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Lapides R, Shah A, Bal S. Incidentally Found Rectal Carcinoid Tumor in a 46-Year-Old Female: The Potential for Complications and the Importance of Screening Guidelines. Cureus 2024; 16:e55163. [PMID: 38558605 PMCID: PMC10980541 DOI: 10.7759/cureus.55163] [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: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
Carcinoid tumors are rare neuroendocrine tumors that can be found in the gastrointestinal tract as well as other areas throughout the body. The neurosecretory nature of these tumors can have implications for other chronic diseases that patients may have, such as diabetes. Certain treatments that may be implemented for patients who have carcinoid tumors, such as somatostatin analogs and Everolimus, can also alter blood glucose control. This highlights the importance of diagnosing and treating carcinoid tumors as early as possible to avoid complications associated with metastasis and more intense treatment. With more advanced diseases, clinicians should consider the possible effects of carcinoid tumors and their treatments on other chronic conditions as they manage the patient. For gastrointestinal carcinoid tumors, colonoscopy screening guidelines are incredibly important to counsel patients on, as resection can yield a complete cure for carcinoid tumors when they are found at an early stage. Here, we describe the case of an incidentally diagnosed rectal carcinoid tumor in a 46-year-old female patient with a history of type 2 diabetes mellitus and hypertension.
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Affiliation(s)
- Rebecca Lapides
- Department of Internal Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, USA
| | - Akash Shah
- Department of Internal Medicine, Nuvance Health, Brookfield, USA
| | - Shubhneet Bal
- Department of Pathology, Danbury Hospital, Danbury, USA
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McMullen T, Al-Jahdali A, de Gara C, Ghosh S, McEwan A, Schiller D. A population-based study of outcomes in patients with gastrointestinal neuroendocrine tumours. Can J Surg 2017; 60:192-197. [PMID: 28327275 DOI: 10.1503/cjs.007616] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neuroendocrine tumours (NETs) are heterogeneous, with varying presentations and treatment options. To our knowledge, there are no randomized and few long-term studies of patient outcomes. The role of surgical and medical therapy for local, regional and metastatic disease continues to be evaluated in the literature. METHODS We conducted a population-based search of the provincial cancer registry to identify patients with gastrointestinal NETs from the stomach, small intestine, colon and rectum diagnosed between 1990 and 2005 and assessed their outcomes. RESULTS We examined clinicopathological information on the outcomes of 530 patients with gastrointestinal NETs. The overall incidence of NETs increased from 11 per million to 19 per million during the study period. Advancing stage and patient age were associated with poor overall or disease-specific outcomes. Surgery, both curative and palliative, was associated with decreased risk of overall (hazard ratio [HR] 0.5, p < 0.001) and disease-specific (HR 0.5, p < 0.001) death. The biggest benefit was observed in patients with distant disease, in whom 5-year disease-specific survival for R0 resections was nearly double that for patients with macroscopic residual disease (92% v. 48%, p = 0.009). Older age was associated with poor 5-year overall and disease-specific survival (p < 0.001). CONCLUSION There has been a significant increase in incidence of gastrointestinal NETs, and advancing patient age, but not sex, is linked to poor outcomes in terms of overall and disease-specific survival. Surgery, both curative and palliative, was associated with decreased risk of overall and disease-specific death. Compared with patients with residual macroscopic disease, patients with distant disease were nearly twice as likely to survive 5 years if they had R0 resections. The use of radioisotope therapy and long-acting octreotide therapy was also associated with improved outcomes overall.
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Affiliation(s)
- Todd McMullen
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan)
| | - Akram Al-Jahdali
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan)
| | - Christopher de Gara
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan)
| | - Sunita Ghosh
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan)
| | - Alexander McEwan
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan)
| | - Daniel Schiller
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan)
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Kim JT, Liu C, Zaytseva YY, Weiss HL, Townsend CM, Evers BM. Neurotensin, a novel target of Wnt/β-catenin pathway, promotes growth of neuroendocrine tumor cells. Int J Cancer 2015; 136:1475-81. [PMID: 25098665 PMCID: PMC4289421 DOI: 10.1002/ijc.29123] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/08/2014] [Accepted: 07/23/2014] [Indexed: 02/06/2023]
Abstract
Wnt/β-catenin signaling plays a pivotal role in regulating cell growth and differentiation by activation of the β-catenin/T-cell factor (TCF) complex and subsequent regulation of a set of target genes that have one or more TCF-binding elements (TBEs). Hyperactivation of this pathway has been implicated in numerous malignancies including human neuroendocrine tumors (NETs). Neurotensin (NT), an intestinal hormone, induces proliferation of several gastrointestinal (GI) cancers including cancers of the pancreas and colon. Here, we analyzed the human NT promoter in silico and found at least four consensus TBEs within the proximal promoter region. Using a combination of ChIP and luciferase reporter assays, we identified one TBE (located ∼900 bp proximal from the transcription start site) that was immunoprecipitated efficiently by TCF4-targeting antibody; mutation of this site attenuated the responsiveness to β-catenin. We also confirmed that the promoter activity and the mRNA and protein expression levels of NT were increased by various Wnt pathway activators and decreased by Wnt inhibitors in NET cell lines BON and QGP-1, which express and secrete NT. Similarly, the intracellular content and secretion of NT were induced by Wnt3a in these cells. Finally, inhibition of NT signaling suppressed cell proliferation and anchorage-independent growth and decreased expression levels of growth-related proteins in NET cells. Our results indicate that NT is a direct target of the Wnt/β-catenin pathway and may be a mediator for NET cell growth.
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Affiliation(s)
- Ji Tae Kim
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Chunming Liu
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY
| | | | - Heidi L. Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | | | - B. Mark Evers
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Surgery, University of Kentucky, Lexington, KY
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Pasieka JL, Dixon E. Small bowel neuroendocrine tumors: the benefits of surgical intervention. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2014. [DOI: 10.2217/ije.14.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Well-differentiated SI NETs are on the rise. Due in part to the indolent nature of these tumors, patients typically have a delay in diagnosis and present with metastatic disease. Surgeries for symptoms of either chronic intermittent small bowel obstruction and/or ischemia or from carcinoid syndrome have proven to provide excellent palliation. Most recently, several series have demonstrated an improved survival in those patients in whom the primary, locoregional disease has been resected. Several newer adjuncts have been developed to aid in the hepatic directed therapies such as ablation therapies, embolization and Y spheres. The ability to cytoreduce 70% or more of the hepatic tumor burden has been shown to not only to provide a biochemical and as such a clinical response, but also appears to prolong survival. All patients with SI NETs should be assessed in a multidisciplinary clinic and the first line of therapy should always be to assess surgical resectabilty.
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Affiliation(s)
- Janice L Pasieka
- University of Calgary, Department of Surgery, Calgary Alberta, Canada
| | - Elijah Dixon
- University of Calgary, Department of Surgery, Calgary Alberta, Canada
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Valentino JD, Li J, Zaytseva YY, Mustain WC, Elliott VA, Kim JT, Harris JW, Campbell K, Weiss H, Wang C, Song J, Anthony L, Townsend CM, Evers BM. Cotargeting the PI3K and RAS pathways for the treatment of neuroendocrine tumors. Clin Cancer Res 2014; 20:1212-22. [PMID: 24443523 DOI: 10.1158/1078-0432.ccr-13-1897] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The precise involvement of the PI3K/mTOR and RAS/MEK pathways in carcinoid tumors is not well defined. Therefore, the purpose of our study was to evaluate the role these pathways play in carcinoid cell proliferation, apoptosis, and secretion and to determine the effects of combined treatment on carcinoid tumor inhibition. METHODS The human neuroendocrine cell lines BON (pancreatic carcinoid), NCI-H727 (lung carcinoid), and QGP-1 (somatostatinoma) were treated with either the pan-PI3K inhibitor, BKM120, or the dual PI3K-mTOR inhibitor, BEZ235, alone or in combination with the MEK inhibitor, PD0325901; proliferation, apoptosis, and protein expression were assessed. Peptide secretion was evaluated in BON and QGP-1 cells. The antiproliferative effect of BEZ235, alone or combined with PD0325901, was then tested in vivo. RESULTS Both BKM120 and BEZ235 decreased proliferation and increased apoptosis; combination with PD0325901 significantly enhanced the antineoplastic effects of either treatment alone. In contrast, neurotensin peptide secretion was markedly stimulated with BKM120 treatment, but not BEZ235. The combination of BEZ235 + PD0325901 significantly inhibited the growth of BON xenografts without systemic toxicity. CONCLUSIONS Both BKM120 and BEZ235 effectively inhibited neuroendocrine tumor (NET) cell proliferation and stimulated apoptosis. However, inhibition of the PI3K pathway alone with BKM120 significantly stimulated neurotensin peptide secretion; this did not occur with the dual inhibition of both PI3K and mTOR using BEZ235 suggesting that this would be a more effective treatment regimen for NETs. Moreover, the combination of BEZ235 and the MEK inhibitor PD0325901 was a safe and more effective therapy in vivo compared with single agents alone.
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Affiliation(s)
- Joseph D Valentino
- Authors' Affiliations: Departments of Surgery, Internal Medicine, and Biostatistics; Markey Cancer Center, University of Kentucky, Lexington, Kentucky; and Department of Surgery, University of Texas Medical Branch, Galveston, Texas
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Kim JT, Li J, Jang ER, Gulhati P, Rychahou PG, Napier DL, Wang C, Weiss HL, Lee EY, Anthony L, Townsend CM, Liu C, Evers B. Deregulation of Wnt/β-catenin signaling through genetic or epigenetic alterations in human neuroendocrine tumors. Carcinogenesis 2013; 34:953-61. [PMID: 23354304 PMCID: PMC3643417 DOI: 10.1093/carcin/bgt018] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/19/2012] [Accepted: 01/12/2013] [Indexed: 12/18/2022] Open
Abstract
Carcinoid tumors are rare neuroendocrine tumors (NETs) that are increasing in incidence. Mutation and altered expression of Wnt/β-catenin signaling components have been described in many tumors but have not been well-studied in NETs. Here, we observed accumulation of β-catenin in the cytoplasm and/or nucleus in 25% of clinical NET tissues. By mutational analysis, the mutations of β-catenin (I35S) and APC (E1317Q, T1493T) were identified in NET cells and the tissues. Expression of representative Wnt inhibitors was absent or markedly decreased in BON, a human pancreatic carcinoid cell line; treatment with 5-aza-2'-deoxycytidine (5-aza-CdR) increased expression levels of the Wnt inhibitors. Methylation analyses demonstrated that CpG islands of SFRP-1 and Axin-2 were methylated, whereas the promoters of DKK-1, DKK-3 and WIF-1 were unmethylated in four NET cells. Aberrant methylation of SFRP-1 was particularly observed in most of clinical NET tissues. In addition, the repression of these unmethylated genes was associated with histone H3 lysine 9 dimethylation (H3K9me2) in BON cells. Together, 5-aza-CdR treatment inhibited cell proliferation and decreased the protein levels of H3K9me2 and G9a. Moreover, a novel G9a inhibitor, UNC0638, suppressed BON cell proliferation through inhibition of Wnt/β-catenin pathway. Overexpression of the inhibitory genes, particularly SFRP-1 and WIF-1 in BON cells, resulted in suppression of anchorage-independent growth and inhibition of tumor growth in mice. Our findings suggest that aberrant Wnt/β-catenin signaling, through either mutations or epigenetic silencing of Wnt antagonists, contributes to the pathogenesis and growth of NETs and have important clinical implications for the prognosis and treatment of NETs.
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Affiliation(s)
- Ji Tae Kim
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Jing Li
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Eun Ryoung Jang
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA
| | - Pat Gulhati
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, University of Kentucky, Lexington, KY, USA
- MD/PhD Program, University of Texas Medical Branch, Galveston, TX, USA
| | - Piotr G. Rychahou
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Dana L. Napier
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Chi Wang
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Heidi L. Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Eun Y. Lee
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Lowell Anthony
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA and
| | | | - Chunming Liu
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA
| | - B.Mark Evers
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, University of Kentucky, Lexington, KY, USA
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Araujo PB, Cheng S, Mete O, Serra S, Morin E, Asa SL, Ezzat S. Evaluation of the WHO 2010 grading and AJCC/UICC staging systems in prognostic behavior of intestinal neuroendocrine tumors. PLoS One 2013; 8:e61538. [PMID: 23620762 PMCID: PMC3631242 DOI: 10.1371/journal.pone.0061538] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/11/2013] [Indexed: 01/17/2023] Open
Abstract
Background The increasing incidence and heterogeneous behavior of intestinal neuroendocrine tumors (iNETs) pose a clinicopathological challenge. Our goal was to decribe the prognostic value of the new WHO 2010 grading and the AJCC/UICC TNM staging systems for iNETs. Moreover, outcomes of patients treated with somatostatin analogs were assessed. Methods We collected epidemiological and clinicopathological data from 93 patients with histologically proven iNETs including progression and survival outcomes. The WHO 2010 grading and the AJCC/UICC TNM staging systems were applied for all cases. RECIST criteria were used to define progression. Kaplan-Meier analyses for progression free survival (PFS) and overall survival (OS) were performed. Results Mean follow-up was 58.6 months (4–213 months). WHO 2010 grading yielded PFS and disease-specific OS of 125.0 and 165.8 months for grade 1 (G1), 100.0 and 144.2 months for G2 and 15.0 and 15.8 months for G3 tumors (p = 0.004 and p = 0.001). Using AJCC staging, patients with stage I and II tumors had no progression and no deaths. Stage III and IV patients demonstrated PFS of 138.4 and 84.7 months (p = 0.003) and disease-specific OS of 210.0 and 112.8 months (p = 0.017). AJCC staging also provided informative PFS (91.2 vs. 50.0 months, p = 0.004) and OS (112.3 vs. 80.0 months, p = 0.005) measures with somatostatin analog use in stage IV patients. Conclusion Our findings underscore the complementarity of WHO 2010 and AJCC classifications in providing better estimates of iNETS disease outcomes and extend the evidence for somatostatin analog benefit in patients with metastatic disease.
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Affiliation(s)
- Paula B. Araujo
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Sonia Cheng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Stefano Serra
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Emilie Morin
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Shereen Ezzat
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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