Multiple endocrine neoplasia type I

Approach of Multiple Endocrine Neoplasia Type 1 (MEN1) Syndrome-Related Skin Tumors

Non-endocrine findings in patients with MEN1 (multiple endocrine neoplasia) syndrome also include skin lesions, especially tumor-type lesions. This is a narrative review of the English-language medical literature including original studies concerning MEN1 and dermatological issues (apart from dermatologic features of each endocrine tumor/neuroendocrine neoplasia), identified through a PubMed-based search (based on clinical relevance, with no timeline restriction or concern regarding the level of statistical significance). We identified 27 original studies involving clinical presentation of patients with MEN1 and cutaneous tumors; eight other original studies that also included the genetic background; and four additional original studies were included. The largest cohorts were from studies in Italy (N = 145 individuals), Spain (N = 90), the United States (N = 48 and N = 32), and Japan (N = 28). The age of patients varied from 18 to 76 years, with the majority of individuals in their forties. The most common cutaneous tumors are angiofibromas (AF), collagenomas (CG), and lipomas (L). Other lesions are atypical nevi, basocellular carcinoma, squamous cell carcinoma, acrochordons, papillomatosis confluens et reticularis, gingival papules, and cutaneous T-cell lymphoma of the eyelid. Non-tumor aspects are confetti-like hypopigmentation, café-au-lait macules, and gingival papules. MEN1 gene, respective menin involvement has also been found in melanomas, but the association with MEN1 remains debatable. Typically, cutaneous tumors (AF, CG, and L) are benign and are surgically treated only for cosmetic reasons. Some of them are reported as first presentation. Even though skin lesions are not pathognomonic, recognizing them plays an important role in early identification of MEN1 patients. Whether a subgroup of MEN1 subjects is prone to developing these types of cutaneous lesions and how they influence MEN1 evolution is still an open issue.

Facial papules as a marker of internal malignancy

Facial papules (bumps) confront the general practitioner during every face-to-face meeting with the patient. Increased awareness and recognition of the facial papules that represent cutaneous signs of internal malignancy will allow an early, aggressive workup and treatment of any associated cancer. This article details the clinical presentation, etiology, pathologic findings, and associated malignancy for such presentations. A skin biopsy for histopathologic diagnosis is necessary to distinguish these clues to underlying malignancy from the numerous benign lesions that cause facial papules.

Anesthetic considerations in the multiple endocrine neoplasia syndromes

PURPOSE OF REVIEW

The multiple endocrine neoplasia (MEN) syndromes present a diverse array of challenges to the anesthesiologist. The tumors and their effects are often underdiagnosed and potentially discovered only when the patient is undergoing surgery for either a component of one of the syndromes or another procedure altogether. This can present the anesthesiologist with a life-threatening situation in the operating room. A thorough understanding of the syndromes, as well as management strategies, will enable the anesthesiologist to handle these patients.

RECENT FINDINGS

Advances in the pharmacologic armamentarium available to physicians have enabled patients with MEN, particularly those with the carcinoid syndrome or pheochromocytoma, to undergo surgery safely, with minimal morbidity and mortality.

SUMMARY

Awareness of the components of the MEN syndromes, as well as careful preoperative preparation, paves the way for a smooth anesthetic and postoperative course in these patients.

Two cases of pancreatic neoplasia in British ferrets (Mustela putorius furo)

Two six-year-old male neutered polecat ferrets (Mustela putorius furo) were presented for the investigation of acute collapse or periodic weakness and weight loss. While blood biochemistry revealed hypoglycaemia in both cases, diagnosis of an insulin-secreting neoplasia was confirmed by exploratory surgery in one case and supported by the use of an insulin assay in the other. Subsequent histopathological examination showed the former to be a pancreatic islet cell carcinoma and the latter to be a pancreatic islet cell adenoma. While neoplasia of the pancreas commonly affects ferrets in the USA, there appears to be only one previous report from the UK.

The early diagnosis of multiple endocrine neoplasia type 1 (MEN 1): a case report

We report the case of a patient presenting amenorrhea, hyperprolactinemia, headache and nuclear magnetic resonance (NMR) evidence of pituitary macroadenoma. The family history revealed that the patient's father had had a referred sporadic insulinoma, removed 25 yr before without evidence of other endocrine disorders. Physical examination evidenced a slight neck enlargement. Among biochemical and endocrinological assays performed, only hyperprolactinemia was observed. Neck ultrasonography (US) revealed a parathyroid enlargement and a 99mTcO4/MIBI scan showed two hyperplasic lesions. Considering the diagnostic suspect of multiple endocrine neoplasia (MEN1), we performed abdominal US and NMR studies, showing a pancreatic lesion compatible with neuroendocrine tumor. A total body 111In-DTPA-d-Phe1 -octreotide scan (Octreoscan) was also carried out, evidencing no pituitary tumor uptake but high uptake of the abdominal lesion. After surgery, the histological examination confirmed the two parathyroid adenomas and four non-functioning pancreatic neuroendocrine tumors. When the patient was admitted for studying the pituitary lesion and for planning the opportune therapy, an early and partially subclinical stage of MEN1 was identified, potentially already clear but otherwise undiagnosed, and the genetic state of the patient's relatives, as possible carriers of DNA mutation, was checked. The DNA study for germline mutations confirmed the clinical diagnosis of MEN1 syndrome in the patient and evidenced the same MEN1 mutation in her father and twin sister. In this case report, we would like to underline that, still today, a correct anamnesis and physical examination are the cornerstone of clinical approach to the patient. Furthermore, initial good practice approach is necessary to plan the diagnostic iter, enabling clinicians to decide upon the best orientation and interpretation of the results among several complicated and expensive exams.

Endoscopic ultrasound in the detection of pancreatic islet cell tumours

The role of endoscopic ultrasound (EUS) in the detection of pancreatic islet cell tumours is reviewed. Functioning islet cell tumours are frequently small at presentation (90%<2 cm). Advances in cross-sectional imaging with CT and MRI have resulted in improved detection rates of these small lesions. The sensitivity of EUS in the detection of insulinoma is similar to helical or multislice CT, i.e. between 82 and 94%, while a combination of both techniques is reported to identify 100% of tumours. EUS may be considered a primary diagnostic tool in these patients. EUS has a secondary role in the detection of gastrinomas as over 50% are malignant and 5% extra-pancreatic in position. CT should be used as a first-line investigation. EUS is valuable in problem solving in these patients. EUS has a role in staging large tumours prior to surgery. EUS-guided fine needle aspiration may provide cytological confirmation of the nature of a tumour prior to surgery.