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Roles for growth factors and mutations in metastatic dissemination. Biochem Soc Trans 2021; 49:1409-1423. [PMID: 34100888 PMCID: PMC8286841 DOI: 10.1042/bst20210048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022]
Abstract
Cancer is initiated largely by specific cohorts of genetic aberrations, which are generated by mutagens and often mimic active growth factor receptors, or downstream effectors. Once initiated cells outgrow and attract blood vessels, a multi-step process, called metastasis, disseminates cancer cells primarily through vascular routes. The major steps of the metastatic cascade comprise intravasation into blood vessels, circulation as single or collectives of cells, and eventual colonization of distant organs. Herein, we consider metastasis as a multi-step process that seized principles and molecular players employed by physiological processes, such as tissue regeneration and migration of neural crest progenitors. Our discussion contrasts the irreversible nature of mutagenesis, which establishes primary tumors, and the reversible epigenetic processes (e.g. epithelial-mesenchymal transition) underlying the establishment of micro-metastases and secondary tumors. Interestingly, analyses of sequencing data from untreated metastases inferred depletion of putative driver mutations among metastases, in line with the pivotal role played by growth factors and epigenetic processes in metastasis. Conceivably, driver mutations may not confer the same advantage in the microenvironment of the primary tumor and of the colonization site, hence phenotypic plasticity rather than rigid cellular states hardwired by mutations becomes advantageous during metastasis. We review the latest reported examples of growth factors harnessed by the metastatic cascade, with the goal of identifying opportunities for anti-metastasis interventions. In summary, because the overwhelming majority of cancer-associated deaths are caused by metastatic disease, understanding the complexity of metastasis, especially the roles played by growth factors, is vital for preventing, diagnosing and treating metastasis.
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Ando K, Fujiya M, Yoshida M, Kobayashi Y, Sugiyama Y, Murakami Y, Iwama T, Sato H, Sasaki T, Kunogi T, Takahashi K, Ueno N, Kashima S, Moriichi K, Tanabe H, Okumura T. Cardiac Metastasis Caused Fatal Ventricular Arrhythmia in a Patient with a Rectal Neuroendocrine Tumor. Intern Med 2021; 60:373-378. [PMID: 33518610 PMCID: PMC7925266 DOI: 10.2169/internalmedicine.5208-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 60-year-old man had received octreotide for a metastatic neuroendocrine tumor (NET) in the rectum. Computed tomography and ultrasonography revealed a cardiac tumor, diffuse thickness of the ventricular wall and pericardial effusion, which was diagnosed as cardiac metastasis. The metastatic lesions continued to grow despite the alteration of chemotherapy, and the patient complained of repeated syncope and was admitted to our hospital at 11 months after the diagnosis of cardiac metastasis. An electrocardiogram during syncope showed sustained ventricular tachycardia, which was considered to be caused by the cardiac metastasis. We herein report a case of NET with cardiac metastasis which caused lethal arrhythmia along with a review of the pertinent literature.
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Affiliation(s)
- Katsuyoshi Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Moe Yoshida
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Yu Kobayashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Yuya Sugiyama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Yuki Murakami
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Takuya Iwama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Hiroki Sato
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Takahiro Sasaki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Takehito Kunogi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Keitaro Takahashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Nobuhiro Ueno
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Shin Kashima
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
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Solitary myocardial metastasis from neuroendocrine tumor: surgical resection as curative surgery. Gen Thorac Cardiovasc Surg 2020; 69:126-129. [PMID: 32556900 DOI: 10.1007/s11748-020-01409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
We present the case of a 70-year-old man with intramyocardial solitary metastasis from a carcinoid bowel tumor. One year previously, he had undergone distal ileum resection for a neuroendocrine tumor. Asymptomatic recurrence was diagnosed with the combination of elevated chromogranin A serum level and somatostatin receptor scintigraphy. The tumor was located on the right ventricle free wall, without obstruction of the right ventricular outflow tract and absence of carcinoid syndrome or liver involvement. Complete resection was obtained under cardiopulmonary bypass. The patient is currently alive without disease 2 years after surgery. Oncologists should be aware of the heart as a possible site of neuroendocrine metastatic disease. This case highlights the value of positron emission tomography with somatostatin analogs for earlier and more frequent metastasis detection. Persistent remission can be obtained with complete surgical resection when the metastatic tumor is localized in the right ventricle without evidence of carcinoid heart disease.
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Kunz WG, Eschbach RS, Stahl R, Kazmierczak PM, Bartenstein P, Rominger A, Auernhammer CJ, Spitzweg C, Ricke J, Cyran CC. Identification and characterization of myocardial metastases in neuroendocrine tumor patients using 68Ga-DOTATATE PET-CT. Cancer Imaging 2018; 18:34. [PMID: 30236163 PMCID: PMC6149059 DOI: 10.1186/s40644-018-0168-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 09/14/2018] [Indexed: 11/27/2022] Open
Abstract
Background Focal 68Ga-DOTATATE PET lesions within the myocardium of neuroendocrine tumor (NET) patients are observed in clinical practice. We determined the frequency and characteristics of lesions that are consistent with cardiac metastasis and assessed the lesion detection rate of conventional imaging. Methods 629 patients who underwent 68Ga-DOTATATE PET-CT at a supraregional comprehensive cancer center on NET were included from a consecutive registry. Inclusion criteria were: (1) focal 68Ga-DOTATATE tracer uptake within the myocardium in more than two sequential PET exams, and (2) contrast-enhanced CT. To determine the diagnostic accuracy of conventional CT imaging, a case-control cohort with a ratio of 1:3 was used. PET and CT were independently analyzed by two blinded readers. Cohen’s κ was assessed for interreader agreement. Descriptive statistics were applied for frequencies and characteristics and group comparisons were analyzed using the Fisher’s exact test. Results The prevalence of myocardial metastases related to the registry was 2.4% (15 of 629 NET patients fulfilling the inclusion criteria), for a total of 21 myocardial 68Ga-DOTATATE foci detected. Myocardial lesions were most frequently located in the left ventricle (43%) and the septum (43%). No patient demonstrated a pericardial effusion. Patients with myocardial metastases did not differ in demographics, tumor grading, disease stage or circulating tumor markers compared to the overall registry (all p > 0.05). Higher Ki67-Indices were observed (p = 0.049) for patients with myocardial metastases. Interreader agreement for PET assessment was excellent (Cohen’s κ = 1.0). CT reading showed a sensitivity of 19% (95% confidence interval: 6–43%) at a specificity of 100% (95% confidence interval: 90–100%). Conclusions 68Ga-DOTATATE PET enables detection of myocardial metastatic lesions in NET patients. In contrast, standard morphologic CT imaging provides very limited sensitivity.
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Affiliation(s)
- Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Ralf S Eschbach
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Robert Stahl
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp M Kazmierczak
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christoph J Auernhammer
- Department of Internal Medicine IV, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Neuroendocrine Tumors of the Gastroenteropancreatic System (GEPNET-KUM), University Hospital, LMU Munich, Munich, Germany
| | - Christine Spitzweg
- Department of Internal Medicine IV, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Neuroendocrine Tumors of the Gastroenteropancreatic System (GEPNET-KUM), University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Neuroendocrine Tumors of the Gastroenteropancreatic System (GEPNET-KUM), University Hospital, LMU Munich, Munich, Germany
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Milione M, Maisonneuve P, Pellegrinelli A, Pusceddu S, Centonze G, Dominoni F, Brambilla C, Rubino M, Faggiano A, Buzzoni R, Concas L, Giacomelli L, Coppa J, Mazzaferro V, de Braud F. Loss of succinate dehydrogenase subunit B (SDHB) as a prognostic factor in advanced ileal well-differentiated neuroendocrine tumors. Endocrine 2017; 57:512-517. [PMID: 27905048 DOI: 10.1007/s12020-016-1180-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Abnormal expression of succinate dehydrogenase, (SDH), in particular of the B subunit (SDHB), is implicated in the pathogenesis of neuroendocrine tumors. This study evaluates the distribution of SDHB in WHO grading G1 and G2 intestinal, well-differentiated neuroendocrine tumors and corresponding lymph node or liver metastases. METHODS We collected ileal well-differentiated neuroendocrine tumors specimens from consecutive patients with prior primary resection and distant synchronous or metachronous liver metastases. We obtained 195 specimens from primary tumors (n = 106) and metastases (n = 89). The expression (E) of SDHB and the immunostaining intensity (I) were evaluated semiquantitatively and combined into a single score. SDHB score was evaluated in primitive tumor and metastatic specimens. RESULTS SDHB was found in all tumor cells. Mean SDHB expression was 72.7 % ± 17.1 % in primitive specimens and 27.9 % ± 24.6 % in metastatic specimens (p < 0.0001). SDH intensity was higher in primitive specimens (p < 0.0001). SDHB score was 9-12 in 96 specimens of the primitive group and 2 metastatic specimens (p < 0.0001). None of the analyzed parameters was predictive of overall survival in the primitive subset. In the metastatic subset, loss of SDHB expression, intensity, and score were prognostic factors for survival. Lower expression and intensity of SDHB in metastatic lesions were associated with longer overall survival. When combining SDHB score and Ki-67 % in the metastatic subset, a lower SDHB score was associated with prolonged overall survival, independently from Ki-67 %. CONCLUSIONS SDHB score was different in primitive and metastatic specimens. The combination of SDHB score and Ki-67 % was a stronger predictor of overall survival than Ki-67 % alone. This stratification might help predict survival.
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Affiliation(s)
- Massimo Milione
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy.
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of oncology (IEO), Milan, Italy
| | - Alessio Pellegrinelli
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Sara Pusceddu
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Giovanni Centonze
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Francesca Dominoni
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Cecilia Brambilla
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Manila Rubino
- Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Antongiulio Faggiano
- Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Roberto Buzzoni
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Laura Concas
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | | | - Jorgelina Coppa
- Department of Surgery, G.I. Surgery and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery, G.I. Surgery and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - Filippo de Braud
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
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Castello A, Briganti V, Sciagrà R. Interventricular septum metastasis in neuroendocrine tumour. Endocrine 2016; 53:870-1. [PMID: 26281000 DOI: 10.1007/s12020-015-0712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Angelo Castello
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Vittorio Briganti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Mahoney B, Scheler J. Somatostatin Receptor Scintigraphy of Neuroendocrine Tumors of the Abdomen and Pelvis. Semin Roentgenol 2016; 51:112-22. [PMID: 27105966 DOI: 10.1053/j.ro.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bruce Mahoney
- Department of Radiology, University of Cincinnati, Cincinnati, OH.
| | - Jennifer Scheler
- Department of Radiology, University of Cincinnati, Cincinnati, OH
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