected in a 67-year-old man who underwent radical prostatectomy for Grade group 2 prostatic adenocarcinoma. Morphologically, the neuroendocrine (NE) lesion appeared distinct from the prostatic adenocarcinoma, labeled for NE markers, was negative for prostatic markers (NKX3.1, PSA, and ERG), and showed an overall low Ki-67 proliferation index (<1%). Follow-up was uneventful with no evidence of residual disease or metastasis.
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Affiliation(s)
- Mohamed Alhamar
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shenon Sethi
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samson W Fine
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Di Fabio F, Ravi P, Allievi N, Khan KA, Abduelraheim A, Moran B. Occult appendix pathology in patients undergoing colorectal cancer resection and prophylactic appendectomy. World J Surg 2024; 48:211-216. [PMID: 38651600 DOI: 10.1002/wjs.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND The risk-benefit balance of prophylactic appendectomy in patients undergoing left colorectal cancer resection is unclear. The aim of this report is to assess the proportion of histologically abnormal appendices in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left-sided resection is performed. METHODS A retrospective study on a prospectively collected database was conducted in a single tertiary-care center. Overall, 717 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021 were analyzed. The primary outcome was the proportion of histologically abnormal appendix specimens at prophylactic appendectomy. The secondary outcome was complications from prophylactic appendectomy. RESULTS Overall, 576/717 (80%) patients had appendectomy at colorectal cancer surgery. In total, 234/576 (41%) had a right-/extended-right hemicolectomy or subtotal colectomy which incorporates appendectomy, and 342/576 (59%) had left-sided resection (left-hemicolectomy, anterior resection or abdominoperineal excision) with prophylactic appendectomy. At definitive histology, 534/576 (92.7%) had a normal appendix. The remaining 42/576 (7.3%) showed abnormal findings, including: 14/576 (2.4%) inflammatory appendix pathology, 2/576 (0.3%) endometriosis, 8/576 (1.4%) hyperplastic polyp, and 18/576 (3.1%) appendix tumors, which encompassed six low-grade appendiceal mucinous neoplasms (LAMNs), three carcinoids, and nine serrated polyps. In the 342 patients who had prophylactic appendectomy, 10 (2.9%) had a neoplasm (two LAMN, three carcinoids, and five serrated polyps). There were no complications attributable to appendectomy. CONCLUSION Occult appendix pathology in patients undergoing colorectal cancer resection is uncommon when prophylactic appendectomy was performed. However, approximately 3% of patients had a synchronous appendix neoplasm.
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Affiliation(s)
- Francesco Di Fabio
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Prabhu Ravi
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Niccolo Allievi
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Kashuf A Khan
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Abu Abduelraheim
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Brendan Moran
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Dabaghi E, Berber E. An update on the use of near-infrared autofluorescence imaging in endocrine surgical procedures. J Surg Oncol 2024; 129:40-47. [PMID: 38031992 DOI: 10.1002/jso.27541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
Over the past decade, near-infrared autofluorescence (NIRAF) imaging has been a major breakthrough in endocrine surgery. Although initial focus was directed at the parathyroid glands, subsequent work has also shown that non-parathyroid neuroendocrine tumors also possess autofluorescence properties. The aim of this review is to present an update and synopsis about NIRAF applications in various endocrine surgical procedures. Methodology includes a review of the literature supplemented with expert opinion. Overall, our review reveals that the use of NIRAF may provide the surgeon with adjunctive critical information that has the potential to change the conduct of many various endocrine surgical procedures.
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Affiliation(s)
- Elissa Dabaghi
- Department of Endocrine Surgery, Cleveland Clinic, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Ohio, USA
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Pogorelić Z, Ercegović V, Bašković M, Jukić M, Karaman I, Mrklić I. Incidence and Management of Appendiceal Neuroendocrine Tumors in Pediatric Population: A Bicentric Experience with 6285 Appendectomies. Children (Basel) 2023; 10:1899. [PMID: 38136101 PMCID: PMC10741616 DOI: 10.3390/children10121899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Neuroendocrine tumors (NETs) are rare tumors that arise from neuroendocrine cells and are the most common tumors of the appendix. NETs of the appendix usually cause no symptoms and often go unnoticed until they cause acute appendicitis or are discovered during an accidental appendectomy. As the trend towards the conservative treatment of acute appendicitis increases in the pediatric population, the question arises as to whether the majority of NETs go undetected and are only discovered at an advanced stage. The purpose of the proposed study is to review the incidence and outcomes of treatment for NETs of the appendix in children and include the data presented in the data pool for further review. METHODS From 1 January 2009 to 1 November 2023, a total of 6285 appendectomies were performed in two large pediatric centers in Croatia. After a retrospective review of the case records and histopathologic findings, a total of 31 children (0.49%) were diagnosed with NET of the appendix and included in the further analysis. The primary outcome of this study was the incidence and treatment outcome of pediatric patients diagnosed with NET of the appendix. Secondary outcomes included the patients' demographic, clinical, and laboratory data and the histopathologic characteristics of tumor species. RESULTS The overall incidence of NETs of the appendix was stable over the study years, with minor fluctuations. The median age of patients was 14 (interquartile range-IQR: 12, 16) years, with a female predominance (64.5%). The majority of patients (96.8%) presented with acute abdominal pain and underwent appendectomy because acute appendicitis was suspected. Acute appendicitis was confirmed by histopathology in 18 (58%) cases. NETs of the appendix were not detected preoperatively in any of the patients. Among patients with confirmed acute appendicitis, most (n = 14; 77.8%) were found to have non-perforated acute appendicitis. In most children, the tumor was located at the tip of the appendix (n = 18; 58.1%), and the majority of tumors had a diameter of less than 1 cm (n = 21, 67.7%). The mitotic count (n = 25, 80.6%) and Ki-67 proliferation index (n = 23, 74.2%) were low in most patients, so most tumors were classified as NET G1 (n = 25, 80.6%), while NET G2 and NET G3 were found in four (12.9%) and two (6.5%) patients, respectively. All children were treated with appendectomy only. The median follow-up time was 54 (IQR: 24, 95) months. CONCLUSIONS The incidence of appendiceal NET among pediatric patients is very low. NET occurs most frequently in adolescents, with a female predominance. Most tumors are less than 1 cm in diameter, located at the tip, and associated with non-perforated appendicitis. Appendectomy is the treatment of choice, and major surgery was not necessary in our cohort.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, 21 000 Split, Croatia;
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Vladimir Ercegović
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, 10 000 Zagreb, Croatia;
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, 21 000 Split, Croatia;
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Ivana Karaman
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, 21 000 Split, Croatia; (I.K.); (I.M.)
| | - Ivana Mrklić
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, 21 000 Split, Croatia; (I.K.); (I.M.)
- Department of Pathology, University of Split School of Medicine, 21 000 Split, Croatia
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Zeineddin S, Aldrink JH, Bering J, Hoyt DW, Kastenberg ZJ, Brungardt J, Dasgupta R, Rinehardt HN, Malek MM, Ziogas IA, Roach JP, Craig BT, Rothstein DH, Lautz TB. Multi-institutional assessment of the prevalence of neuroendocrine tumors in children undergoing laparoscopic appendectomy for acute appendicitis in the United States. Pediatr Blood Cancer 2023; 70:e30620. [PMID: 37555297 DOI: 10.1002/pbc.30620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
As non-operative management of acute appendicitis in children has become more common, missed incidental appendiceal pathology can be an unintended consequence. We assessed the prevalence of neuroendocrine tumors in appendectomy specimens from eight US children's hospitals from 2012 to 2021. The prevalence of neuroendocrine tumors (NET) was found to be 1:271, with a median age of 14 years and 62% female. Most tumors were small (median 6 mm; interquartile range [IQR]: 3-10), and no recurrence was noted during the follow-up period (median 22.5 months; IQR: 3-53). The possibility of delayed diagnosis of these tumors should be part of the discussion for non-operative management of pediatric acute appendicitis.
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Affiliation(s)
- Suhail Zeineddin
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jakob Bering
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David W Hoyt
- Division of Pediatric Surgery, Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - Joseph Brungardt
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Hannah N Rinehardt
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ioannis A Ziogas
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan P Roach
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian T Craig
- Division of Pediatric Surgery, Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David H Rothstein
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
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Abuzakhm SM, Sukrithan V, Fruth B, Qin R, Strosberg J, Hobday TJ, Semrad T, Reidy-Lagunes D, Kindler HL, Kim GP, Knox JJ, Kaubisch A, Villalona-Calero M, Chen H, Erlichman C, Shah MH. A phase II study of bevacizumab and temsirolimus in advanced extra-pancreatic neuroendocrine tumors. Endocr Relat Cancer 2023; 30:e220301. [PMID: 37702588 PMCID: PMC10585708 DOI: 10.1530/erc-22-0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
We assessed the efficacy and safety of combining bevacizumab with temsirolimus in patients with advanced extra-pancreatic neuroendocrine tumors. This NCI-sponsored multicenter, open-label, phase II study (NCT01010126) enrolled patients with advanced, recurrent, or metastatic extra-pancreatic neuroendocrine tumors. All patients were treated with temsirolimus and bevacizumab until disease progression or unacceptable toxicity. Temsirolimus 25 mg was administered i.v. on days 1, 8, 15, and 22 and bevacizumab 10 mg/kg i.v. on days 1 and 15 of a 4-week cycle. Discontinuation of temsirolimus or bevacizumab did not require discontinuation of the other agent. The primary endpoints were objective response rate and 6-month progression-free survival rate. Fifty-nine patients were enrolled in this study, and 54 were evaluated for efficacy and adverse events. While median progression-free survival was 7.1 months, the median duration of treatment with temsirolimus was 3.9 months and that with bevacizumab was 3.5 months. The objective response rate of combination therapy was 2%, and 6-month progression-free survival was 48%. The most frequently reported grade 3-4 adverse events included fatigue (13%), hypertension (13%), and bleeding (13%). Close to 54% of the patients discontinued treatment due to adverse events, refusal of further treatment, or treatment delays. Three deaths occurred in the study, of which two were due to treatment-related bowel perforations. Given the minimal efficacy and increased toxicity seen with the combination of bevacizumab and temsirolimus, we do not recommend the use of this regimen in patients with advanced extra-pancreatic neuroendocrine tumors.
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Affiliation(s)
| | | | | | - Rui Qin
- Janssen Pharmaceuticals, Raritan, NJ
| | | | | | | | | | | | - George P. Kim
- George Washington University Cancer Center, Washington, DC
| | | | | | | | - Helen Chen
- CTEP National Cancer Institute, Bethesda, MD
| | | | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Duponchelle L, Baudin E, Subtil F, Do Cao C, Dansin E, Perrier M, Teissier MP, Haissaguerre M, Cansouline X, Hadoux J, Jepiral G, Lombard-Bohas C, Mercier O, Tronc F, Walter T. Surgery of primary lung carcinoid tumors at metastatic stage: A national study from the French Group of Endocrine Tumors (GTE) and ENDOCAN-RENATEN network. J Neuroendocrinol 2023; 35:e13331. [PMID: 37602933 DOI: 10.1111/jne.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Abstract
The outcome following surgery for patients with primary lung neuroendocrine tumors at metastatic stage remains poorly characterized. We conducted a retrospective national study including patients with metastatic lung neuroendocrine tumors at diagnosis. We performed a safety study to evaluate major morbidity and mortality of surgical resection of the primary tumor and compared patients in the operative to the nonoperative group. A total of 155 patients were included: 41 in the operative group and 114 in the nonoperative group, median age was 64 years. Metastases were mainly located in the liver (74.2%) and the bone (49.7%). The primary endpoint was met as the rate of major complications was 4.9% and there was no postoperative mortality. In the operative group 42.5% of patients had improvement of their pulmonary symptoms versus 14.4% in the nonoperative group. The median overall survival was not reached in the operative group and was 4.3 years (95% CI [3.5;4.9]) in the nonoperative group (univariate analysis, HR = 0.42 95% CI [0.23-0.77], p = .002). After multivariate analysis, only an ECOG-PS ≥1 (vs. 0, HR = 2.44, 95% CI [1.46;4.07], p = .001) and >1 metastatic site (vs. 1; HR = 1.83, 95% CI [1.06;3.16], p = .030) remained significantly associated with overall survival. The resection of the primary tumor was not significantly associated with overall survival (HR = 0.63, 95% CI [0.32;1.24], p = .183). In conclusion, surgery of primary lung neuroendocrine tumors at metastatic stage is a safe option that should be considered in selected patients in order to improve symptoms with a view to improving their quality of life. Larger studies are warranted to evaluate the impact of surgery on survival.
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Affiliation(s)
- Lucie Duponchelle
- Service de Chirurgie Thoracique, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Eric Baudin
- Service de Médecine Nucléaire et Cancérologie Endocrinienne, Institut Gustave Roussy, Villejuif, France
| | - Fabien Subtil
- Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5588, Villeurbanne, France
| | - Christine Do Cao
- Service d'Endocrinologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Eric Dansin
- Comité d'Oncologie Thoracique, CLCC Oscar Lambret, Lille, France
| | - Marine Perrier
- Service d'Hépato-Gastro-Entérologie, Centre Hospitalier Universitaire de Reims et Champagne-Ardenne, Reims, France
| | - Marie-Pierre Teissier
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Magalie Haissaguerre
- Service d'Endocrinologie et Oncologie Endocrinienne, Hôpital Haut Leveque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Xavier Cansouline
- INSERM N2C UMR 1069, Université de Tours, Service de Chirurgie Thoracique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Julien Hadoux
- Service de Cancérologie Endocrinienne, Institut Gustave Roussy, Villejuif, France
| | - Galina Jepiral
- Groupe d'étude des Tumeurs Endocrines (GTE), Paris, France
| | - Catherine Lombard-Bohas
- Oncologie Médicale, Groupement Hospitalier Centre, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Olaf Mercier
- Service de Chirurgie Thoracique et Transplantation Cardio-Pulmonaire, Hôpital Marie Lannelongue, Université Paris-Saclay, Centre International des Cancers Thoraciques, GHPSJ, Le Plessis Robinson, France
| | - François Tronc
- Service de Chirurgie Thoracique, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- University of Lyon, Université Lyon 1, Lyon, France
| | - Thomas Walter
- Oncologie Médicale, Groupement Hospitalier Centre, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
- University of Lyon, Université Lyon 1, Lyon, France
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12
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Zhang S, Lo JC, Jaffe MG, Arzumanyan H. Elevated Serum Androstenedione Level in a Patient With Ectopic Adrenocorticotropic Hormone Syndrome. AACE Clin Case Rep 2023; 9:142-145. [PMID: 37736320 PMCID: PMC10509380 DOI: 10.1016/j.aace.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 09/23/2023] Open
Abstract
Background/Objective Ectopic Cushing syndrome can be challenging to diagnose when its presentation is atypical. Herein, we highlight features of ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with worsening hypertension, hypokalemia, ACTH-dependent hypercortisolism, and disproportionate elevation in serum androstenedione levels. Case Report A 59-year-old woman presented with rapidly progressing hypertension, severe hypokalemia, confusion, and weakness. Her medical history included well-controlled hypertension receiving amlodipine 5 mg/day, which worsened 3 months prior to admission requiring losartan and spironolactone therapy, with twice daily potassium supplementation. Physical examination was notable for bruising, muscle wasting, thin extremities, facial fullness, and abdominal adiposity despite body mass index 17 kg/m2. Laboratory evaluation showed potassium 2.6 mEq/L (3.5-5.3), morning cortisol >50 mcg/dL (8-25), 24-hour urine cortisol 8369 mcg/day (<50), ACTH 308 pg/mL (<46), androstenedione 398 ng/dL (20-75), dehydroepiandrosterone sulfate 48 mcg/dL (≤430), and testosterone 11 ng/dL (≤4.5) levels. A 3.8-cm carcinoid right lung tumor was identified, and resection was performed with clean margins. Cortisol, androstenedione, and potassium levels rapidly normalized postoperatively and blood pressure returned to baseline, well-controlled on amlodipine. Discussion Our case illustrates disproportionate elevation in androstenedione levels despite normal dehydroepiandrosterone sulfate and testosterone in a woman with ectopic ACTH syndrome. Limited reports have observed similar discordance in androgen profiles in ectopic versus pituitary ACTH hypersecretion, potentially attributable to differential activation of androgen biosynthesis. Conclusion Adrenal androgen assessment may help differentiate pituitary versus ectopic ACTH secretion in which androstenedione is elevated, but studies are needed to determine whether disproportionate androstenedione elevation reliably predicts the origin of ACTH excess.
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Affiliation(s)
- Sherry Zhang
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Joan C. Lo
- Department of Endocrinology, Kaiser Permanente Oakland Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- The Permanente Medical Group, Oakland, California
| | - Marc G. Jaffe
- The Permanente Medical Group, Oakland, California
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Hasmik Arzumanyan
- Department of Endocrinology, Kaiser Permanente Oakland Medical Center, Oakland, California
- The Permanente Medical Group, Oakland, California
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13
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Kudelka MR, Abou-Alfa GK, O’Reilly EM, Foote MB, Sirohi B, Elias R, Shamseddine A, Paroder V, Moussa AM, Cohen P, Ganesh K. Metastatic well differentiated serotonin-producing pancreatic neuroendocrine tumor with carcinoid heart disease: a case report. J Gastrointest Oncol 2023; 14:1878-1886. [PMID: 37720425 PMCID: PMC10502540 DOI: 10.21037/jgo-22-909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/08/2023] [Indexed: 09/19/2023] Open
Abstract
Background Less than two percent of pancreatic neuroendocrine tumors (NETs) produce serotonin. Serotonin can cause carcinoid syndrome and less commonly carcinoid heart disease (CHD). CHD is associated with increased mortality and requires a more aggressive approach. Here we present a rare case of a serotonin-producing pancreatic NET complicated by CHD at presentation and discuss timing of systemic therapy, liver-directed therapy, and heart failure management. Case Description A 36-year-old white man presented with diarrhea, lower extremity edema, and exertional dyspnea. He was found to have a well-differentiated serotonin-producing pancreatic NETs grade three with bilobar liver metastasis complicated by carcinoid syndrome and CHD. His symptoms and disease burden improved with somatostatin analog and liver-directed therapy with bland embolization to control carcinoid symptoms and obtain rapid hormonal control to prevent progression of CHD. He concurrently received diuretics to manage his heart failure and was considered for valvular replacement surgery, which was deferred for optimal hormonal control. Conclusions Our case highlights the importance of multidisciplinary care for patients with pancreatic NETs and early identification and management of CHD. Although uncommon, serotonin-producing pancreatic NETs can present with CHD and require combination of somatostatin analogs, liver-directed therapy, and heart failure management.
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Affiliation(s)
- Matthew R. Kudelka
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Michael B. Foote
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | | | - Rawad Elias
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Ali Shamseddine
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Viktoriya Paroder
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Amgad M. Moussa
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - Paul Cohen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Karuna Ganesh
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
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14
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Davies RA, Alam NZ, Wright GM. Lung neuroendocrine neoplasms: a single centre surgical series and analysis of staging. ANZ J Surg 2023. [PMID: 37106553 DOI: 10.1111/ans.18493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/25/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND To review the outcomes of surgically resected lung neuroendocrine neoplasms (LNEN) at a tertiary referral centre and to validate a previously published LNEN-specific staging system (NETL). METHODS All patients who were identified on histopathology to have LNEN were included. Pre-, intra- and post-operative outcomes were collected, including long-term survival. Patients were staged by both the TNM (seventh and eighth edition) and NETL staging (seventh and eighth edition definitions). Kaplan-Meier (KM) survival analysis was performed according to histopathology and stage, along with uni- and multivariate analyses. RESULT A total of 132 patients were included in the study, with a median age of 65 years; 55% were female. Typical carcinoid (TC) was the most common pathology (53.4%) followed by large cell neuroendocrine carcinoma (LCNEC - 23.5%), atypical carcinoid (AC - 20.5%) and small cell carcinoma (3.0%). The most common operation performed was a lobectomy (55.3%). Overall survival at 5 years was 80% (100% TC, 78.2% AC, LCNEC 40.9%) and 5-year disease free survival was 76.8% (TC 94.3%, AC 56.8%, LCNEC 56.4%). KM curves showed a trend towards NETL performing better than TNM, however, in multivariate analysis only the histological subtype was found to be significant in our study. CONCLUSION This is the largest known Australian series of LNEN to date, showing survival comparable to international outcomes. We have demonstrated large variations in outcome, driven by histological grade. The TNM system does not correlate with survival and we have not been able to show that currently proposed NETL staging is superior.
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Affiliation(s)
- Reece A Davies
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Naveed Z Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Gavin M Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Care Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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15
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Kvaščevičius L, Lesinskas E, Petroška D, Kvaščevičius R, Šatinskienė I. Late Recurrence of a Rare Middle Ear Neuroendocrine Tumor With an Intracranial Extension to the Temporal Fossa: A Case Report. Cureus 2023; 15:e37900. [PMID: 37214069 PMCID: PMC10199781 DOI: 10.7759/cureus.37900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
We report a clinical case of an extremely rare neuroendocrine tumor of the right middle ear (MeNET) that recurred after 13 years with a local extension into the right temporal fossa. In the current medical literature, there are approximately 150 cases of MeNETs and even fewer cases with more than 10 years of follow-up, recurrence, and intracranial tumor progression. Therefore, we believe that this paper can make an important contribution to the existing and future knowledge about this disease. The purpose of this article is to present our experience in treating such a rare neoplasm in a 35-year-old woman. The patient initially complained of worsening hearing in her right ear over the past year. The final diagnosis was made based on the findings of computed tomography (CT), magnetic resonance imaging (MRI), and histological and immunohistochemical evaluation of excisional biopsies of the original and recurrent tumors. The primary tumor masses were removed with clear resection margins, and the ossicular chain was reconstructed. The patient has been monitored clinically and radiologically with temporal bone CTs every year and MRIs three times in general since then. A postoperative audiogram showed remaining mixed hearing loss in the right ear that eventually worsened as the tumor grew. Tumor recurrence and progression after 156 months (13 years) were seen on CT and MRI, requiring further treatment. After resection of the recurrent tumor, paresis of the right facial nerve developed, which was treated with dexamethasone. The surgical treatment caused the initial symptoms to disappear, but the facial nerve paresis persisted with mild functional improvement. The patient is not receiving adjuvant radiotherapy and is being monitored closely because the tumor may recur in the future.
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Affiliation(s)
| | - Eugenijus Lesinskas
- Otorhinolaryngology, Vilnius University Hospital Santaros Klinikos, Vilnius, LTU
- Medicine, Vilnius University, Vilnius, LTU
| | - Donatas Petroška
- Pathology, Vilnius University Hospital Santaros Klinikos, Vilnius, LTU
- Medicine, Vilnius University, Vilnius, LTU
| | - Robertas Kvaščevičius
- Neurosurgery, Vilnius University Hospital Santaros Klinikos, Vilnius, LTU
- Medicine, Vilnius University, Vilnius, LTU
| | - Inga Šatinskienė
- Otorhinolaryngology, Vilnius University Hospital Santaros Klinikos, Vilnius, LTU
- Medicine, Vilnius University, Vilnius, LTU
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16
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Wirth MA, Khan HM, Sabiq F, Agoumi M, Neufeld A. Metastatic neuroendocrine tumor masquerading as orbital cysticercosis. Neuroradiol J 2023; 36:229-231. [PMID: 36044662 PMCID: PMC10034697 DOI: 10.1177/19714009221124305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Orbital metastases secondary to neuroendocrine tumors are exceedingly rare. We present a unique case of a 30-year-old female initially presenting with fever, chills, periorbital swelling, and painful proptosis. CT orbits revealed two ovoid-shaped ring-enhancing lesions in the right lateral and superior rectus muscles and clear sinuses, atypical for infectious post-septal cellulitis. Further work-up included serologic analysis, auto-immune panel, and MRI. Further imaging showed pseudocystic orbital lesions mimicking orbital cysticercosis. Additionally, given the bilateral nature of the lesions and patient's country of origin, this parasitic process was highly suspected. A course of albendazole and steroids led to resolution of symptoms. With a presentation at age 30, this is by far the youngest case reported in literature to date.
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Affiliation(s)
- Magdalena A Wirth
- Department of Ophthalmology, 12358University of British Columbia, Vancouver, Canada
- Department of Ophthalmology, 30841University Hospital Zurich, Zurich, Switzerland
| | - Haaris M Khan
- Faculty of Medicine, 12358University of British Columbia, Vancouver, Canada
| | - Farahna Sabiq
- Department of Radiology, 12358University of British Columbia, Vancouver, Canada
| | - Mehdi Agoumi
- Department of Pathology, 12358Surrey Memorial Hospital, Surrey, Canada
| | - Anastasia Neufeld
- Department of Ophthalmology, 12358University of British Columbia, Vancouver, Canada
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17
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Vellani SD, Nigro A, Varatharajan S, Dworkin LD, Creeden JF. Emerging Immunotherapeutic and Diagnostic Modalities in Carcinoid Tumors. Molecules 2023; 28. [PMID: 36903295 DOI: 10.3390/molecules28052047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Evasion of innate immunity represents a frequently employed method by which tumor cells survive and thrive. Previously, the development of immunotherapeutic agents capable of overcoming this evasion has realized pronounced clinical utility across a variety of cancer types. More recently, immunological strategies have been investigated as potentially viable therapeutic and diagnostic modalities in the management of carcinoid tumors. Classic treatment options for carcinoid tumors rely upon surgical resection or non-immune pharmacology. Though surgical intervention can be curative, tumor characteristics, such as size, location, and spread, heavily limit success. Non-immune pharmacologic treatments can be similarly limited, and many demonstrate problematic side effects. Immunotherapy may be able to overcome these limitations and further improve clinical outcomes. Similarly, emerging immunologic carcinoid biomarkers may improve diagnostic capabilities. Recent developments in immunotherapeutic and diagnostic modalities of carcinoid management are summarized here.
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Monlezun DJ, Badalamenti A, Javaid A, Marmagkiolis K, Honan K, Kim JW, Patel R, Akhanti B, Halperin D, Dasari A, Koutroumpakis E, Kim P, Lopez-Mattei J, Yusuf SW, Cilingiroglu M, Mamas MA, Gregoric I, Yao J, Hassan S, Iliescu C. Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the "forgotten pulmonic valve". Front Cardiovasc Med 2023; 9:1071138. [PMID: 36843627 PMCID: PMC9945326 DOI: 10.3389/fcvm.2022.1071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023] Open
Abstract
Background Carcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT). Methods Machine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016-2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures. Results Among 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012). Conclusion This analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the "forgotten pulmonic valve" to improve outcomes and disparities in this understudied patient population.
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Affiliation(s)
- Dominique J. Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States,Center for Artificial Intelligence and Health Equities, Global System Analytics and Structures (GSAS), New Orleans, LA, United States,*Correspondence: Dominique J. Monlezun ✉
| | - Andrew Badalamenti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Awad Javaid
- Division of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Kostas Marmagkiolis
- Division of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Kevin Honan
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Jin Wan Kim
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Rishi Patel
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Bindu Akhanti
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Dan Halperin
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Arvind Dasari
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Igor Gregoric
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - James Yao
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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Sei Y, Forbes J, Da B, Chitsaz E, Feng J, Zhao X, Hughes MS, Wank SA. Diagnostic value of whole-mount crypt analysis of ileal biopsy specimens for the patients with familial small intestinal neuroendocrine tumors. Ther Adv Med Oncol 2023; 15:17588359231156871. [PMID: 36936198 PMCID: PMC10014972 DOI: 10.1177/17588359231156871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/27/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Aims Early-stage small intestinal neuroendocrine tumors (SI-NETs) are generally asymptomatic and difficult to diagnose. As a result, patients often present with late-stage incurable disease. SI-NETs originate from enterochromaffin (EC) cells, which develop enteroendocrine cell (EEC) clusters consisting of a subset of EC cells at the crypt bottom at an early stage of tumor progression. In a familial form of SI-NET, EEC clusters arise in a multifocal and polyclonal fashion. We sought to determine whether early detection and analysis of cryptal EEC clusters could provide insight into the development of SI-NETs and allow successful pre-symptomatic screening for at risk family members of patients with SI-NETs. Methods Isolated crypts from endoscopic ileal biopsies or surgically removed specimens from 43 patients with familial SI-NET and 20 controls were formalin-fixed, immunostained for chromogranin A, and examined by confocal three-dimensional analysis for the presence of EEC cluster formations. Results Examination of multiple areas of macroscopic tumor-free mucosa in surgically resected specimens from patients with familial SI-NET revealed widely distributed, independent, multifocal EEC micro-tumor formations of varying sizes. Consistent with this finding, randomly sampled ileal biopsy specimens identified aberrant crypt containing endocrine cell clusters (ACECs) in patients. ACECs were found exclusively in patients (23/43, 53%) and not in controls (0/20). Furthermore, analysis of positions and numbers of EECs in crypts and ACECs indicated significant increases in EECs at the crypt bottom, predominantly at positions 0 and 1' (p < 0.0001 compared to controls), suggesting the progression of EEC accumulation below +4 position as the early process of ACEC formation. These findings also suggested that ACECs were precursors in the development of micro-tumors and subsequent macro-tumors. Conclusion This study indicates that SI-NETs develop from deep crypt EC cells to become ACECs, micro-tumors, and ultimately gross tumors. This process occurs widely throughout the distal small intestine in patients with familial SI-NETs consistent with but not exclusively explained by germline disease. Finally, analysis of crypts from ileal biopsies could contribute in part to earlier diagnostic screening processes avoiding late-stage presentation of incurable disease.
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Affiliation(s)
- Yoshitatsu Sei
- Digestive Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes of
Health, Bethesda, MD, USA
| | - Joanne Forbes
- Digestive Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes of
Health, Bethesda, MD, USA
| | - Ben Da
- Digestive Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes of
Health, Bethesda, MD, USA
| | - Ehsan Chitsaz
- Digestive Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes of
Health, Bethesda, MD, USA
| | - Jianying Feng
- Digestive Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes of
Health, Bethesda, MD, USA
| | - Xilin Zhao
- Digestive Diseases Branch, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes of
Health, Bethesda, MD, USA
| | - Marybeth S. Hughes
- Surgery Branch, National Cancer Institute,
National Institutes of Health, Bethesda, MD, USA
- Current Address: Surgical Oncology, East
Virginia Medical School, Norfolk, VA
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20
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Lee SA, Hata JL, Thompson MP, Fallat ME, Riggle KM, Bickel SG. Atypical pulmonary carcinoid tumor encapsulated by a Staphylococcus aureus infection. Pediatr Pulmonol 2023; 58:353-355. [PMID: 36193652 DOI: 10.1002/ppul.26175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/05/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Stanley A Lee
- Department of Pediatric Pulmonology, Allergy and Immunology, Norton Children's Hospital and University of Louisville, Louisville, Kentucky, USA
| | - Jessica L Hata
- Department of Pediatric Pathology, Norton Children's Hospital and University of Louisville, Louisville, Kentucky, USA
| | - Matthew P Thompson
- Department of Pediatric Pathology, Norton Children's Hospital and University of Louisville, Louisville, Kentucky, USA
| | - Mary E Fallat
- Department of Pediatric Surgery, Norton Children's Hospital and University of Louisville, Louisville, Kentucky, USA
| | - Kevin M Riggle
- Department of Pediatric Surgery, Norton Children's Hospital and University of Louisville, Louisville, Kentucky, USA
| | - Scott G Bickel
- Department of Pediatric Pulmonology, Allergy and Immunology, Norton Children's Hospital and University of Louisville, Louisville, Kentucky, USA
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21
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Duess JW, Lange A, Zeidler J, Blaser J, Dingemann C, Ure BM, Lacher M, Gosemann JH, Hofmann AD. Appendiceal Carcinoids in Children-Prevalence, Treatment and Outcome in a Large Nationwide Pediatric Cohort. Medicina (B Aires) 2022; 59:medicina59010080. [PMID: 36676704 PMCID: PMC9863284 DOI: 10.3390/medicina59010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives: Appendiceal carcinoids are rare neuroendocrine tumors and mainly found incidentally during histopathological examination following appendectomy. This observational cohort study was performed to determine the prevalence, treatment modalities and outcomes in children diagnosed with an appendiceal carcinoid tumor. Materials and Methods: Data from the largest German statutory health insurance "Techniker Krankenkasse" were analyzed within an 8-year period: January 2010 to December 2012 and January 2016 to December 2020. Patient characteristics, surgical technique, type of surgical department, diagnostic management, and postoperative morbidity were analyzed. Results: Out of 40.499 patients following appendectomy, appendiceal carcinoids were found in 44 children, resulting in a prevalence of 0.11%. Mean age at appendectomy was 14.7 (±2.6) years. Laparoscopic approach was performed in 40 (91%) cases. Right-sided hemicolectomy was performed in 8 (18%) patients. Additional diagnostic work-up (CT and MRI) was recorded in 5 (11%) children. Conclusions: This large nationwide pediatric study shows that 1 in 1000 patients was found to have a neuroendocrine tumor of the appendix (prevalence 0.11%), emphasizing its low prevalence in the pediatric age group. The majority of patients were treated with appendectomy only. However, treatment modalities are still variable. Longer follow-up analyses are needed to evaluate published guidelines and recommendations to aim for a limited surgical approach.
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Affiliation(s)
- Johannes Wolfgang Duess
- Department of Pediatric Surgery, University of Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-97-26400; Fax: +49-341-97-26409
| | - Ansgar Lange
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, 30159 Hannover, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, 30159 Hannover, Germany
| | - Jochen Blaser
- Techniker Health Insurance, Representative Officer of Lower Saxony, 30159 Hannover, Germany
| | - Carmen Dingemann
- Department of Pediatric Surgery, Medical School Hannover, 30625 Hannover, Germany
| | - Benno M. Ure
- Department of Pediatric Surgery, Medical School Hannover, 30625 Hannover, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, 04103 Leipzig, Germany
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22
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Ouvrard E, Mestier LD, Boursier C, Lachachi B, Sahakian N, Chevalier E, Mikail N, Carullo J, Bando-Delaunay A, Walter T, Malouf GG, Addeo P, Poncet G, Sebag F, Lebtahi R, Goichot B, Taïeb D, Imperiale A. 18F-DOPA PET/CT at the Forefront of Initial or Presurgical Evaluation of Small-Intestine Neuroendocrine Tumors. J Nucl Med 2022; 63:1865-1870. [PMID: 35589408 DOI: 10.2967/jnumed.122.263984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/27/2022] [Indexed: 01/11/2023] Open
Abstract
Our objective was to compare the respective value of 68Ga-DOTATOC and 18F-DOPA PET/CT for initial staging or presurgical work-up of patients with small-intestine neuroendocrine tumors (SiNETs). Methods: This was a retrospective, multicenter, noninterventional investigation involving 53 non-surgically treated SiNET patients who underwent both 68Ga-DOTATOC and 18F-DOPA PET/CT within a 6-mo interval without surgical intervention or therapeutic change between the 2 PET/CT studies. Percentage detection rate was calculated according to per-region and per-lesion analyses. Sensitivity for primary tumor detection was assessed in 37 surgically treated patients, taking surgical results (76 SiNETs) as the diagnostic gold standard. Results: 68Ga-DOTATOC PET/CT and 18F-DOPA PET/CT individually identified at least 1 primary SiNET in 92% (34/37) of the patients. Intestinal tumor multifocality was confirmed by histology in 8 patients. 68Ga-DOTATOC and 18F-DOPA PET/CT were concordantly positive for tumor multifocality in 5 patients, discordantly positive in 2 patients, and concordantly negative in 1 patient. The detection rate for subdiaphragmatic nodal metastases on per-region-based analysis was 91% and 98% for 68Ga-DOTATOC and 18F-DOPA PET/CT, respectively (P = 0.18). 18F-DOPA PET/CT detected a higher number of abnormal subdiaphragmatic nodes (P = 0.009). Regarding mesenteric nodes only, 18F-DOPA PET/CT detected more positive regions (P = 0.005) and nodal lesions (P = 0.003) than 68Ga-DOTATOC PET/CT, including nodes at the origin of mesenteric vessels. For detection of distant metastases, 68Ga-DOTATOC and 18F-DOPA PET/CT performed equally well on a per-region-based analysis. As compared with 68Ga-DOTATOC, 18F-DOPA PET/CT detected more hepatic (P < 0.001), peritoneal (P < 0.001), and lung metastases (P < 0.001). Conclusion: 18F-DOPA PET/CT detected more lesions than 68Ga-DOTATOC PET/CT in the studied patients. The respective roles of the two should be discussed in terms of disease staging and treatment selection.
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Affiliation(s)
- Eric Ouvrard
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe, University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Louis De Mestier
- Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital, Université de Paris, and INSERM U1149, Centre of Research in Inflammation, Paris, France
| | | | | | - Nicolas Sahakian
- Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | | | - Nidaa Mikail
- Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital, Université de Paris, Paris, France
| | - Josefina Carullo
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe, University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France.,Nuclear Medicine, Sanatorio Allende S.A., Cordoba, Argentina
| | - Aurélie Bando-Delaunay
- Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital, Université de Paris, Paris, France
| | - Thomas Walter
- Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Gabriel G Malouf
- Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospitals of Strasbourg, Strasbourg, France
| | - Gilles Poncet
- Digestive and Oncologic Surgery, Edouard-Herriot University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Frederic Sebag
- Endocrine Surgery, Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Rachida Lebtahi
- Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital, Université de Paris, Paris, France
| | - Bernard Goichot
- Diabetes and Metabolic Disorders, Internal Medicine, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France
| | - David Taïeb
- Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France.,European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France; and
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe, University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France; .,Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
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23
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Elajami MK, Burton LP, Bahmad HF, Chaaya G, Schwartz M. Repurposed Effect of (177)Lu-DOTATATE in the Treatment of Mantle Cell Lymphoma. Curr Oncol 2022; 29:7552-7. [PMID: 36290871 DOI: 10.3390/curroncol29100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Mantle cell lymphoma (MCL) is an uncommon subcategory of non-Hodgkin lymphoma (NHL). Pathogenesis primarily includes overexpression of CCND1 and SOX11 along with other molecular aberrations. Lutetium 177Lu-DOTATATE is a radiolabeled somatostatin analogue used for the treatment of gastrointestinal neuroendocrine tumors. There are no clinical data supporting the use of Lutetium 177Lu-DOTATATE in the treatment of lymphoma. We describe the case of an 84-year-old man with a history of MCL and carcinoid tumor of the lung. Following progression of the carcinoid malignancy, the patient was treated with Lutetium 177Lu-DOTATATE. After treatment, there was an overall improvement of the patient's MCL that was demonstrated by stable lymphadenopathy on serial CT scans and down-trend of the absolute lymphocyte count. Therefore, we hypothesize that 177Lu-DOTATATE might have a role and can be repurposed for treating MCL.
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24
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Takagi H, Matsumura Y, Fukuhara M, Inomata S, Yamaguchi H, Watanabe M, Ozaki Y, Muto S, Okabe N, Shio Y, Saito H, Tanabe H, Shimabukuro M, Suzuki H. Ectopic adrenocorticotropic hormone-secreting carcinoid with solitary cryptococcosis in the lungs. Cancer Rep (Hoboken) 2022; 5:e1731. [PMID: 36196010 PMCID: PMC9675365 DOI: 10.1002/cnr2.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 08/30/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Carcinoid tumors can on rare occasions ectopically produce adrenocorticotropic hormone (ACTH), causing Cushing's syndrome, and patients could become immunocompromised. Care must therefore be taken regarding infectious complications. In particular, ACTH-producing pulmonary carcinoid is not easy to diagnose by itself, and when combined with pulmonary nodules as infectious foci, each is very difficult to diagnose. CASE The patient was a 71-year-old woman with refractory diabetes. She showed clinical symptoms of Cushing's syndrome during treatment for diabetes and ectopic ACTH production was suspected based on biochemical and imaging tests. Nodules were identified in the left lung apex and lingual segment. Examination of resected nodules revealed that the nodule in the apex was pulmonary cryptococcosis, while the nodule in the lingual segment represented typical carcinoid. After surgery, clinical symptoms, laboratory findings, and diabetes all improved. CONCLUSION We present this very instructive case in terms of the difficulty of diagnosing ACTH-producing tumors, the possibility of infection complicating the immunodeficiency caused by ACTH-producing tumors, and the surgical strategy.
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Affiliation(s)
- Hironori Takagi
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan,Department of Chest SurgeryIwaki City Medical CenterIwakiJapan
| | - Yuki Matsumura
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | | | - Sho Inomata
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Hikaru Yamaguchi
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Masayuki Watanabe
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Yuki Ozaki
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Satoshi Muto
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Naoyuki Okabe
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Yutaka Shio
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
| | - Haruka Saito
- Department of Diabetes, Endocrinology and MetabolismFukushima Medical UniversityFukushimaJapan
| | - Hayato Tanabe
- Department of Diabetes, Endocrinology and MetabolismFukushima Medical UniversityFukushimaJapan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and MetabolismFukushima Medical UniversityFukushimaJapan
| | - Hiroyuki Suzuki
- Department of Chest SurgeryFukushima Medical UniversityFukushimaJapan
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25
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Bădan MI, Piciu D. IMMUNOHISTOCHEMICAL MARKERS AND SPECT/CT SOMATOSTATIN-RECEPTOR (99MTC-TEKTROTYD) UPTAKE IN WELL AND MODERATELY DIFFERENTIATED NEUROENDOCRINE TUMORS. Acta Endocrinol (Buchar) 2022; 18:523-530. [PMID: 37152876 PMCID: PMC10162825 DOI: 10.4183/aeb.2022.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Context Diagnosis of primary NETs (neuroendocrine tumors) is challenging and often late due to tumor heterogeneity, and a wide variety of general symptoms. Low grade NETs are often indolent and have a good prognosis, especially in the early stages. Even so, some tumors are diagnosed using SPECT/CT either in the metastatic stage or directly as a metastasis with an unknown primary tumor. Objective This study aims to characterize well and moderately differentiated NETs, using Tektrotyd SPECT/CT imaging as well as from the viewpoint of NET immunohistochemical biomarker expression. Design Patients diagnosed with low grade neuroendocrine tumors (carcinoids) investigated over a period of 2 years, using SPECT/CT with 99mTc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) and confirmed through at least two immunohistochemical neuroendocrine markers were evaluated. Subjects and Methods Twenty-seven cases with neuroendocrine tumors were analyzed. Four patients met the inclusion criteria. Staining intensity was scored using a weak, moderate, or strong scoring system. CD56 was quantified using criteria derived from Her2 cell membrane staining evaluations. Results Patients included in the study had two well differentiated (G1) NETs and two moderately differentiated (G2) NETs. SPECT/CT with Tektrotyd showed variable intensity ranging from discreet to strong. All tumors expressed chromogranin A with at least moderate intensity, weak to moderate intensity for synaptophysin and variable CD56 intensity. Conclusions Chromogranin A and synaptophysin staining patterns may aid in primary tumor identification. CD56 stain intensity showed an inverse correlation with Tektrotyd uptake in carcinoids. Additional studies merit further investigation for use in clinical settings.
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Affiliation(s)
- M I Bădan
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Doctoral School
| | - D Piciu
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Doctoral School
- "Prof. Dr. Ion Chiricuta" Institute of Oncology - Nuclear Medicine, Cluj-Napoca, Romania
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26
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Hayes AR, Grossman AB. Distinguishing Cushing's disease from the ectopic ACTH syndrome: Needles in a haystack or hiding in plain sight? J Neuroendocrinol 2022; 34:e13137. [PMID: 35980277 PMCID: PMC9542389 DOI: 10.1111/jne.13137] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
In the context of ACTH-dependent Cushing's syndrome, ectopic ACTH secretion from a neuroendocrine tumour is not uncommon, and needs to be carefully differentiated from pituitary-dependent Cushing's syndrome, Cushing's disease, in order to optimise therapy. Some cases may be quite obvious, while in others the diagnosis may be difficult to confirm and the source of ACTH problematic, as many clinical and biochemical tests may overlap with Cushing's disease. Imaging is essential, but needs to be interpreted in the light of both anatomical as well as functional imaging modalities. In this review we summarise some of the main diagnostic problems, and emphasise the multimodal and interdisciplinary nature of the diagnostic pathways.
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Affiliation(s)
- Aimee R. Hayes
- Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondonUK
| | - Ashley B. Grossman
- Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondonUK
- Centre for EndocrinologyBarts and the London School of MedicineLondonUK
- Green Templeton CollegeUniversity of OxfordOxfordUK
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27
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Scopel M, De Carlo E, Bergamo F, Murgioni S, Carandina R, Cervino AR, Burei M, Vianello F, Zagonel V, Fassan M, Vettor R. Bone metastases from neuroendocrine tumors: clinical and biological considerations. Endocr Connect 2022; 11:EC-21-0568. [PMID: 35671272 PMCID: PMC9254287 DOI: 10.1530/ec-21-0568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022]
Abstract
We considered 351 patients affected by neuroendocrine tumors (NETs), followed at the University Hospital of Padua and at the Veneto Oncological Institute. Of these, 72 (20.5%) suffered from bone metastases. The sample was divided according to the timing of presentation of bone metastases into synchronous (within 6 months of diagnosis of primary tumor) and metachronous (after 6 months). We collected data on the type and grading of the primary tumor and on the features of bone metastases. Our analysis shows that the group of synchronous metastases generally presents primary tumors with a higher degree of malignancy rather than the ones of the metachronous group. This is supported by the finding of a Ki-67 level in GEP-NETs, at the diagnosis of bone metastases, significantly higher in the synchronous group. Moreover, in low-grade NETs, chromogranin A values are higher in the patients with synchronous metastases, indicating a more burden of disease. The parameters of phospho-calcium metabolism are within the normal range, and we do not find significant differences between the groups. Serious bone complications are not frequent and are not correlated with the site of origin of the primary tumor. From the analysis of the survival curves of the total sample, a cumulative survival rate of 33% at 10 years emerges. The average survival is 80 months, higher than what is reported in the literature, while the median is 84 months. In our observation period, synchronous patients tend to have a worse prognosis than metachronous ones with 52-months survival rates of 58 and 86%.
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Affiliation(s)
- Matteo Scopel
- Medical Clinic III, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy
- Correspondence should be addressed to M Scopel:
| | - Eugenio De Carlo
- Medical Clinic III, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy
| | - Francesca Bergamo
- Unit of Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Sabina Murgioni
- Unit of Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Anna Rita Cervino
- Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Marta Burei
- Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Federica Vianello
- Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Unit of Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Roberto Vettor
- Medical Clinic III, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy
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28
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Fine GC, Covington MF, Koppula BR, Salem AE, Wiggins RH, Hoffman JM, Morton KA. PET-CT in Clinical Adult Oncology-VI. Primary Cutaneous Cancer, Sarcomas and Neuroendocrine Tumors. Cancers (Basel) 2022; 14:2835. [PMID: 35740501 PMCID: PMC9221374 DOI: 10.3390/cancers14122835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
PET-CT is an advanced imaging modality with many oncologic applications, including staging, therapeutic assessment, restaging and surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, the potential pitfalls and nuances that characterize these applications, and guidelines for image interpretation. Tumor-specific clinical information and representative PET-CT images are provided. The current, sixth article in this series addresses PET-CT in an evaluation of aggressive cutaneous malignancies, sarcomas and neuroendocrine tumors. A discussion of the role of FDG PET for all types of tumors in these categories is beyond the scope of this review. Rather, this article focuses on the most common malignancies in adult patients encountered in clinical practice. It also focuses on Food and Drug Agency (FDA)-approved and clinically available radiopharmaceuticals rather than research tracers or those requiring a local cyclotron. This information will serve as a guide to primary providers for the appropriate role of PET-CT in managing patients with cutaneous malignancies, sarcomas and neuroendocrine tumors. The nuances of PET-CT interpretation as a practical guide for imaging providers, including radiologists, nuclear medicine physicians and their trainees, are also addressed.
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Affiliation(s)
- Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
- Faculty of Medicine, Department of Radiodiagnosis and Intervention, Alexandria University, Alexandria 21526, Egypt
| | - Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
- Intermountain Healthcare Hospitals, Summit Physician Specialists, Murray, UT 84123, USA
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29
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Kiesewetter B, Mazal P, Kretschmer-Chott E, Mayerhoefer ME, Raderer M. Pulmonary neuroendocrine tumours and somatostatin receptor status: an assessment of unlicensed use of somatostatin analogues in the clinical practice. ESMO Open 2022; 7:100478. [PMID: 35525183 PMCID: PMC9271480 DOI: 10.1016/j.esmoop.2022.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background The use of somatostatin analogues (SSAs) has not been formally approved in pulmonary neuroendocrine tumours (NETs) in the absence of positive controlled trials, even though it is recommended as a potential therapeutic option in recent guidelines. Patients and methods We have assessed the use of SSA in the general practice in Austria by retrospectively analysing patients with pulmonary NETs referred to our European Neuroendocrine Tumor Society centre in Vienna for second opinion or further therapy. In addition, we have analysed the somatostatin receptor (SSTR) expression of those patients by immunohistochemistry (IHC) and SSTR imaging, e.g. 68Ga-DOTANOC-positron emission tomography/computed tomography, and whether such analyses had been carried out before referral at our centre. Results Out of 34 patients (19 atypical and 15 typical carcinoids) with metastatic or advanced disease, 10/34 (29%) had been prescribed SSA before referral. No IHC for SSTR had been carried out, and only 9/34 (27%) had undergone SSTR imaging by nuclear medicine. Sufficient material for IHC was available in 29/34 (85%) patients and SSTR-IHC was rated negative in 13/29 (45%), weakly positive in 4/29 (14%), moderately positive in 5/29 (17%) and strongly positive in 7/29 (24%) patients. On SSTR imaging, 8/34 patients (24%) were positive, 13/34 (38%) negative and 13/34 patients (38%) showed a mix of positive and negative NET lesions. In 11/29 (38%) patients with both IHC and imaging available, discordance of SSTR expression on imaging and histological assessment was detected. Conclusions These data show that uncritical use of SSA should be discouraged, and assessment of SSTR, preferably by imaging, is mandatory before prescription of SSA in pulmonary NETs. SSAs are not formally approved in pulmonary NETs. SSAs are recommended as a potential therapeutic option for advanced lung NETs in guidelines. We assessed the use of SSAs for lung NET in the general practice in Austria. Only 27% had undergone SSTR imaging before referral and receptor status was highly heterogeneous. Our data emphasize that uncritical use of SSAs should be discouraged; assessment of SSTRs is recommended.
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Affiliation(s)
| | | | - E Kretschmer-Chott
- Departments of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - M E Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Biomedical Imaging and Image-guided Therapy, Division of General and Paediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - M Raderer
- Departments of Medicine I, Division of Oncology.
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Yukawa T, Ishida Y, Naomoto Y, Monobe Y, Fukazawa T, Yamatsuji T. Neuroendocrine tumor secondary to pulmonary hypoplasia: A case report. Thorac Cancer 2022; 13:1227-1231. [PMID: 35301802 PMCID: PMC9013649 DOI: 10.1111/1759-7714.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/28/2022] Open
Abstract
Pulmonary hypoplasia is diagnosed during the perinatal period and is a cause of death in newborns. However, these developmental abnormalities are diagnosed in adulthood in some cases. A 70‐year‐old male smoker was diagnosed with stage IIIA pulmonary adenocarcinoma in the right upper lobe with right middle lobe hypoplasia. He subsequently underwent right upper and middle lobectomy with lymph node dissection by video‐assisted thoracoscopic surgery. In addition to an invasive adenocarcinoma in the right upper lobe, pathological examination of the hypoplastic lobe revealed neuroendocrine hyperplasia, as well as tumorlets and a typical carcinoid. Eight cases of pulmonary neuroendocrine tumors that developed from pulmonary hypoplasia have been reported to date. Interestingly, all but one case occurred in the right middle lobe. Neuroendocrine cell hyperplasia has been reported to develop in hypoplastic lungs postnatally; therefore, we speculated that the lesion was the origin of these neuroendocrine tumors. Moreover, the pathological findings suggested that atelectasis was involved in the pathogenesis of this rare condition. In adults, when lobar hypoplasia is diagnosed, neuroendocrine tumors should be anticipated.
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Affiliation(s)
- Takuro Yukawa
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yuta Ishida
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yoshio Naomoto
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yasumasa Monobe
- Department of Pathology 1, Kawasaki Medical School, Okayama, Japan
| | - Takuya Fukazawa
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Tomoki Yamatsuji
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
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Jagiella-Lodise O, Jagiella V, Weitman E. An abdominal wall neuroendocrine tumor of unknown primary origin: A case report and review of the literature. Cancer Rep (Hoboken) 2022; 5:e1610. [PMID: 35142106 PMCID: PMC9458506 DOI: 10.1002/cnr2.1610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine and nervous system. NETs, often found in the gastrointestinal tract, can be found anywhere in the body, and have metastatic potential. NETs occasionally present with metastatic disease without an identifiable primary tumor. Case A 79‐year‐old female patient presented with an abdominal wall mass. Percutaneous biopsy was consistent with a NET. Preoperative endoscopy and PillCam were unremarkable. PET Dotatate demonstrated uptake in the abdominal wall as well as vague uptake in the pelvis. Intraoperatively, we identified a suspicious nodule on the sigmoid colon, which was consistent with a drop metastasis on final pathology. Conclusion In this case report we present a patient with a NET metastasis to the abdominal wall without a known primary site. This case highlights the limitations of endoscopy and imaging in the workup of metastatic NETs. Additionally, this is a novel case report of a metastatic NET to the abdominal wall without an identifiable primary site.
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Affiliation(s)
| | | | - Evan Weitman
- Piedmont Atlanta Hospital, Division of Surgical Oncology & HPB Surgery, Atlanta, Georgia, USA
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Kapoor R, Mandelia A, Farzana N, Nigam N, Dabadghao P, Sharma SP, Kanneganti P, Pande S. Bronchial Carcinoid Tumor in an Adolescent Female: Diagnosis and Management by a Multi-Disciplinary Team. J Indian Assoc Pediatr Surg 2022; 27:500-502. [PMID: 36238335 PMCID: PMC9552641 DOI: 10.4103/jiaps.jiaps_132_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/30/2021] [Accepted: 11/18/2021] [Indexed: 11/06/2022] Open
Abstract
Bronchial carcinoid is the most common primary malignant lung tumor in children; however, it remains a very rare diagnosis due to the overall low incidence of childhood lung malignancies. We report a case of a 17-year-old girl with respiratory symptoms who was initially misdiagnosed as a case of COVID pneumonia. She was later detected to have a right mainstem bronchial carcinoid which was managed successfully by a multi-disciplinary team.
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Affiliation(s)
- Rohit Kapoor
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Mandelia
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Ankur Mandelia, Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh, India. E-mail:
| | - Nayab Farzana
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Nigam
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shyamendra Pratap Sharma
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pujana Kanneganti
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shantanu Pande
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Wu HH, Wang LH, Li HY. Isolated metastasis of mediastinal carcinoid to the left ventricle: A case report. Echocardiography 2021; 38:2091-2094. [PMID: 34806221 DOI: 10.1111/echo.15253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022] Open
Abstract
Carcinoid tumors are uncommon neuroendocrine tumors that produce high levels of serotonin and are mainly located in the gastrointestinal tract and bronchopulmonary system but very rarely in the mediastinum. These are slow-growing tumors that most commonly present metastatic lesions in the liver, followed by the bones, lungs, and peritoneum. Solid cardiac metastases from carcinoid tumors have seldom been reported. In this case report, we present a patient with a rare localized metastasis in the left ventricle with an antecedent history of resected carcinoid tumor of the anterior mediastinum.
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Affiliation(s)
- Hui-Hui Wu
- Department of Echocardiography, Yuhuangding Hospital,Qingdao University, Yantai, China
| | - Li-Hong Wang
- Department of Echocardiography, Yuhuangding Hospital,Qingdao University, Yantai, China
| | - Hong-Yan Li
- Department of Pharmacy, Yuhuangding Hospital, Qingdao University, Yantai, China
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Lesi O, Walton SJ, Ballanamada Appaiah NN, Rasheed N, Dahanayaka J, Ideawor P, Saad Abdalla Al-Zawi A. Prevalence of Carcinoma in Appendectomy Specimens for Patients Presenting With Acute Appendicitis: A Single-Center Study. Cureus 2021; 13:e19611. [PMID: 34956748 PMCID: PMC8674459 DOI: 10.7759/cureus.19611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Acute appendicitis is the most common general surgical emergency globally. Its etiology includes the presence of luminal obstruction by faecoliths, lymphoid hyperplasia, impacted stool, and rarely by appendiceal or caecal cancer. Malignancy related to acute appendicitis is usually seen in the older age group. Aim To identify the subset rate of patients operated for acute appendicitis who have appendiceal carcinoma and analyze the outcome of their post-operative management. Material and methods A retrospective study of a cohort of 529 patients aged > 40 diagnosed with acute appendicitis with subsequent appendectomy in the period between 1 January 2014 and 31 December 2019 at Basildon and Thurrock University Hospital, Essex, United Kingdom was conducted. We analyzed the clinical data of the cohort including demographic information, diagnosis, pre-operative imaging, histological diagnosis as well as post-operative management where indicated. Results The median age of patients was 54.5 years (range 40-92). The male to female ratio in the appendicectomy cohort was 1:1.1. About 45% were aged 40-49 years, 24.8% were aged 50-59 and 30.2% were ≥60 years. Post-operative histology revealed acute appendicitis in 82.4% of the group. In 11% of the patients, the histology revealed the presence of other benign pathology as mucocele of the appendix, acute diverticulitis, follicular hyperplasia, and fibrous obliteration. The diagnosis of appendicular malignancy was seen in 1.9%. Conclusion Incidental appendiceal cancers in the resected specimens after acute appendicitis are rare but may be associated with a poor prognosis. It is recommended to consider such diagnosis in particular when dealing with acute appendicitis in older patients with longer symptom history, and in presence of peri-appendicular mass.
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Affiliation(s)
- Omotara Lesi
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Sarah-Jane Walton
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | | | - Noreen Rasheed
- Radiology, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Jayasiri Dahanayaka
- General and Breast Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Philip Ideawor
- Pathology, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Abdalla Saad Abdalla Al-Zawi
- General and Breast Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
- General and Breast Surgery, Anglia Ruskin University, Chelmsford, GBR
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Semeraro GC, Cipolla CM, Cardinale DM. Role of Cardiac Biomarkers in Cancer Patients. Cancers (Basel) 2021; 13:5426. [PMID: 34771589 DOI: 10.3390/cancers13215426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Cardiac biomarkers have proved increasingly useful in the various branches of cardiology, not sparing the field of cardio-oncology. With specific reference to the latter subject, they have been investigated as predictors and/or diagnostic and monitoring tools, as well as prognostic factors, with the purpose of allowing the early prevention of many cardiovascular complications related to the direct action of some cancer types or related to the toxicity of its treatments. However, despite this great potential and excellent cost-effectiveness, their usefulness in some areas still seems to be limited due to lack of sufficient specificity or sensitivity. In fact, in clinical practice, while their use is nowadays standard in some circumstances, evidence does not yet support their routine use in other cases. Abstract In patients with cancer—and especially some specific subtypes—the heart can be pathologically affected due to the direct action of the tumor or its secretion products or due to the toxicity of some oncological treatments. Cardiac biomarkers have been investigated as inexpensive and easily accessible tools for prediction, early diagnosis, monitoring, or prognosis of various forms of cancer-related cardiac diseases. However, their clinical usefulness was not always clearly demonstrated in every area of cardioncology. For the identification of anthracycline related cardiotoxicity in the very early stages troponins proved to be more efficient detectors than imaging methods. Nevertheless, the lack of a standardized dosage methodology and of cardiotoxicity specific thresholds, do not yet allow to outline the precise way to employ them in clinical routine and to incorporate them into appropriate diagnostic or managing algorithms. Cardiac biomarkers proved also effective in patients with primary cardiac amyloidosis, in which both troponins and natriuretic peptides were able to predict adverse outcome, and carcinoid heart disease, where a precise diagnostic cut-off for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was identified to screen patients with valvular involvement. Likewise, NT-proBNP proved to be an excellent predictor of postoperative atrial fibrillation (POAF). On the contrary, evidence is still not sufficient to promote the routine use of cardiac biomarkers to early diagnose myocarditis due to immune check points inhibitors (ICIs), radiotherapy induced cardiotoxicity and cardiac complications related to androgenetic deprivation. In this review we present all the evidence gathered so far regarding the usefulness and limitations of these relatively inexpensive diagnostic tools in the field of cardio-oncology.
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Yalçın B, Karnak İ, Orhan D, Oğuz B, Aydın B, Kurucu N, Varan A, Kutluk T. Paediatric appendiceal neuroendocrine tumours: a review of 33 cases from a single center. ANZ J Surg 2021; 92:742-746. [PMID: 34664383 DOI: 10.1111/ans.17284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendiceal neurendocrine tumours (NETs) are rare neoplasms and diagnosis is commonly incidental following appendectomy. We aimed to review our experience with appendiceal NETs. METHODS Records of children with appendiceal NETs were reviewed and data concerning demographic characteristics, clinical findings, surgical procedures, histopathological findings, management and outcomes were recorded. RESULTS Between 1985 and 2021, 33 cases with appendiceal NETs (median age 11.8 years, range 7.8-16; male/female = 10/23) were identified. All but one patients presented with abdominal pain, six had vomiting, four had fever and they underwent appendectomies with presumed diagnosis of acute appendicitis. Abscess drainage and appendectomy was performed in a 16-year-old girl for suspected right ovarian mass, and tumour was positive in the omentum. Histopathological diagnosis was classical carcinoid tumour (NET) in all cases. Median tumour size was 0.9 cm (n = 26, range, 0.1-3.5 cm); tumours were ≤1 cm in 19 cases, 2 cm in one, 3.5 cm in another case. Tumours were located in the tip (n = 11), body (n = 6) and base of appendix (n = 1) (in others data unavailable). In 28 patients with data, tumour extended to submucosa in five, to tunica muscularis in seven, to subserosa in six, to serosa in six, to mesoappendix in three, to periappendiceal fat in one. Three cases were lost to follow-up, 31 cases were alive (median follow-up 53 months). CONCLUSIONS Paediatric appendiceal NETs do not behave aggressively and appendectomy alone is sufficient for tumours ≤2 cm regardless of local invasion. The need for further extensive surgery in tumours >2 cm also remains controversial.
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Affiliation(s)
- Bilgehan Yalçın
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berna Oğuz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burça Aydın
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgün Kurucu
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Varan
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tezer Kutluk
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Torii A, Oki M, Ishii Y, Yamada A, Shigematsu F, Ishida A, Niwa H, Kogure Y, Kitagawa C, Saka H. The Role of Rigid Bronchoscopic Intervention for Bronchial Carcinoid. TOHOKU J EXP MED 2021; 255:105-110. [PMID: 34645769 DOI: 10.1620/tjem.255.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bronchial carcinoid is a rare malignant tumor that is categorized as a typical carcinoid or atypical carcinoid. Many institutions use flexible bronchoscopy for diagnosis. However, due to the hemorrhagic nature of the tumor, the amount of specimen obtained is often small, making it difficult to obtain an accurate diagnosis. The use of rigid bronchoscopy may not only contribute to obtaining a diagnosis but also be beneficial in the treatment plan. The aim of this study was to evaluate the efficacy of rigid bronchoscopic interventions for the diagnosis and treatment of bronchial carcinoids. All patients with bronchial carcinoids who underwent rigid bronchoscopic intervention under general anesthesia at our institution between June 2006 and August 2018 were analyzed retrospectively. Eight patients [3 men and 5 women; median age, 71 years (range 45-82 years)] were eligible for the analysis. None of the cases had accurate subtyping preoperatively before intervention. In contrast, all cases were diagnosed as carcinoid with subtypes (5 patients had typical carcinoid and 3 had atypical carcinoid) following rigid bronchoscopic intervention. All respiratory symptoms improved immediately after the procedure. One instance of bleeding occurred, and was easily controlled by argon plasma coagulation and intraluminal administration of epinephrine under flexible and rigid bronchoscopy. Four patients (3 with typical carcinoid and 1 with atypical carcinoid) underwent radical surgery sequentially, and no recurrences were observed. We conclude that rigid bronchoscopic intervention is safe and effective for accurate diagnosis and improvement of respiratory symptoms in patients with bronchial carcinoids.
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Affiliation(s)
- Atsushi Torii
- Department of Respiratory Medicine, Nagoya Medical Center
| | - Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center
| | - Yurika Ishii
- Department of Respiratory Medicine, Nagoya Medical Center
| | - Arisa Yamada
- Department of Respiratory Medicine, Nagoya Medical Center
| | | | - Akane Ishida
- Department of Respiratory Medicine, Nagoya Medical Center
| | - Hideyuki Niwa
- Department of Respiratory Medicine, Nagoya Medical Center
| | | | | | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center
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Matrood S, Apostolidis L, Schrader J, Krug S, Lahner H, Ramaswamy A, Librizzi D, Kender Z, Kröcher A, Kreutzfeldt S, Gress TM, Rinke A. Multicenter Analysis of Presacral Neuroendocrine Neoplasms-Clinicopathological Characterization and Treatment Outcomes of a Rare Disease. Front Endocrinol (Lausanne) 2021; 12:709256. [PMID: 34690926 PMCID: PMC8527170 DOI: 10.3389/fendo.2021.709256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Neuroendocrine neoplasms (NENs) of the presacral space are an extremely rare disease entity with largely unknown outcome and no established standard of care treatment. Therefore, we wanted to analyze clinical presentation, histopathological findings, treatment outcomes, and prognosis in a multicentric patient cohort. Methods We searched local databases of six German NEN centers for patients with presacral NEN. Retrospective descriptive analyses of age, sex, stage at diagnosis, symptoms, grade, immunohistochemical investigations, biomarkers, treatment, and treatment outcome were performed. Kaplan-Meier analysis was used to determine median overall survival. Results We identified 17 patients (11 female, 6 male) with a median age of 50 years (range, 35-66) at diagnosis. Twelve cases presented initially with distant metastases including bone metastases in nine cases. On pathological review the majority of patients had well-differentiated G2 tumors. Immunohistochemical profile resembled rectal NENs. All but one patient had non-functioning tumors. Somatostatin receptor imaging was positive in 14 of 15 investigated cases. Eight patients were treated surgically including palliative resections; 14 patients received somatostatin analogs with limited efficacy. With 14 PRRTs completed, 79% showed clinical benefit, whereas only one patient with neuroendocrine carcinoma (NEC) responded to chemotherapy. Treatment with everolimus in three patients was not successful, whereas cabozantinib resulted in a disease stabilization in a heavily pretreated patient. During a median observation period of 44.5 months, 6 patients died. Median overall survival was not reached. Conclusion Presacral NEN are histopathologically similar to rectal NENs. Presacral NEN should be considered as possible primary in NEN of unknown primary. The majority of tumors is non-functioning and somatostatin receptor positive. PRRT demonstrated promising activity; tyrosine kinase inhibitors warrant further investigations. Further molecular characterization and prospective evaluation of this rare tumor entity are needed.
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Affiliation(s)
- Sami Matrood
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps University, Marburg, Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Schrader
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Krug
- Clinic for Internal Medicine I, Martin-Luther University Halle/Wittenberg, Halle, Germany
| | - Harald Lahner
- Department of Endocrinology and Metabolism, University Hospital Essen, Essen, Germany
| | - Annette Ramaswamy
- Institute of Pathology, UKGM Marburg and Philipps University, Marburg, Germany
| | - Damiano Librizzi
- Department of Nuclear Medicine, UKGM Marburg and Philipps University, Marburg, Germany
| | - Zoltan Kender
- Department of Internal Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Kröcher
- Clinic for Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Simon Kreutzfeldt
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Matthias Gress
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps University, Marburg, Germany
| | - Anja Rinke
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps University, Marburg, Germany
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Ichimata M, Nishiyama S, Matsuyama F, Fukazawa E, Harada K, Katayama R, Toshima A, Kagawa Y, Yamagami T, Kobayashi T. Long-term survival in a dog with primary hepatic neuroendocrine tumor treated with toceranib phosphate. J Vet Med Sci 2021; 83:1554-1558. [PMID: 34408099 PMCID: PMC8569883 DOI: 10.1292/jvms.21-0254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Primary hepatic neuroendocrine tumors (PHNETs) are rare in dogs, and limited information exists about the treatment of these tumors. A 12-year-old castrated male French bulldog was presented to our clinic with gastrointestinal signs. Diagnostic tests revealed increased hepatic enzyme levels, a mass in the hepatic quadrate lobe, multiple intrahepatic nodules, and enlarged hepatic hilar lymph nodes. The liver mass was diagnosed cytologically as a malignant epithelial tumor suspected to be of neuroendocrine origin. The dog was treated with single-agent toceranib phosphate (TOC) and survived 25.1 months after the initial presentation. On necropsy, a liver mass was found and was subsequently diagnosed as a PHNET on histopathology. To the best of our knowledge, this is the first report of long-term survival in a dog with PHNET treated with TOC.
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Affiliation(s)
- Masanao Ichimata
- Japan Small Animal Cancer Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | | | - Fukiko Matsuyama
- Japan Small Animal Cancer Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | - Eri Fukazawa
- Japan Small Animal Cancer Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | - Kei Harada
- Japan Small Animal Cancer Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | - Ryuzo Katayama
- Japan Small Animal Cancer Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | - Atsushi Toshima
- Japan Small Animal Medical Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | - Yumiko Kagawa
- North Lab., 8-35 Hondori, 2 Kita, Shiroishi-ku, Sapporo, Hokkaido 003-0027, Japan
| | - Tetsushi Yamagami
- Japan Small Animal Medical Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
| | - Tetsuya Kobayashi
- Japan Small Animal Cancer Center, 1-10-4 Higashi-Tokorozawa, Tokorozawa-shi, Saitama 359-0023, Japan
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Zvizdic Z, Milisic E, Ibisevic N, Pasic IS, Vranic S. Appendiceal carcinoid in a pediatric patient with Peutz-Jeghers syndrome: A case report and comprehensive literature review. Medicine (Baltimore) 2021; 100:e27389. [PMID: 34596162 PMCID: PMC8483869 DOI: 10.1097/md.0000000000027389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population. PATIENT CONCERNS We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted. DIAGNOSIS A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a "coffee bean" appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps. INTERVENTIONS An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed. OUTCOMES Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences. LESSONS Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermina Ibisevic
- Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Irmina Sefic Pasic
- Department of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
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Mohib O, Papleux E, Remmelink M, Gottignies P, De Bels D. An ectopic Cushing's syndrome as a cause of severe refractory hypokalemia in the ICU. Acta Clin Belg 2021; 76:373-378. [PMID: 32089125 DOI: 10.1080/17843286.2020.1734162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Ectopic Cushing's syndrome is a very rare condition caused by an ACTH-secreting tumor outside the pituitary or adrenal glands, and the majority of these cases are encountered in the context of paraneoplastic syndromes. The ectopic source of ACTH secretion is not always obvious to detection and can be challenging. We report a rare case, in which a hidden ACTH-secreting carcinoid tumor of the lung caused a severe refractory hypokalemia, leading us to a race against time to locate the tumor.Case presentation: A 33-year-old young male was admitted to the ICU for the management of a severe hypokalemia, and complains from several months of depression, increased weight, disabling non-radiating dorsal lower back pain and refractory arterial hypertension. The physical examination immediately suggested a Cushing's syndrome. The 24-h cortisoluria confirmed hypercortisolism and the increased ACTH level was oriented towards ACTH-dependent Cushing's syndrome. Thereafter, a dexamethasone suppression test was negative, indicating in favor of ectopic ACTH secretion. The etiological assessment via imaging and isotopes revealed a solitary pulmonary nodule at the right lower lobe estimated at 18 mm, the resection and anatomopathological analysis of which led to the diagnosis of carcinoid pulmonary tumor, and resolved hypercortisolism and its complications.Conclusion: A delayed diagnosis of Cushing's syndrome result in a consequent morbi-mortality, mainly due to cardiovascular events. The optimal treatment for ectopic Cushing's syndrome is surgical resection, thus making the localization of the tumor a key element.
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Affiliation(s)
- Othmane Mohib
- Internal Medicine Department, Brugmann University Hospital, Brussels, Belgium
| | | | - Myriam Remmelink
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Gottignies
- Department of Emergency and Intensive Care, IRIS Hospitals South, Brussels, Belgium
| | - David De Bels
- Department of Intensive Care, Brugmann University Hospital, Brussels, Belgium
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Pelosi G, Travis WD. The Ki-67 antigen in the new 2021 World Health Organization classification of lung neuroendocrine neoplasms. Pathologica 2021; 113:377-387. [PMID: 34837096 PMCID: PMC8720414 DOI: 10.32074/1591-951x-542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 01/14/2023] Open
Abstract
Prof. Rosai's work has permeated the surgical pathology in many fields, including the 2017 World Health Organization classification on tumors of endocrine organs and pulmonary neuroendocrine cell pathology, with stimulating contributions which have also anticipated the subsequent evolution of knowledge. Among the many studies authored by Prof. Rosai, we would like to recall one of which whose topic has been encased in the new 2021 World Health Organization classification on lung tumors. This is an eminently practical paper dealing with the use of the proliferation antigen Ki-67 in lung neuroendocrine neoplasms. While these neoplasms are primarily ranked upon histologic features and Ki-67 labeling index does not play any role in classification, diagnostic dilemmas may however arise in severely crushed biopsy or cytology samples where this marker proves helpful to avoid misdiagnoses of carcinoids as small cell carcinoma. Another application of Ki-67 labeling index endorsed by the 2021 World Health Organization classification regards, alongside mitotic count, the emerging recognition of lung atypical carcinoids with increased mitotic or proliferation rates, whose biological boundaries straddle a subset of large cell neuroendocrine carcinoma. This article focuses on these two practical applications of the proliferation marker Ki-67 in keeping with the 2021 World Health Organization classification, which provides standards for taxonomy, diagnosis and clinical decision making in lung neuroendocrine neoplasm patients.
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Affiliation(s)
- Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - William D. Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
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43
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Ghemigian A, Carsote M, Sandru F, Petca RC, Oproiu AM, Petca A, Valea A. Neuroendocrine neoplasia and bone (Review). Exp Ther Med 2021; 22:1219. [PMID: 34584564 DOI: 10.3892/etm.2021.10653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/29/2021] [Indexed: 12/12/2022] Open
Abstract
This is a narrative review focusing on neuroendocrine neoplasia (NEN) and bone status, in terms of metastases and osteoporosis/fractures. One fifth of NEN have skeletal dissemination, this affinity being regulated by intrinsic tumor factors such as the C-X-C chemokine receptor 4 (CXCR4). Bone colonization impairs the patient quality of life, representing a surrogate of reduced survival. Patients with NEN without bone metastases may exhibit low bone mineral density, perhaps carcinoid-related osteoporosis, yet not a standardized cause of osteoporosis. Case-finding strategies to address bone health in NEN with a good prognosis are lacking. Contributors to fractures in NEN subjects may include: menopausal status and advanced age, different drugs, induced hypogonadism, malnutrition, malabsorption (due to intestinal resection, carcinoid syndrome), hypovitaminosis D, impaired glucose profile (due to excessive hormones such as glucagon, somatostatinoma or use of somatostatin analogues), various corticoid regimes, and high risk of fall due to sarcopenia. Pheocromocytoma/paraganglioma involve bone through malignant forms (bone is an elective site) and potential secondary osteoporosis due to excessive hormonal content and increased sympathetic activity which is a key player of bone microarchitecture/quality as reflected by low Trabecular Bone Score. Glucocorticoid osteoporosis is related to NEN-associated ectopic Cushing syndrome. Currently, there are a lack of studies to emphasis that excessive gut-derivate serotonin in NENs with carcinoid syndrome is a specific activator of bone loss thus a contributor to carcinoid-related osteoporosis.
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Affiliation(s)
- Adina Ghemigian
- Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Elias' Emergency University Hospital, 011461 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 061344 Bucharest, Romania
| | - Ana-Maria Oproiu
- Department of Plastic and Reconstructive Surgery, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, 'I. Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.,Department of Endocrinology, Clinical County Hospital, 400000 Cluj-Napoca, Romania
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Lauricella E, Cives M, Bracigliano A, Clemente O, Felici V, Lippolis R, Amoruso B, Pelle' E, Mandriani B, Esposto C, Forte C, Perri F, Porta C, Tafuto S. The psychological impact of COVID-19 pandemic on patients with neuroendocrine tumors: Between resilience and vulnerability. J Neuroendocrinol 2021; 33:e13041. [PMID: 34596289 PMCID: PMC8646700 DOI: 10.1111/jne.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/06/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has added another layer of complexity to the fears of patients with neuroendocrine tumors (NETs). Little is known regarding the psychological impact of the COVID-19 outbreak on patients with gastroenteropancreatic or bronchopulmonary (BP) NETs. We longitudinally surveyed the mental symptoms and concerns of NET patients during the plateau phase of the first (W1) and second epidemic waves (W2) in Italy. Seven specific constructs (depression, anxiety, stress, health-related quality of life, NET-related quality of life, patient-physician relationship, psychological distress) were investigated using validated screening instruments, including DASS-21, EORTC QLQ-C30, EORTC QLQ GI.NET21, PDRQ9 and IES-R. We enrolled 197 patients (98 males) with a median age of 62 years. The majority of the patients had G1/G2 neoplasms. Some 38% of the patients were on active treatment. At W1, the prevalence of depression, anxiety and stress was 32%, 36% and 26% respectively. The frequency of depression and anxiety increased to 38% and 41% at W2, whereas no modifications were recorded in the frequency of stress. Poor educational status was associated with higher levels of anxiety at both W1 (odds ratio [OR] = 1.33 ± 0.22; p = .07) and W2 (OR = 1.45 ± 0.26; p = .03). Notably, post-traumatic stress symptoms were observed in the 58% of the patients, and both single marital status (OR = 0.16, 95% confidence interval [CI] = 0.06-0.48; p = .0009) and low levels of formal education (OR = 0.47, 95% CI = 0.23-0.99; p = .05) predicted their occurrence. No significant deteriorations of health-related quality of life domains were observed from W1 to W2. High patient care satisfaction was documented despite the changes in health systems resource allocation. NET patients have an increased risk of developing post-traumatic stress symptoms as result of the COVID-19 pandemic. Specific screening measures and psychological interventions should be implemented in NET clinics to prevent, recognize and treat mental distress in this vulnerable population.
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Affiliation(s)
- Eleonora Lauricella
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Mauro Cives
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
- National Cancer Institute, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Ottavia Clemente
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Valentina Felici
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Rossella Lippolis
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Brunella Amoruso
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Eleonora Pelle'
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Barbara Mandriani
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Chiara Esposto
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Cira Forte
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Francesco Perri
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Salvatore Tafuto
- Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Naples, Italy
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45
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Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management. Therap Adv Gastroenterol 2021; 14:17562848211038771. [PMID: 34484423 PMCID: PMC8414617 DOI: 10.1177/17562848211038771] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 02/04/2023] Open
Abstract
Autoimmune gastritis (AIG) is a chronic immune-mediated, inflammatory condition that involves the destruction of the gastric oxyntic mucosa through the autoimmune-mediated loss of parietal cells, with replacement by atrophic and metaplastic tissue. Diagnosing AIG is important, given the need for ongoing clinical management and vigilance with respect to downstream complications, the most serious of which is gastric adenocarcinoma. Other clinical consequences include gastric neuroendocrine tumors, consequences related to decreased gastric acid and decreased intrinsic factor due to parietal cell destruction and antibodies against intrinsic factor (e.g. micronutrient deficiencies), as well as concomitant autoimmune disorders. Considering the prevalence of AIG and the potential for severe clinical outcomes, it is important to engage in efforts to reduce practice pattern variability related to diagnosis and management. Accordingly, herein, we review of the epidemiology, pathogenesis, clinical presentation of AIG, including both gastric and extragastric manifestations, and provide an overview of clinical management.
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Affiliation(s)
- Sheila D Rustgi
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Priyesha Bijlani
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Shailja C Shah
- Section of Gastroenterology, VA San Diego Healthcare System, 3350 La Jolla Villa Drive, San Diego, CA 92161, USA
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46
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Abstract
Gastric neuroendocrine tumor (gNET) is a rare carcinoid of the stomach whose incidence is increasing due to widespread use of upper gastrointestinal endoscopy (UGIE). There are four types of gNETs with different management strategies and prognosis. Here, we present a patient who came with abdomen pain and intermittent melena. UGIE showed a sessile polyp in the stomach. The patient subsequently underwent polypectomy and was symptomatically relieved.
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Affiliation(s)
- Naresh Kargwal
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Viraj Panda
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Abhijeet Jha
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
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47
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Saito K, Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kato S, Hanaoka M. Short- and Long-Term Outcomes of Robotic Surgery for Rectal Neuroendocrine Tumor. Surg Innov 2021; 29:315-320. [PMID: 34228945 DOI: 10.1177/15533506211030436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The optimal radical surgical approach for rectal neuroendocrine tumor (NET) is unknown. Methods. This study evaluated the short- and long-term outcomes of 27 patients who underwent robotic radical surgery for rectal NET between 2011 and 2019. Results. The median distance from the lower border of the tumor to the anal verge was 5.0 cm. The median tumor size was 9.5 mm. Six patients (22%) had lymph node metastasis. The incidences of postoperative complications of grade II and grade III or more according to the Clavien-Dindo classification were 11% and 0%, respectively. All patients underwent sphincter-preserving surgery, and no patients required conversion to open surgery. The median follow-up time was 48.9 months, and both the 3-year overall survival and relapse-free survival rates were 100%. Conclusions. Short- and long-term outcomes of robotic surgery for rectal NET tumor were favorable. Robotic surgery may be a useful surgical approach for rectal NET.
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Affiliation(s)
- Kentaro Saito
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shunichiro Kato
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Marie Hanaoka
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
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48
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Foster JH, Sher A, Seghers V, Poston J, Wells D, Delpassand ES, Potter S, Mahajan P, Venkatramani R. Peptide receptor radionuclide therapy for treatment of metastatic neuroendocrine tumors in children. Pediatr Blood Cancer 2021; 68:e29056. [PMID: 33844446 DOI: 10.1002/pbc.29056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/10/2022]
Abstract
Neuroendocrine tumors (NETs) of the pancreas and midgut are extremely rare in children, and patients presenting with metastatic disease have poor survival. Given this rarity, treatments are extrapolated from guidelines for adults with NET. Recent clinical trials in adults with NETs have shown that the addition of peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTATATE resulted in a disease control rate of nearly 80%, with minimal side effects. We report our experience using 177 Lu-DOTATATE to treat two pediatric patients with metastatic NET.
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Affiliation(s)
- Jennifer H Foster
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Andrew Sher
- Edward B. Singleton Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Victor Seghers
- Edward B. Singleton Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Jay Poston
- Edward B. Singleton Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Donald Wells
- Dell Children's Medical Center, Austin, Texas, USA
| | | | - Samara Potter
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Priya Mahajan
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Rajkumar Venkatramani
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
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Raptis D, Savvides E, Langas G, Chatzimavroudis G, Papaziogas B. Neuroendocrine neoplasm of the cystic duct: report of two cases and literature review. Hippokratia 2021; 25:141-144. [PMID: 36683907 PMCID: PMC9851141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neuroendocrine neoplasm (NEN) of the cystic duct (CD) is an extremely rare entity, with misty clinical manifestation and incidental, in most cases, diagnosis. Due to its rarity, several dilemmas arise concerning the optimal treatment of this type of malignancy. CASE DESCRIPTION We report two cases of histologically confirmed NENs of the CD from our institution. Furthermore, we present a literature review focusing on the treatment type and likelihood of recurrence. The two patients underwent laparoscopic cholecystectomy (CCE) due to cholelithiasis and were both diagnosed with well-differentiated Grade 1 (G1) NEN. The first patient did not undergo further treatment as the surgical margins were clear. Regarding the second patient, complementary resection of the CD remnant was performed since the histopathological diagnosis indicated positive surgical margins. Active postoperative surveillance was suggested, and both patients remain disease-free to date. In the literature, we identified 22 previous cases of NENs of CD. Since there are still no standard guidelines, various surgical plans were adopted, varying from simple CCE to hepatic lobectomy and Roux en Y hepaticojejunostomy. Postoperative surveillance is reported for up to four years. Regardless of the implicated treatment plan, no patient was diagnosed with recurrent malignancy and the mortality rate was very low (1/22). CONCLUSION We propose that cholecystectomy with ligation of the CD proximal to its junction with the common hepatic duct is an adequate oncological treatment for G1 NENs of the CD. When preoperative or perioperative suspicion for malignancy is made, a frozen section of the CD should be sent for pathological examination to confirm radical resection (R0). Nevertheless, there is a need for further research that could validate our findings. HIPPOKRATIA 2021, 25 (3):141-144.
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Affiliation(s)
- D Raptis
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Savvides
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Langas
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Chatzimavroudis
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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50
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Blazevic A, Starmans MPA, Brabander T, Dwarkasing RS, van Gils RAH, Hofland J, Franssen GJH, Feelders RA, Niessen WJ, Klein S, de Herder WW. Predicting symptomatic mesenteric mass in small intestinal neuroendocrine tumors using radiomics. Endocr Relat Cancer 2021; 28:529-539. [PMID: 34003139 DOI: 10.1530/erc-21-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/08/2022]
Abstract
Metastatic mesenteric masses of small intestinal neuroendocrine tumors (SI-NETs) are known to often cause intestinal complications. The aim of this study was to identify patients at risk to develop these complications based on routinely acquired CT scans using a standardized set of clinical criteria and radiomics. Retrospectively, CT scans of SI-NET patients with a mesenteric mass were included and systematically evaluated by five clinicians. For the radiomics approach, 1128 features were extracted from segmentations of the mesenteric mass and mesentery, after which radiomics models were created using a combination of machine learning approaches. The performances were compared to a multidisciplinary tumor board (MTB). The dataset included 68 patients (32 asymptomatic, 36 symptomatic). The clinicians had AUCs between 0.62 and 0.85 and showed poor agreement. The best radiomics model had a mean AUC of 0.77. The MTB had a sensitivity of 0.64 and specificity of 0.68. We conclude that systematic clinical evaluation of SI-NETs to predict intestinal complications had a similar performance than an expert MTB, but poor inter-observer agreement. Radiomics showed a similar performance and is objective, and thus is a promising tool to correctly identify these patients. However, further validation is needed before the transition to clinical practice.
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Affiliation(s)
- Anela Blazevic
- Department of Internal Medicine, section Endocrinology, Erasmus MC, Rotterdam,the Netherlands
| | - Martijn P A Starmans
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Tessa Brabander
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Roy S Dwarkasing
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Renza A H van Gils
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Johannes Hofland
- Department of Internal Medicine, section Endocrinology, Erasmus MC, Rotterdam,the Netherlands
| | | | - Richard A Feelders
- Department of Internal Medicine, section Endocrinology, Erasmus MC, Rotterdam,the Netherlands
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
- Faculty of Applied Sciences, Department of Radiology and Nuclear Medicine, Delft University of Technology, Delft, the Netherlands
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Wouter W de Herder
- Department of Internal Medicine, section Endocrinology, Erasmus MC, Rotterdam,the Netherlands
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