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Pokhrel A, Wu R, Wang JC. Review of Merkel cell carcinoma with solitary pancreatic metastases mimicking primary neuroendocrine tumor of the pancreas. Clin J Gastroenterol 2023; 16:641-662. [PMID: 37421584 DOI: 10.1007/s12328-023-01821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE/BACKGROUND Merkel cell carcinoma (MCC) but metastases to the pancreas are very rare. There are only a few cases of isolated metastases of MCC to the pancreas. Because of this rarity, it can be wrongly diagnosed as a neuroendocrine tumor of the pancreas(pNET), especially the poorly differentiated neuroendocrine carcinoma (PNEC) subtype, in which the treatment is vastly different than that of MCC with isolated metastases of the pancreas. METHODS An electronic search of the PubMed and google scholar databases was performed to obtain the literature on MCC with pancreatic metastases, using the following search terms: Merkel cell carcinoma, pancreas, and metastases. Results are limited to the following available article types: case reports and case series. We identified 45 cases of MCC with pancreatic metastases from the PubMed and Google Scholar database search and examined their potential relevance. Only 22 cases with isolated pancreatic metastases were taken for review including one case that we encountered. RESULTS The results from our review of cases of isolated pancreatic metastases of MCC were compared to the characteristics of the poorly differentiated pancreatic neuroendocrine tumor (PNEC). We found the following: (a) MCC with isolated pancreatic metastases occurred at an older age than PNEC and with male gender predominance (b) Most of the metastases occurred within 2 years of initial diagnosis of MCC (c) Resection of pancreatic mass was the first line treatment in case of resectable PNECs whereas resection of metastases was infrequently performed in MCC with pancreatic metastases.
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Affiliation(s)
- Akriti Pokhrel
- Department of Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Richard Wu
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Department of Pathology, Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
- Department of Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
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2
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Tyriakidis K, Stadlmann S, Pederiva S. Long-Lasting Complete Remission of Small-Cell Carcinoma of the Pancreas with Carboplatin and Etoposide Complicated by Gallbladder Adenocarcinoma Diagnosed during Follow-Up. Case Rep Oncol 2021; 14:365-370. [PMID: 33776730 PMCID: PMC7983696 DOI: 10.1159/000514048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022] Open
Abstract
Small-cell carcinoma of the pancreas (PSCC) is a highly aggressive neoplasia with a dismal prognosis. It is extremely rare, with only a few cases reported in the literature. There is a paucity of clinical data to guide management and since the disease is mainly diagnosed at an advanced stage standard treatment consists of chemotherapy based upon treatment protocols used for small-cell lung cancer. We report the case of a female diagnosed with PSCC who achieved complete clinical remission after treatment with carboplatin and etoposide. During a 3-year follow-up the patient developed a gallbladder adenocarcinoma that was treated by surgical resection but relapsed within 20 months with widespread hematogenous metastasis.
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Affiliation(s)
| | - Sylvia Stadlmann
- Institute of Pathology, Cantonal Hospital Baden, Baden, Switzerland
| | - Stefanie Pederiva
- Department of Medical Oncology, Cantonal Hospital Baden, Baden, Switzerland
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3
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El Rassy E, Tabchi S, Kourie HR, Assi T, Chebib R, Farhat F, Kattan J. Pancreatic small cell cancer. Clin Res Hepatol Gastroenterol 2016; 40:276-280. [PMID: 26566245 DOI: 10.1016/j.clinre.2015.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 02/04/2023]
Abstract
Small cell carcinoma (SCC) is most commonly associated with lung cancer. Extra-pulmonary SCC can originate in virtually any organ system, with the gastrointestinal tract being the most common site of involvement. We review the clinical presentation, pathogenesis, histology, imaging modalities and optimal therapeutic management of PSCC in light of available evidence.
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Affiliation(s)
- Elie El Rassy
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon, Lebanon.
| | - Samer Tabchi
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon, Lebanon
| | - Hampig Raphael Kourie
- Department of Oncology, Jules Bordet Institute, Free University of Brussels (ULB), 1, Héger-Bordet Street, Brussels, Belgium
| | - Tarek Assi
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon, Lebanon
| | - Ralph Chebib
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon, Lebanon
| | - Fadi Farhat
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon, Lebanon
| | - Joseph Kattan
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon, Lebanon
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Esposito I, Segler A, Steiger K, Klöppel G. Pathology, genetics and precursors of human and experimental pancreatic neoplasms: An update. Pancreatology 2015; 15:598-610. [PMID: 26365060 DOI: 10.1016/j.pan.2015.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/02/2015] [Accepted: 08/12/2015] [Indexed: 12/11/2022]
Abstract
Over the past decade, there have been substantial improvements in our knowledge of pancreatic neoplasms and their precursor lesions. Extensive genetic analyses, recently using high-throughput molecular techniques and next-generation sequencing methodologies, and the development of sophisticated genetically engineered mouse models closely recapitulating human disease, have improved our understanding of the genetic basis of pancreatic neoplasms. These advances are paving the way for refined, molecular-based classifications of pancreatic neoplasms with the potential to better predict prognosis and, possibly, response to therapy. Another major development resides in the identification of subsets of pancreatic exocrine and endocrine neoplasms which occur in the context of hereditary syndromes and whose genetic basis and tumor development have been at least partially defined. However, despite all molecular progress, correct and careful morphological characterization of tissue specimens both in the context of experimental and routine diagnostic pathology represents the basis for any further genetic investigation or clinical decision. This review focuses on the current and new concepts of classification and on the current models of tumor development, both in the field of exocrine and endocrine neoplasms, and underscores the importance of applying standardized terminology to allow adequate data interpretation and promote scientific exchange in the field of pancreas research.
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Affiliation(s)
- Irene Esposito
- Institute of Pathology, Heinrich-Heine-University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Angela Segler
- Institute of Pathology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Günter Klöppel
- Institute of Pathology, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
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5
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Basturk O, Tang L, Hruban RH, Adsay NV, Yang Z, Krasinskas AM, Vakiani E, La Rosa S, Jang KT, Frankel WL, Liu X, Zhang L, Giordano TJ, Bellizzi AM, Chen JH, Shi C, Allen P, Reidy DL, Wolfgang CL, Saka B, Rezaee N, Deshpande V, Klimstra DS. Poorly differentiated neuroendocrine carcinomas of the pancreas: a clinicopathologic analysis of 44 cases. Am J Surg Pathol 2014; 38:437-47. [PMID: 24503751 PMCID: PMC3977000 DOI: 10.1097/pas.0000000000000169] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the pancreas, poorly differentiated neuroendocrine carcinomas include small cell carcinoma and large cell neuroendocrine carcinoma and are rare; data regarding their pathologic and clinical features are very limited. DESIGN A total of 107 pancreatic resections originally diagnosed as poorly differentiated neuroendocrine carcinomas were reassessed using the classification and grading (mitotic rate/Ki67 index) criteria put forth by the World Health Organization in 2010 for the gastroenteropancreatic system. Immunohistochemical labeling for neuroendocrine and acinar differentiation markers was performed. Sixty-three cases were reclassified, mostly as well-differentiated neuroendocrine tumor (NET) or acinar cell carcinoma, and eliminated. The clinicopathologic features and survival of the remaining 44 poorly differentiated neuroendocrine carcinomas were further assessed. RESULTS The mean patient age was 59 years (range, 21 to 82 y), and the male/female ratio was 1.4. Twenty-seven tumors were located in the head of the pancreas, 3 in the body, and 11 in the tail. The median tumor size was 4 cm (range, 2 to 18 cm). Twenty-seven tumors were large cell neuroendocrine carcinomas, and 17 were small cell carcinomas (mean mitotic rate, 37/10 and 51/10 HPF; mean Ki67 index, 66% and 75%, respectively). Eight tumors had combined components, mostly adenocarcinomas. In addition, 2 tumors had components of well-differentiated NET. Eighty-eight percent of the patients had nodal or distant metastatic disease at presentation, and an additional 7% developed metastases subsequently. Follow-up information was available for 43 patients; 33 died of disease, with a median survival of 11 months (range, 0 to 104 mo); 8 were alive with disease, with a median follow-up of 19.5 months (range, 0 to 71 mo). The 2- and 5-year survival rates were 22.5% and 16.1%, respectively. CONCLUSIONS Poorly differentiated neuroendocrine carcinoma of the pancreas is a highly aggressive neoplasm, with frequent metastases and poor survival. Most patients die within less than a year. Most (61%) are large cell neuroendocrine carcinomas. Well-differentiated NET and acinar cell carcinoma are often misdiagnosed as poorly differentiated neuroendocrine carcinoma, emphasizing that diagnostic criteria need to be clearly followed to ensure accurate diagnosis.
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Affiliation(s)
- Olca Basturk
- Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Laura Tang
- Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ralph H. Hruban
- Departments of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD
| | | | - Zhaohai Yang
- Departments of Pathology, Penn State Hershey MC, Hershey, PA
| | | | - Efsevia Vakiani
- Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Stefano La Rosa
- Departments of Pathology, Ospedale di Circolo, Varese, Italy
| | - Kee-Taek Jang
- Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Xiuli Liu
- Departments of Pathology, Cleveland Clinic, Cleveland, OH
| | - Lizhi Zhang
- Departments of Pathology, Mayo Clinic, Rochester, MN
| | | | - Andrew M. Bellizzi
- Departments of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Jey-Hsin Chen
- Departments of Pathology, Indiana University, Indianapolis, IN
| | - Chanjuan Shi
- Departments of Pathology, Vanderbilt University, Nashville, TN
| | - Peter Allen
- Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Diane L. Reidy
- Department of Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christopher L. Wolfgang
- Departments of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD
- Departments of Surgery, The Johns Hopkins University, Baltimore, MD
| | - Burcu Saka
- Departments of Pathology, Emory University, Atlanta, GA
| | - Neda Rezaee
- Departments of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD
- Departments of Surgery, The Johns Hopkins University, Baltimore, MD
| | - Vikram Deshpande
- Departments of Pathology, Massachusetts General Hospital, Boston, MA
| | - David S. Klimstra
- Departments of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Ramella Munhoz R, de Mendonça Rego JF, de Celis Ferrari AR, Ignez Braghiroli M, Mendonça Bariani G, Marcelo Hoff P, Perego Costa F, Eduardo Flesch Pfiffer T, Riechelmann R. Combination of irinotecan and a platinum agent for poorly differentiated neuroendocrine carcinomas. Rare Tumors 2013; 5:e39. [PMID: 24179651 PMCID: PMC3804814 DOI: 10.4081/rt.2013.e39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 01/17/2023] Open
Abstract
Extrapulmonary poorly differentiated neuroendocrine carcinoma (PDNEC) is a rare and highly aggressive neoplasm for which the optimal chemotherapy remains unclear. The objective of this study was to evaluate the outcomes of patients with PDNEC treated with cisplatin and irinotecan (IP) and perform a review of the literature. From 2008 to 2012, patients with advanced PDNEC (Ki67≥20%) who received the IP combination were selected for analysis. Radiologic responses were determined through Response Evaluation Criteria In Solid Tumors criteria. Twenty-eight patients were included. The median age at diagnosis was 57 years and the most common presentation was pancreatic PDNEC. Twenty-five patients (89%) received chemotherapy with cisplatin and irinotecan and three received carboplatin and irinotecan. Forty-six percent of the patients achieved objective response and the median time to tumor progression was 3.7 months. The median overall survival was 11.7 months. Thirteen patients (46%) had treatment interruptions or dose reductions due to grade 3/4 toxicity. This retrospective cohort of advanced extrapulmonary PDNEC patients suggests that the IP combination is feasible and resulted in similar response rate and median survival to other treatments previously reported.
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Wang D, Rong Y, Wu W, Jin D. Primary small cell carcinoma of the pancreas: rare type of pancreatic cancer and review of the literatures. World J Surg Oncol 2012; 10:32. [PMID: 22316327 PMCID: PMC3299603 DOI: 10.1186/1477-7819-10-32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 02/08/2012] [Indexed: 12/27/2022] Open
Abstract
Back ground Primary small cell carcinoma of the pancreas (SCCP) is a rare malignancy with an extremely poor prognosis which accounts for 1 to 1.4 percent of all pancreatic malignancies. Case presentation We present the case of a 62-year-old man with a half-month history of upper abdominal discomfort who was diagnosed with SCC of the pancreatic tail. A Chest X-ray showed no evidence of primary lung tumor. The diagnosis of a SCCP was confirmed by post-surgery pathology and immunohistology. In our review of the published reports of SCCP, we only found a few cases reported in the literatures. The diagnosis of SCCP needs the post-surgery pathology and immunohistology and the prognosis of SCCP is extremely poor. There was a significant increase in median survival, from 1 to 6 months, in treated patients compared to patients treated only by symptomatic management. Chemotherapy was the most common treatment and the combination of cisplatin/etoposide was most frequently prescribed. Conclusion The accurate diagnosis of (SCCP) is necessary for determining prognosis and deciding appropriate therapy.
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Affiliation(s)
- Dansong Wang
- Pancreatic cancer group, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Abstract
OBJECTIVES Limited data are available to guide the management of very rare exocrine neoplasms of the pancreas (VREP). Available evidence suggests that VREP have different risk factors and prognoses from those of adenocarcinoma of the pancreas. The primary objectives for this study were to determine the survival, comorbidities, and response to treatment of patients seen at Mayo Clinic with VREP. METHODS We reviewed patients from 1975 to 2005 who had VREP and compared them to patients with adenocarcinomas that were matched for TNM, grade, and decade of treatment. RESULTS Sixty-six patients with VREP were identified. The most commonly identified neoplasms were acinar cell carcinoma (n = 15), small cell carcinoma (n = 12), and squamous cell carcinoma (n = 8). Abdominal discomfort and jaundice were the most common presenting symptoms. The median overall survival for patients with VREP, 10.4 months (range, 3.7-23 months), was better than that for matched controls, 8.2 months (range, 4-15.4 months) (P = 0.01). There was no difference in the survival of patients with stage 4 disease between cases, 8 months (range, 2.3-21.8 months), and controls, 6.7 months (range, 2.3-10.8 months) (P = 0.17). CONCLUSIONS We present one of the largest series of VREP to date. The overall survival of all patients with VREP was better than matched controls, but no statistical difference was seen between the groups with stage 4 disease.
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Sakamoto H, Kitano M, Komaki T, Noda K, Chikugo T, Kudo M. Small cell carcinoma of the pancreas: role of EUS-FNA and subsequent effective chemotherapy using carboplatin and etoposide. J Gastroenterol 2009; 44:432-8. [PMID: 19333541 DOI: 10.1007/s00535-009-0004-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 10/06/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small cell carcinoma (SCC) of the pancreas is a rare entity, with only a few cases reported in the literature. The aim of this study was to evaluate the effectiveness of combination chemotherapy with carboplatin and etoposide (CE) in SCC of the pancreas. METHODS We performed a retrospective analysis of four patients diagnosed with SCC among 279 patients with malignant pancreatic tumors treated between 2000 and 2007. All patients were treated with combination chemotherapy using a schedule consisting of intravenous (IV) carboplatin (150 mg/m(2)) on day 1 and IV etoposide (80 mg/m(2)) on days 1, 2, and 3 every 28 days. RESULTS Pathological diagnosis was confirmed by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) in all patients. Three patients treated with the combination chemotherapy achieved remission, two with a complete response and one with a partial response. The remaining one patient showed no change. One of the two patients with a complete response survived for 56 months following the diagnosis. CONCLUSIONS Combination chemotherapy with CE may be effective for the treatment of SCC of the pancreas; EUS-FNA plays an important role in distinguishing SCC from other pancreatic malignancies, leading to the appropriate treatment being given.
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Affiliation(s)
- Hiroki Sakamoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
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Chung MS, Ha TK, Lee KG, Paik SS. A case of long survival in poorly differentiated small cell carcinoma of the pancreas. World J Gastroenterol 2008; 14:4964-7. [PMID: 18756608 PMCID: PMC2739953 DOI: 10.3748/wjg.14.4964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 07/22/2008] [Accepted: 07/29/2008] [Indexed: 02/06/2023] Open
Abstract
Small cell carcinoma (SCC) of the pancreas is rare. It has similar histological features to pulmonary small cell carcinoma and is equally aggressive. Most patients with SCC in the pancreas reported in case studies died within 1 year after diagnosis. We present a case of unusually long-term survival after surgery and combined chemotherapy for SCC of the pancreas. A 62-year-old woman presented with epigastric pain and jaundice. Computed tomography revealed dilated common bile duct caused by external compression of the mass in the pancreatic head. Exploratory laparotomy and pancreaticoduodenectomy (PPPD) was performed with histopathological analysis confirming a primary small cell carcinoma of the pancreas. After an uneventful postoperative recovery, the patient was treated with 6 cycles of combined chemotherapy consisting of cisplantin and ectoposide. During the follow-up, there was no evidence of recurrence and the patient has remained in a good health condition for 36 mo since the diagnosis.
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Abstract
Extrapulmonary small cell carcinomas (EPSCCs) are uncommon malignant neoplasms with a reported incidence of 0.1% to 0.4% in the United States. Since their first description in 1930, they have been seen in nearly every organ system. Like their more common pulmonary counterparts, EPSCCs are thought to arise from a multipotential stem cell. However, there is recent molecular evidence that small cell elements may arise as a late-stage phenomenon in the genetic progression of more organ-typical carcinomas. The morphologic, immunohistochemical, and ultrastructural features are similar to those described in pulmonary small cell carcinomas (PSCCs). The differential diagnosis of EPSCC includes PSCC, other neuroendocrine tumors, small round blue cell tumors, metastatic melanoma, lymphoma, and poorly differentiated non-small cell carcinomas. Molecular alterations reported to occur in EPSCCs include abnormalities described in PSCC and changes found in carcinomas more typically encountered in the organ from which they arise. In this article we discuss the pathology of EPSCC with a review of theories of histogenesis, sites of occurrence, diagnostic features, differential diagnosis, molecular alterations, and clinical behavior.
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Affiliation(s)
- Shellaine R Frazier
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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12
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Brenner B, Tang LH, Shia J, Klimstra DS, Kelsen DP. Small cell carcinomas of the gastrointestinal tract: clinicopathological features and treatment approach. Semin Oncol 2007; 34:43-50. [PMID: 17270665 DOI: 10.1053/j.seminoncol.2006.10.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Small cell undifferentiated carcinoma (SmCC) of the gastrointestinal tract (GIT) is a rare and highly aggressive malignancy. To date, fewer than 1,000 cases have been reported, with an estimated prevalence of 0.1% to 1% of all gastrointestinal (GI) tumors. Data on the disease are scarce due to its rarity and the fact that most authors have focused on one site within the GIT. In light of the limited data and its perceived similarity to SmCC of the lung, the disease has usually been treated as the latter. Nevertheless, recent clinicopathologic and molecular data imply several differences between the two entities, questioning the extent to which extrapolations from one to the other can be made. We review the available data on GI SmCC with emphasis on outlining its clinicopathologic features and the recommended treatment approach.
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Affiliation(s)
- Baruch Brenner
- Institute of Oncology, Rabin Medical Center, Beilinson Campus, Petach Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Wang RF, Chou YH, Hwang JI, Tiu CM, Chiou HJ, Chen SP, Chiang JH, Tsay SH. Primary small cell carcinoma of the pancreas with an unusual sonographic appearance. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:82-4. [PMID: 17206725 DOI: 10.1002/jcu.20291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We present a case of primary pancreatic small cell carcinoma with an unusual sonographic feature. A 75-year-old woman presented with poor appetite and weight loss. Abdominal sonographic examination revealed a diffusely enlarged pancreas with relative increased echogenicity and smooth contour. CT also confirmed the diffuse infiltrative pattern of the tumor. The diagnosis was confirmed via sonographically guided biopsy. The tumor was composed of small cells with hyperchromatic nuclei and scanty cytoplasm infiltrating the pancreatic tissue, consistent with small cell carcinoma of the pancreas. Primary pancreatic small cell carcinoma rarely presents as the diffuse infiltrating type. These unusual sonographic features must be differentiated from other pancreatic tumors presenting as diffuse pancreatic enlargement.
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Affiliation(s)
- Ruei-Fang Wang
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, and School of Medicine, Fu-Jen Catholic University, no. 95, Wunchang Rd., Shihlin District, Taipei City 111, Taiwan, ROC
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14
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Kinoshita K, Minami T, Ohmori Y, Kanayama S, Yoshikawa K, Tsujimura T. Curative resection of a small cell carcinoma of the pancreas: report of a case of long survival without chemotherapy. J Gastroenterol Hepatol 2004; 19:1087-91. [PMID: 15304133 DOI: 10.1111/j.1440-1746.2004.02910.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 41-year-old asymptomatic man was, by chance, diagnosed as having a mass in the left upper quadrant of the abdomen by ultrasound. Computed tomography and magnetic resonance imaging showed a slightly enhanced heterogeneous mass, measuring about 5 cm in diameter, adjacent to the pancreas tail and spleen. On abdominal angiography the tumor was found to be fed by the splenic artery, and no encasement was observed. At operation the tumor was connected to the pancreas tail and attached to the spleen, and no metastasis was evident. As a result of these observations, a curative resection was performed. On histological examination the tumor cells had no ductal or architectural organization and were continuous to the normal pancreatic tissues. The cells were negative for Grimelius argylphile and the periodic acid schiff stain. Immunohistochemistry indicated that the tumor cells were positive for keratin and epithelial membrane antigen, but negative for chromogranin A, vimentin, alpha1-antitrypsin and alpha1-antichymotrypsin. The tumor was diagnosed as a small cell carcinoma of the pancreas, which is a rare disease. In previously reported cases curative resection of the tumor had not been possible because of its rapid progression and metastasis, and the prognosis is generally very poor. In our case, however, curative resection of the tumor was done, and the patient is healthy with no signs of recurrence for 56 months after the operation and with no additional therapy.
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Affiliation(s)
- Kazuo Kinoshita
- Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan.
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Berkel S, Hummel F, Gaa J, Back W, Hofheinz R, Queisser W, Singer MV, Löhr M. Poorly differentiated small cell carcinoma of the pancreas. A case report and review of the literature. Pancreatology 2004; 4:521-6. [PMID: 15334003 DOI: 10.1159/000080526] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Small cell carcinoma (SCC) of the pancreas is a rare malignancy with an extremely poor prognosis. We present the case of a 74-year-old man with a 2-month history of upper abdominal discomfort who was diagnosed with SCC of the pancreas tail, involvement of peripancreatic and mesenteric lymph nodes and multiple liver metastases (extended disease). A CT scan and a positive somatostatin receptor scintigraphy showed no evidence of a primary lung tumour. The diagnosis of a SCC was confirmed by biopsy. Local tumour control could be achieved by gemcitabine once a week and a long-acting somatostatin analogue once a month, but liver metastasis showed progress. Thus, 5-fluorouracil on a weekly basis was started. The patient died 8 months after diagnosis and had not been hospitalised in the meantime.
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Affiliation(s)
- Simone Berkel
- Department of Medicine II, Mannheim Medical Faculty, University of Heidelberg, Heidelberg, Germany
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16
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Brenner B, Tang LH, Klimstra DS, Kelsen DP. Small-Cell Carcinomas of the Gastrointestinal Tract: A Review. J Clin Oncol 2004; 22:2730-9. [PMID: 15226341 DOI: 10.1200/jco.2004.09.075] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PurposeTo improve our understanding of the entity of small-cell carcinoma (SmCC) of the gastrointestinal (GI) tract.MethodsA MEDLINE search was done, using the terms “small cell carcinoma” or “oat cell carcinoma” combined with “gastrointestinal” or with any of the GI sites, for the period 1970 to 2003. The 138 eligible reports identified in this way were reviewed for clinical data.ResultsTo date, approximately 544 cases of GI SmCC have been reported. The disease represents 0.1% to 1% of all GI malignancies, with the esophagus being the most common primary site. A majority of patients present with overt distant metastases. Systemic symptoms are common; ectopic hormonal secretion may occur. By light microscopy, GI SmCCs are essentially indistinguishable from primary pulmonary SmCC. The presence of non-SmCC components is common. Data from molecular analysis of the disease has identified some similarities to pulmonary SmCC. Chemotherapy represents the main treatment option, with modest impact on survival. In locoregional disease, the literature suggests that treatment be initiated using chemoradiotherapy and then, if metastatic disease is still excluded, surgical resection be considered. The disease is highly aggressive, and survival is in the range of several weeks for untreated patients and of 6 to 12 months for those receiving therapy.ConclusionSmCC of the GI tract is a rare and lethal disease. Although there are many similarities to pulmonary SmCC, some differences between the two entities are suggested. While chemotherapy can achieve significant palliation, surgery may have a potential impact on long-term survival of patients with locoregional disease.
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Affiliation(s)
- Baruch Brenner
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill School of Medicine, Cornell University, New York, NY 10021, USA
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17
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Abstract
The aggressiveness of poorly-differentiated neuroendocrine tumors is similar to small-cell lung cancer within a median survival of 6 months without treatment. Most patients have metastatic disease and poor condition at the time of diagnosis, and cannot be approached surgically with curative intent. Moertel et al. [Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin, Cancer 1991;68:227--232] reported an objective response rate of 67% with a chemotherapy regimen combining etoposide plus cisplatin, with a median survival of 19 months and a median time to progression of 11 months. Since this publication, this regimen has been considered as the reference treatment for poorly-differentiated neuroendocrine tumors. A French retrospective study has recently confirmed the high chemosensitivity of those tumors. However, the prognosis remains poor with a 2-year survival lower than 20% and other therapeutic approaches should be developed.
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Affiliation(s)
- E Mitry
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92104 Boulogne Cedex, France.
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18
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Abstract
BACKGROUND AND OBJECTIVES Small cell carcinoma of the gallbladder is rare with only 36 cases reported in the literature. Early reports demonstrated an extremely poor prognosis for this histologic type. Five new cases are reported and the previous experience in the literature is reviewed to further clarify the clinical behavior of this malignancy. METHODS A retrospective analysis is performed on 5 new cases. An extensive review of the literature is also performed. RESULTS Twenty-eight pure small cell carcinomas and 8 combined small cell carcinomas with adenocarcinoma are reported in the literature. Conclusions from the literature review reveal that small cell carcinoma of the gallbladder affects an elderly patient population (median age 65 years), has a female preponderance (76%), is associated with cholelithiasis (72%), metastasizes to nodes (88%), liver (88%), lung (23%), and peritoneum (19%), and has a median survival of 4 months. Pure tumors had median survivals of 9 months and combined tumors had median survivals of 4.5 months. The 5 patients in the literature treated with surgery and chemotherapy had improved median survival of 13 months. The 5 newly reported cases had similar epidemiological characteristics to the literature data, however, these cases were managed aggressively with surgery and chemotherapy, demonstrating a median survival of 31 months. CONCLUSIONS Although small cell carcinoma of the gallbladder is a distinct histologic and clinical entity, it has many clinical characteristics similar to adenocarcinoma of the gallbladder including comparable natural history and tendency for locoregional spread. Aggressive multimodality therapy, especially the combination of surgery and chemotherapy, may improve survival.
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Affiliation(s)
- T L Moskal
- Department of Upper Gastrointestinal Surgery and Endoscopy, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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19
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Abstract
Small cell undifferentiated carcinoma of the pancreas is a rare neoplasm: Only 12 cases have previously been documented. This paper describes the clinical evolution, immunohistochemical profile, and ultrastructural features of a case occurring in a 37-year-old woman.
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Affiliation(s)
- N G Ordóñez
- University of Texas, M.D. Anderson Cancer Center, Department of Pathology, Houston 77030, USA
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20
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Wahid NA, Neugut AI, Hibshoosh H, Brunetti JC, Fountain KS, Rubin M. Response of small cell carcinoma of pancreas to a small cell lung cancer regimen: a case report. Cancer Invest 1996; 14:335-9. [PMID: 8689428 DOI: 10.3109/07357909609012160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Small cell carcinoma of the pancreas is a very rare malignancy with 18 cases reported in the literature, of which only 3 were treated with chemotherapy. A 52-year-old man was diagnosed with small cell carcinoma originating in the head of the pancreas and invading the duodenum. He was treated with a similar approach as for localized small cell lung cancer, with six cycles of combination chemotherapy and local radiotherapy, and went into complete remission. After 3 months, he developed liver metastases along with an enlarged left supraclavicular lymph node. He was treated with two cycles of CVA, but developed lung metastases and was treated with ifosfamide/mesna. However, his overall condition deteriorated and hospice care was instituted until the patient's demise. The patient survived 14 months following diagnosis, significantly longer than the 15 reported patients with small cell pancreatic carcinomas not treated with chemotherapy. Combination chemotherapy and radiation therapy as it is utilized for small cell lung cancer appear to be beneficial for small cell carcinoma of the pancreas.
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Affiliation(s)
- N A Wahid
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York 10032, USA
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21
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Abstract
Extrapulmonary small cell cancer is rare, but it occurs in a wide variety of sites, where it has a behaviour quite different from the tumours normally found at those sites. Prognosis is generally poor, but combined modality treatment with combination chemotherapy can often achieve useful palliation and, occasionally, long term remission and cure.
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22
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O'Byrne KJ, Goggins MG, McDonald GS, Daly PA, Kelleher DP, Weir DG. A metastatic neuroendocrine anaplastic small cell tumor in a patient with multiple endocrine neoplasia type 1 syndrome. Assessment of disease status and response to doxorubicin, cyclophosphamide, etoposide chemotherapy through scintigraphic imaging with 111In-pentetreotide. Cancer 1994; 74:2374-8. [PMID: 7922988 DOI: 10.1002/1097-0142(19941015)74:8<2374::aid-cncr2820740824>3.0.co;2-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Extrapulmonary small cell and small cell neuroendocrine tumors of unknown primary site are, in general, aggressive neoplasms with a short median survival. Like small cell lung cancer (SCLC), they often are responsive to chemotherapy and radiotherapy. Small cell lung cancer and well differentiated neuroendocrine carcinomas of the gastrointestinal tract and pancreas tend to express somatostatin receptors. These tumors may be localized in patients by scintigraphic imaging using radiolabeled somatostatin analogues. A patient with anaplastic neuroendocrine small cell tumor arising on a background of multiple endocrine neoplasia type 1 syndrome is reported. The patient had a known large pancreatic gastrinoma and previously treated parathyroid adenopathy. At presentation, there was small cell cancer throughout the liver and skeleton. Imaging with a radiolabeled somatostatin analogue, 111In-pentetreotide (Mallinckrodt Medical B. V., Petten, Holland), revealed all sites of disease detected by routine biochemical and radiologic methods. After six cycles of chemotherapy with doxorubicin, cyclophosphamide, and etoposide, there was almost complete clearance of the metastatic disease. 111In-pentetreotide scintigraphy revealed uptake consistent with small areas of residual disease in the liver, the abdomen (in mesenteric lymph nodes), and posterior thorax (in a rib). The primary gastrinoma present before the onset of the anaplastic small cell cancer showed no evidence of response to the treatment. The patient remained well for 1 year and then relapsed with brain, lung, liver, and skeletal metastases. Despite an initial response to salvage radiotherapy and chemotherapy with carboplatin and dacarbazine, the patient died 6 months later.
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Affiliation(s)
- K J O'Byrne
- Department of Clinical Medicine, St. James's Hospital and Trinity College, Dublin, Ireland
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23
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Abstract
A 59 yr old male presented with abdominal pain and jaundice. CT scan showed a tumor in the pancreas with secondaries in the liver, peri-pancreatic lymph nodes, vertebral bone marrow and subcutaneous tissue of the neck together with a cervical lymph node. The patient died after 2 wks and autopsy revealed complete replacement of the pancreas by tumor. Careful dissection of both lungs failed to show any tumor. A diagnosis of primary small cell carcinoma of the pancreas was made. Review of the literature indicates that this type of carcinoma accounts for about 1% of all pancreatic cancers and is commoner in elderly males who have a history of cigarette smoking. There is usually a rapid progression of disease and widespread dissemination, especially if untreated. Some success has been obtained with chemotherapy.
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Affiliation(s)
- R Chetty
- Nuffield Department of Pathology, University of Oxford, John Radcliffe Hospital, Headington, United Kingdom
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24
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O'Connor TP, Wade TP, Sunwoo YC, Reimers HJ, Palmer DC, Silverberg AB, Johnson FE. Small cell undifferentiated carcinoma of the pancreas. Report of a patient with tumor marker studies. Cancer 1992; 70:1514-9. [PMID: 1325274 DOI: 10.1002/1097-0142(19920915)70:6<1514::aid-cncr2820700612>3.0.co;2-c] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Small cell undifferentiated carcinoma of the pancreas is a rare type of pancreatic neoplasm. METHODS The authors report the clinical and pathologic aspects of a patient with this malignant lesion and an extensive serologic and immunohistochemical survey of potential ectopically produced hormones or tumor markers. RESULTS Neuron-specific enolase (NSE) emerged as a tumor marker. CONCLUSIONS NSE could be valuable in the diagnosis and management of other patients with this rare disease.
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Affiliation(s)
- T P O'Connor
- Department of Surgery, John Cochran Veterans Administration Medical Center, St. Louis, MO
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