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Wedin M, Janson ET, Wallin G, Sundin A, Daskalakis K. Prevalence of metastases outside the liver and abdominal lymph nodes on 68Ga-DOTATOC-PET/CT in patients with small intestinal and pancreatic neuroendocrine tumours. J Neuroendocrinol 2024; 36:e13391. [PMID: 38590270 DOI: 10.1111/jne.13391] [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: 05/22/2023] [Revised: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 04/10/2024]
Abstract
Metastases outside the liver and abdominal/retroperitoneal lymph nodes are nowadays detected frequently in patients with neuroendocrine tumours (NETs), owing to the high sensitivity of positron emission tomography (PET) with Gallium-68-DOTA-somatostatin analogues (68Ga-SSA) and concomitant diagnostic computed tomography (CT). Our aim was to determine the prevalence of extra-abdominal metastases on 68Ga-DOTATOC-PET/CT in a cohort of patients with small intestinal (Si-NET) and pancreatic NET (Pan-NET), as well as that of pancreatic metastasis in patients with Si-NET. Among 2090 patients examined by 68Ga-DOTATOC-PET/CT at two tertiary referral centres, a total of 1177 patients with a history of Si- or Pan-NET, were identified. The most recent 68Ga-DOTATOC-PET/CT report for each patient was reviewed, and the location and number of metastases of interest were recorded. Lesions outside the liver and abdominal nodes were found in 26% of patients (n = 310/1177), of whom 21.5% (255/1177) were diagnosed with Si-NET and 4.5% (55/1177) Pan-NET. Bone metastases were found in 18.4% (215/1177), metastases to Virchow's lymph node in 7.1% (83/1177), and lung/pleura in 4.8% (56/1177). In the subset of 255 Si-NET patients, 5.4% (41/255) manifested lesions in the pancreas, 1.5% in the breast (18/255), 1.3% in the heart (15/255) and 1% in the orbita (12/255). In Si-NET patients, the Ki-67 proliferation index was higher in those with ≥2 metastatic sites of interest, than with 1 metastatic site, (p <0.001). Overall, extra-abdominal or pancreatic metastases were more often found in patients with Si-NET (34%) than in those with Pan-NET (13%) (p <0.001). Bone metastases were 2.6 times more frequent in patients with Si-NET compared to Pan-NET patients (p <0.001). Lesions to the breast and orbita were encountered in almost only Si-NET patients. In conclusion, lesions outside the liver and abdominal nodes were detected in as many as 26% of the patients, with different prevalence and metastatic patterns in patients with Si-NET compared to Pan-NET. The impact of such metastases on overall survival and clinical decision-making needs further evaluation.
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Affiliation(s)
- Maria Wedin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Tiensuu Janson
- Department of Medical Sciences, Endocrine Oncology unit, Uppsala University, Uppsala, Sweden
| | - Göran Wallin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Sundin
- Department of Surgical Sciences, Radiology and Molecular Imaging, Uppsala University, Uppsala, Sweden
| | - Kosmas Daskalakis
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 2nd Department of Surgery, 'Korgialenio-Benakio', Red Cross General Hospital, Athens, Greece
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2
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Urrego Díaz JA, González M, Romero-Rojas AE, Strosberg J, Jiménez-Vásquez P. Neuroendocrine Tumor Metastases to the Breast: A Case Report and Review of the Literature. Cureus 2023; 15:e40703. [PMID: 37485220 PMCID: PMC10359153 DOI: 10.7759/cureus.40703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Breast metastases from neuroendocrine neoplasms (NENs) are considered infrequent. We report a case of a patient with ileocecal neuroendocrine tumor (NET) metastases to both breasts, for whom the initial clinical presentation was chronic diarrhea. Breast metastasis was initially suspected by a 68-Gallium DOTANOC positron emission tomography (PET)/CT and was confirmed by histopathology. We also performed a literature review in which we identified 116 cases of NENs metastatic to the breast reported so far. Most cases occurred in older women, were caused by NETs, and had the gastrointestinal tract as the primary site.
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Affiliation(s)
| | | | | | | | - Paola Jiménez-Vásquez
- Gastrointestinal and Neuroendocrine Tumors, Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, COL
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Polydorides AD, Liu Q. Evaluation of Pathologic Prognostic Factors in Neuroendocrine Tumors of the Small Intestine. Am J Surg Pathol 2022; 46:547-556. [PMID: 35192293 DOI: 10.1097/pas.0000000000001808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The precise contributions of histopathologic features in the determination of stage and prognosis in small intestinal neuroendocrine tumors (NETs) are still under debate, particularly as they pertain to primary tumor size, mesenteric tumor deposits (TDs), and number of regional lymph nodes with metastatic disease. This single-institution series reviewed 162 patients with small bowel NETs (84 females, mean age: 60.3±12.0 y). All cases examined (100%) were immunoreactive for both chromogranin A and synaptophysin. Primary tumor size >1 cm (P=0.048; odds ratio [OR]=3.06, 95% confidence interval [CI]: 1.01-9.24) and lymphovascular invasion (P=0.007; OR=4.85, 95% CI: 1.53-15.40) were associated with the presence of lymph node metastasis. Conversely, TDs (P=0.041; OR=2.73, 95% CI: 1.04-7.17) and higher pT stage (P=0.006; OR=4.33, 95% CI: 1.53-12.28) were associated with the presence of distant metastasis (pM). A cutoff of ≥7 positive lymph nodes was associated with pM (P=0.041), and a thusly defined modified pN stage (pNmod) significantly predicted pM (P=0.024), compared with the prototypical pN (cutoff of ≥12 positive lymph nodes), which did not. Over a median follow-up of 35.7 months, higher pNmod (P=0.014; OR=2.15, 95% CI: 1.16-3.96) and pM (P<0.001; OR=11.00, 95% CI: 4.14-29.20) were associated with disease progression. Proportional hazards regression showed that higher pNmod (P=0.020; hazard ratio=1.51, 95% CI: 1.07-2.15) and pM (P<0.001; hazard ratio=5.48, 95% CI: 2.90-10.37) were associated with worse progression-free survival. Finally, Kaplan-Meier survival analysis demonstrated that higher pNmod (P=0.003), pM (P<0.001), and overall stage group (P<0.001) were associated with worse progression-free survival, while higher pM also predicted worse disease-specific survival (P=0.025). These data support requiring either chromogranin or synaptophysin, but not both, for small bowel NET diagnosis, the current inclusion of a 1 cm cutoff in primary tumor size and the presence of TDs in staging guidelines, and would further suggest lowering the cutoff number of positive lymph nodes qualifying for pN2 to 7 (from 12).
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Affiliation(s)
- Alexandros D Polydorides
- Department of Pathology, Molecular, and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Bilateral breast metastases as the first manifestation of an occult pancreatic neuroendocrine tumor. Radiol Case Rep 2021; 16:3807-3814. [PMID: 34745398 PMCID: PMC8551534 DOI: 10.1016/j.radcr.2021.09.008] [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: 08/18/2021] [Revised: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 11/23/2022] Open
Abstract
Breast metastases are uncommon findings compared to primary breast cancer and in particular bilateral secondary breast lesions from neuroendocrine tumor (NET)s are extremely rare with just less over 13 cases described in literature. We reported herewith the case of a 54-year-old woman who presented to our Breast Unit after noticing multiple, mobile, bilateral breast lumps. Imaging studies confirmed the presence of multiple, circumscribed, bilateral breast masses with slightly spiculated margins, classified as suspicious for malignancy (BI-RADS 4). A tru-cut biopsy was carried out on the largest lesion of each side and histopathologic and immunohistochemistry examination was consistent with metastases from pancreatic neuroendocrine tumor (PNET). Total-body CT revealed the presence of a mass located in the pancreatic body - tail with associated abdominal lymphadenopathies and multiple secondary nodules in bilateral breast and in the liver. Stage IV disease was diagnosed, patient did not undergo surgery and started LAR – octreotide therapy. Although rare, breast metastases from NETs represent an important diagnostic challenge for practitioners because of the difficulty to differentiate from a primary breast carcinoma or even from benign breast lesions. Clinicians should be aware of the possibility of bilateral breast metastases in differential diagnosis of breast lesions in order to ensure the correct diagnosis and the most appropriate management of these patients.
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Uccella S, Finzi G, Sessa F, La Rosa S. On the Endless Dilemma of Neuroendocrine Neoplasms of the Breast: a Journey Through Concepts and Entities. Endocr Pathol 2020; 31:321-329. [PMID: 32613538 DOI: 10.1007/s12022-020-09637-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuroendocrine differentiation in breast carcinomas has been a matter of discussion since it was first described almost 60 years ago. Indeed, so-called neuroendocrine neoplasms of the breast (Br-NENs) are a less well-defined group of neoplasms than analogous entities in other anatomic sites, such as the lung and the gastroenteropancreatic (GEP) tract. Pure neuroendocrine phenotype is extremely rare, whereas the expression of neuroendocrine markers in usual breast carcinomas, both of special and of non-special type, without evident neuroendocrine morphology, is more common. In this context, the diagnostic criteria and the classification scheme for Br-NENs have been continuously changing over time and real consensus on this topic is still lacking, despite the recent publication of the 5th edition of the WHO classification of breast tumors. In this review, we will recapitulate the evolution of the concept of Br-NEN; revise the available knowledge on their morphological, molecular, and clinical features; and critically discuss the current classification scheme.
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Affiliation(s)
- Silvia Uccella
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Giovanna Finzi
- Department of Pathology, ASST dei Sette Laghi, Varese, Italy
| | - Fausto Sessa
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Stefano La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
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Zagami P, Kandaraki E, Renne G, Grimaldi F, Spada F, Laffi A, Fazio N. The rare entity of bilateral and unilateral neuroendocrine metastases to the breast: a case series and literature review. Ecancermedicalscience 2020; 14:1123. [PMID: 33209114 PMCID: PMC7652541 DOI: 10.3332/ecancer.2020.1123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Primary neuroendocrine neoplasms (NENs) in the breast are very rare. Until 2011, the prevalence was 0.1% of all breast lesions and 1% of all NENs, whereas metastatic breast NENs represent 1%–2% of all breast tumours. However, it seems that over the last 5 years the diagnostic frequency of breast NENs has increased, probably for more alert specialists and advanced diagnostic tools, leading to a prevalence of 2%–5% of diagnosed breast cancers, mostly in the elderly population. Breast metastases from extramammary malignancies are uncommon and bilateral ones are even more uncommon, with few reported in the literature. We describe four clinical settings of breast metastases from different NENs and the multidisciplinary approach for diagnosis and treatment. Methods Four patients were found to have NEN primaries metastasised to the breast. A literature review was conducted to identify similar cases and characterise breast metastases from neuroendocrinal tumors (NETs). Results Two patients presented with bilateral breast metastases (one with well-differentiated panNET and another with atypical lung carcinoid) and two had unilateral (one with moderately differentiated lung NET and one with atypical lung carcinoid). There are about 13 cases of NEN breast metastases reported in the English literature. The ileum is the most common primary site, followed by the appendix, duodenum, pancreas and lung. Conclusion Breast lesions from extramammary primary often pose a diagnostic challenge, since a breast nodule can be the first and often the only presentation of the disease. However, differentiating between primary and secondary NEN breast lesions is essential, owing to different clinical management and prognosis.
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Affiliation(s)
- Paola Zagami
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
| | - Eleni Kandaraki
- Department of Pathology, European Institute of Oncology, Milan 20132, Italy
| | - Giuseppe Renne
- Department of Pathology, European Institute of Oncology, Milan 20132, Italy
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University of Udine, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
| | - Alice Laffi
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
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7
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Papalampros A, Mpaili E, Moris D, Sarlanis H, Tsoli M, Felekouras E, Trafalis DT, Kontos M. A case report on metastatic ileal neuroendocrine neoplasm to the breast masquerading as primary breast cancer: A diagnostic challenge and management dilemma. Medicine (Baltimore) 2019; 98:e14989. [PMID: 31008928 PMCID: PMC6494217 DOI: 10.1097/md.0000000000014989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Metastatic neuroendocrine neoplasms (NENs) to the breast are very rare entities comprising only 1% to 2% of all metastatic breast tumors. In this article, we describe a case of a neuroendocrine ileal neoplasm metastatic to breast and liver, with breast metastatic tumor to be the initial manifestation of the disease. PATIENT CONCERNS We herein report a rare case of a female patient admitted to our department with a palpable painful mass on her left breast. DIAGNOSIS The surgical and histological investigation revealed a metastatic neuroendocrine neoplasm to the breast originated from terminal ileum. INTERVENTIONS A left lumpectomy, right hemicolectomy, cholecystectomy, left hepatectomy along with liver metastasectomies (V, VI, VIII) plus radiofrequency ablation of lesions to the right liver lobe plus standard lymphadenectomy was performed. OUTCOMES Considering the advanced stage of the disease, the patient received an adjuvant therapy of somatostatin analog plus everolimus. Under the guidance of oncological consultation, patients follow-up with CT and MRI scan and clinical re-evaluations in the first 3 and 6 months, substantiates no evidence of recurrence and she presents herself asymptomatic. LESSONS An appropriate level of suspicion and selective immunohistochemistry in these cases, particularly where no prior history of a known primary neuroendocrine neoplasm occurs, may help to diagnose a previously undetected neuroendocrine tumor elsewhere in the body and provide guidance for the appropriate treatment selection.
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Affiliation(s)
- Alexandros Papalampros
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eustratia Mpaili
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC
| | | | - Marina Tsoli
- 1st Propaedeutic Department of Internal Medicine
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios T. Trafalis
- Department of Pharmacology, Unit of Clinical Pharmacology and Therapeutic Oncology, Medical School, National and Kapodistrian University of Athens
| | - Michael Kontos
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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8
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Retro-orbital, Breast, Cardiac, Skin, and Subcutaneous Metastases of Neuroendocrine Tumor From a Tail Gut Cyst on 68Ga-DOTATATE PET/CT Imaging. Clin Nucl Med 2017; 42:364-367. [PMID: 28166144 DOI: 10.1097/rlu.0000000000001551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tail gut cysts are rare congenital lesions developing from postanal primitive gut remnants. They are mostly benign but carry a potential of malignant transformation, such as adenocarcinoma, neuroendocrine tumor, adenosquamous carcinoma, and pseudomyxoma peritonei. We present a 39-year-old woman with a neuroendocrine tumor arising within a tail gut cyst. She underwent complete resection in 2011. After 4 years, she was admitted with breast nodules, left proptosis, and gaze difficulties. Ga-DOTATATE PET/CT demonstrated extensive metastases including pelvic, lymph node, adrenal gland, bone, retro-orbital, cardiac, breast, skin, and subcutaneous metastases.
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9
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Policeni F, Pakalniskis B, Yang L. Occult Primary Neuroendocrine Tumor Metastasis to the Breast Detected on Screening Mammogram. J Clin Imaging Sci 2016; 6:41. [PMID: 27761301 PMCID: PMC5070031 DOI: 10.4103/2156-7514.191439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/25/2016] [Indexed: 11/25/2022] Open
Abstract
Metastatic tumors are rare in the breast. Well-differentiated neuroendocrine tumors (WDNETs) are slow-growing neoplasms that arise from neuroendocrine cells, particularly in the gastrointestinal tract and bronchial tree. Metastatic WDNET to the breast is a rare entity. We present a case report of ileal WDNET metastatic to the breast which was initially identified as a small mass in the patient's left breast on screening mammography. Targeted ultrasound identified a suspicious mass, and ultrasound-guided percutaneous core biopsy was performed. Pathology revealed metastatic WDNET. Breast magnetic resonance imaging (MRI) was then performed and demonstrated left axillary Level 2 lymphadenopathy, and liver lesions were suspicious for metastasis. The patient underwent abdominal computed tomography (CT) to evaluate for distant metastatic disease. A spiculated mass was found near the ileocecal valve, suggestive of primary ileal WDNET. In addition, CT identified multiple liver lesions, most compatible with metastasis. Indium 111 OctreoScan confirmed radiotracer uptake in the ileum consistent with primary neuroendocrine tumor. In this report, we review the imaging characteristics of metastatic WDNET to the breast by different imaging modalities including mammogram, ultrasound, and breast MRI.
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Affiliation(s)
- Fabiana Policeni
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Limin Yang
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Qu FL, Bernard L, Benabu JC, Dubost V, Gharbi M, Mathelin C. [Mammary metastasis from lung neuroendocrine tumor: Place of loco-regional treatment]. ACTA ACUST UNITED AC 2016; 44:452-4. [PMID: 27426692 DOI: 10.1016/j.gyobfe.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/31/2016] [Indexed: 02/02/2023]
Affiliation(s)
- F L Qu
- Unité de sénologie, hôpitaux universitaires de Strasbourg, hôpital Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France; Unité de sénologie, hôpital Ruijin, avenue 2(e) Ruijin, 20025 Shanghai, Chine
| | - L Bernard
- Unité de sénologie, hôpitaux universitaires de Strasbourg, hôpital Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - J-C Benabu
- Unité de sénologie, hôpitaux universitaires de Strasbourg, hôpital Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - V Dubost
- Unité de sénologie, hôpitaux universitaires de Strasbourg, hôpital Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - M Gharbi
- Unité de sénologie, hôpitaux universitaires de Strasbourg, hôpital Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - C Mathelin
- Unité de sénologie, hôpitaux universitaires de Strasbourg, hôpital Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire, biologie du cancer (IGBMC), 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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