Islet Cell Tumors

A population-based analysis of a rare oncologic entity: Malignant pancreatic tumors in children

PURPOSE

To examine the clinicopathological characteristics and prognosis of pediatric patients with malignant pancreatic tumors in a population-based cohort.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant pancreatic tumors, diagnosed between 1973 and 2013. Kaplan-Meier analysis was performed to determine median and five-year overall survival (OS) rates. Univariate survival analysis was executed using the log-rank test. Cox proportional hazards model was used to identify variables independently associated with mortality.

RESULTS

A total of 114 patients with pancreatic malignancies were identified. Median patient age was 16years and the majority of patients were white (64%) females (61.4%). The most prevalent histologic subtype was neuroendocrine tumors (35.1%), whereas pancreatoblastoma was more common during the first decade of life (P<0.001). Distant metastases were noted in 41.7% of the patients, while 33.3% and 25% had localized and regional disease respectively. Five-year OS rates were 77%, 66.4% and 64.8% for patients with pancreatoblastoma, neuroendocrine and epithelial tumors respectively. No death was observed in the solid pseudopapillary tumor group. Only history of having cancer-directed surgery (CDS) was significantly associated with lower overall mortality (HR: 5.1, 95% CI: 2.1, 12.4).

CONCLUSION

Pancreatic malignancies are rare in children. Their prognosis is variable and only CDS was independently associated with superior survival.

EVIDENCE RATING/CLASSIFICATION

Prognosis study, Level II.

Spinal Metastasis Resulting from Atypical Thymic Carcinoid: A Case Report

BACKGROUND

Thymic carcinoid with spinal metastasis is an extremely rare entity. Clinically, the tumor presents either by its endocrine manifestations or by mechanical compression of surrounding structures. However, no previously published case studies have reported neck pain and neurologic deficit in the initial presentation of an atypical thymic carcinoid.

CASE DESCRIPTION

A 56-year-old man, a nonsmoker, presented with a 12-month history of intermittent neck pain and a 1-month history of progressive numbness and weakness of the right upper limb. Cervical MRI showed multiple abnormal signals and C2 soft-tissue mass intruding into the vertebral canal. Cervical CT scan showed multiple bone lesions. The diagnosis of thymic carcinoid was obtained by preoperative lymph node biopsy. The patient underwent cervical laminectomy and occipitocervical fixation. Significant alleviation of pain and neurologic improvement were achieved. The postoperative pathological examination confirmed the diagnosis of thymic carcinoid.

CONCLUSIONS

Neck pain and neurologic deficit could be the first presentation of thymic carcinoid with spinal metastasis. Palliative surgery is an effective method to improve quality of life in patients with thymic carcinoid with spinal metastasis.

Pancreatic neuroendocrine tumors: contemporary diagnosis and management

Pancreatic neuroendocrine tumors (PNETs) are neoplasms that arise from the hormone producing cells of the islets of Langerhans, also known as pancreatic islet cells. PNETs are considered a subgroup of neuroendocrine tumors, and have unique biology, natural history and clinical management. These tumors are classified as 'functional' or 'non-functional' depending on whether they release peptide hormones that produce specific hormone- related symptoms, usually in established patterns based on tumor subtype. This manuscript will review pancreatic neuroendocrine tumor subtypes, syndromes, diagnosis, and clinical management.

Pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms representing <5% of all pancreatic malignancies with an estimated incidence of 1-1.5 cases/100,000. PNETs are broadly classified as either functional or nonfunctional. Functional PNETs include insulinomas, gastrinomas, vasoactive intestinal peptideomas, glucagonomas, and somatostatinomas. The clinical manifestations associated with these tumors are the result of excessive hormonal secretion and action. The functional nature of these tumors makes pancreatic hormone testing critical not only for initial diagnosis but also for follow-up, because they are important tumor markers. Nonfunctional PNETs typically remain clinically silent until a substantial mass effect occurs. Although the majority of PNETs occur sporadically, it is important to recognize that these tumors may be associated with a variety of familial syndromes and in many cases genetic testing of PNET patients is warranted. This article familiarizes the reader with the clinical presentation and the biochemical, radiologic, and genetic testing indicated for diagnosis and follow-up of patients with PNET.

Carcinoid tumor of the thymus associated with Cushing's syndrome and dysgeusia: case report and review of the literature

A 30-year-old man was hospitalized with edema, polyuria, and abnormalities in taste. ACTH and cortisol levels at admission were markedly elevated, even after attempted suppression with 8 mg dexamethasone. A thoracic-abdominal CT revealed an anterior mediastinal lesion and hyperplasia of both adrenal glands. After excision of the mediastinal mass, which confirmed the presence of a carcinoid thymic tumor, the patient became totally asymptomatic, with normal ACTH and cortisol levels. A carcinoid thymic tumor has a poor prognosis, especially when it is associated with Cushing's syndrome. Most patients will present recidivism or metastasis within 5 years after surgery. However, the low number of cases available for analysis makes it difficult to establish optimum therapeutic approaches.

Malignant pancreatic tumors: incidence and outcome in 58 pediatric patients

OBJECTIVE

The purpose of the study was to examine current incidence trends and outcomes for children with pancreatic malignancies.

METHODS

The Surveillance, Epidemiology, and End Results registry (1973-2004) was examined for pediatric patients with pancreatic malignancies (up to 19 years of age).

RESULTS

Malignant pancreatic neoplasms were identified in 58 patients. Females outnumbered males 1.9 to 1 (38 vs 20) for an age population-adjusted incidence of 0.021 and 0.015 per 100,000. Overall, 70% (n = 41) of patients were white. Asians had the highest incidence. Tumors were classified as exocrine (n = 31, 53.4%), endocrine (n = 19, 32.8%), or sarcomas (n = 5, 8.6%). Exocrine tumors included pancreatoblastoma (n = 10), solid-cystic tumor (SCT) (n = 10), ductal adenocarcinoma (DA) (n = 7), and acinar cell carcinoma (ACC) (n = 4). All SCTs and 80% of pancreatoblastomas were seen in females, whereas males had a higher incidence of DA 71% (P = .036). Ductal adenocarcinoma, SCT, acinar cell carcinoma, sarcomas, and endocrine tumors were more common in children older than 10 years, whereas pancreatoblastoma was more common in younger children (P = .045). Almost half of patients (n = 25) presented with distant metastasis; of these, 44% were endocrine tumors. Survival was significantly greater for female patients (P = .004) and for those who had surgery (P = .001) by both univariate and multivariate analysis. There was a significant difference in tumor type 15-year survival with DA having the worst (23%) and SCT the best (100%).

CONCLUSIONS

Pediatric pancreatic neoplasms are uncommon and carry a variable prognosis. Both female sex and surgery were independent predictors of improved survival.

Wilms' tumor, pancreatic islet cell carcinoma, and pheochromocytoma in a child

We present the first case of Wilms' tumor, pancreatic islet cell carcinoma, and pheochromocytoma affecting the same individual. This case underscores the importance of repeat biopsies in patients with multiple neoplasms to confirm the diagnosis and guide management.