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Folkert IW, Sinnamon AJ, Concors SJ, Bennett BJ, Fraker DL, Mahmoud NN, Metz DC, Stashek KM, Roses RE. Grade is a Dominant Risk Factor for Metastasis in Patients with Rectal Neuroendocrine Tumors. Ann Surg Oncol 2019; 27:855-863. [DOI: 10.1245/s10434-019-07848-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Indexed: 02/06/2023]
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Nam SJ, Chae GB, Lee S, Park SC, Kang CD, Lee SJ. A small, well-differentiated rectal neuroendocrine tumor with multiple lymph node metastases: A case report. Oncol Lett 2018; 15:7139-7143. [PMID: 29725436 PMCID: PMC5920250 DOI: 10.3892/ol.2018.8257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/29/2018] [Indexed: 11/05/2022] Open
Abstract
The incidence of rectal neuroendocrine tumor (NET), which is often diagnosed during routine surveillance endoscopy, is increasing. The majority of these tumors are small and asymptomatic, possessing benign features with favorable prognoses. At present, small rectal NETs without high-risk factors are typically treated by local resection, including endoscopic mucosal resection, endoscopic submucosal dissection, or transanal endoscopic microsurgery, with or without additional imaging follow-up by abdominal computed tomography or magnetic resonance imaging. The present study, however, describes a case of a small rectal NET without any known risk factors, which was accompanied by substantial locoregional lymph node metastasis, underscoring the importance of imaging studies for rectal NETs.
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Affiliation(s)
- Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Gi Bong Chae
- Department of Surgery, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Seungkoo Lee
- Department of Pathology, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
| | - Sung Joon Lee
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon 24289, Republic of Korea
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Park CS, Lee SH, Kim SB, Kim KO, Jang BI. Multiple rectal neuroendocrine tumors: report of five cases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 64:103-9. [PMID: 25168053 DOI: 10.4166/kjg.2014.64.2.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.
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Affiliation(s)
- Chan Seo Park
- Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea
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Lim CS, Park SJ, Park MI, Moon W, Kim HH, Lee JS, Kim BJ, Ku DY. Successful endoscopic mucosal resection of a low esophageal carcinoid tumor. Clin Endosc 2013; 46:576-8. [PMID: 24143324 PMCID: PMC3797947 DOI: 10.5946/ce.2013.46.5.576] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/15/2012] [Accepted: 10/29/2012] [Indexed: 12/14/2022] Open
Abstract
Esophageal carcinoid tumors remain some of the rarest of all carcinoid tumors, with only several cases previously reported in the literature. The endoscopic mucosal resection of selected carcinoid tumors has been shown to be a valid, safe, and effective method of treatment. Endoscopic ultrasonography is the technique of choice to select patients eligible for endoscopic resection. Here, we report successful endoscopic mucosal resection of a low esophageal carcinoid tumor and review the relevant literature. The present case is the first reported case of esophageal carcinoid tumor in Korea.
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Affiliation(s)
- Chang Sup Lim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Yamagishi D, Matsubara N, Noda M, Yamano T, Tsukamoto K, Kuno T, Hamanaka M, Kobayashi M, Ikeuchi H, Matsuda I, Hirota S, Tomita N. Clinicopathological characteristics of rectal carcinoid patients undergoing surgical resection. Oncol Lett 2012; 4:910-914. [PMID: 23162621 DOI: 10.3892/ol.2012.868] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/26/2012] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to clarify the clinical aspects, histopathological features and prognosis of patients with rectal carcinoids, focusing on properties associated with metastasis, in order to gain insights into appropriate management. A total of 20 patients (15 males, 5 females; mean age, 54.9 years; range, 23-71) who underwent surgery for rectal carcinoid tumors at the Department of Colorectal Surgery, Hyogo College of Medicine, between May 2000 and January 2011 were analyzed. Ki-67 immunostaining was performed in 13 cases with available tumor tissue specimens. Of the 20 patients, a radical operation including rectal resection with a lymphadenectomy was performed in 16. The mean tumor size was 11.9 mm (3-25 mm) and lymph node metastasis was confirmed in 9 cases, including 3 with lesions no greater than 7 mm in diameter. Overall, 16 (80%) of the tumors were localized in the submucosal layer and 4 (20%) involved the proper muscle layer. Ki-67 labeling index and lymphovascular invasion were shown to be associated with lymph node and/or distant metastasis by multiple logistic regression analysis, but were not statistically significant in ANOVA findings. Lymph node metastasis from rectal carcinoids, even those smaller than 10 mm in diameter, was not a rare event. More attention should be given to decision-making, including the possibility of endoscopic resection for the treatment of rectal carcinoid tumors regardless of size.
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Yeung JMC, Ferris NJ, Lynch AC, Heriot AG. Preoperative staging of rectal cancer. Future Oncol 2009; 5:1295-306. [DOI: 10.2217/fon.09.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Preoperative staging is now an essential factor in the multidisciplinary management of rectal cancer because tumor stage is the strongest predictive factor for recurrence. Preoperative staging of rectal cancer can be divided into either local or distant staging. Local staging incorporates the assessment of mural wall invasion, circumferential resection margin involvement, as well as the nodal status for metastasis. Distant staging assesses for evidence of metastatic disease. The aim of this review is to consider the indications and limitations of the current preoperative imaging modalities for rectal cancer staging including clinical examination, endorectal ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography–computed tomography, with respect to local and distant disease.
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Affiliation(s)
- Justin MC Yeung
- Colorectal Fellow, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas J Ferris
- Consultant Radiologist, Department of Diagnostic Radiology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Craig Lynch
- Consultant Surgeon, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander G Heriot
- Consultant Surgeon, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Brown G, Davies S, Williams GT, Bourne MW, Newcombe RG, Radcliffe AG, Blethyn J, Dallimore NS, Rees BI, Phillips CJ, Maughan TS. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer 2004; 91:23-9. [PMID: 15188013 PMCID: PMC2364763 DOI: 10.1038/sj.bjc.6601871] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In rectal cancer, preoperative staging should identify early tumours suitable for treatment by surgery alone and locally advanced tumours that require therapy to induce tumour regression from the potential resection margin. Currently, local staging can be performed by digital rectal examination (DRE), endoluminal ultrasound (EUS) or magnetic resonance imaging (MRI). Each staging method was compared for clinical benefit and cost-effectiveness. The accuracy of high-resolution MRI, DRE and EUS in identifying favourable, unfavourable and locally advanced rectal carcinomas in 98 patients undergoing total mesorectal excision was compared prospectively against the resection specimen pathological as the gold standard. Agreement between each staging modality with pathology assessment of tumour favourability was calculated with the chance-corrected agreement given as the kappa statistic, based on marginal homogenised data. Differences in effectiveness of the staging modalities were compared with differences in costs of the staging modalities to generate cost effectiveness ratios. Agreement between staging and histologic assessment of tumour favourability was 94% for MRI (κ=0.81, s.e.=0.05; κW=0.83), compared with very poor agreements of 65% for DRE (κ=0.08, s.e.=0.068, κW=0.16) and 69% for EUS (κ=0.17, s.e.=0.065, κW=0.17). The resource benefits resulting from the use of MRI rather than DRE was £67164 and £92244 when MRI was used rather than EUS. Magnetic resonance imaging dominated both DRE and EUS on cost and clinical effectiveness by selecting appropriate patients for neoadjuvant therapy and justifies its use for local staging of rectal cancer patients.
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Affiliation(s)
- G Brown
- Department of Radiology, University Hospital of Wales, Cardiff, Wales, UK.
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Onogawa S, Tanaka S, Kitadai Y, Sumii M, Yoshihara M, Shimamoto F, Haruma K, Chayama K. Small rectal carcinoid with lymph node metastasis diagnosed prior to treatment. Eur J Gastroenterol Hepatol 2003; 15:195-7. [PMID: 12560766 DOI: 10.1097/00042737-200302000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We treated a 59-year-old man with a small, yellowish, submucosal rectal tumour that was detected incidentally during a colonoscopic examination. Endoscopic ultrasonography revealed a hypoechoic submucosal tumour 13 mm in diameter. Computed tomography and magnetic resonance imaging studies were performed, and pararectal and para-obturator lymph node involvement was confirmed. The patient underwent Miles' operation with lymph node dissection; 24 months later, he is disease free. We were able to diagnose rectal carcinoid tumour and evaluate the lymph node metastasis prior to surgery. Even with a small carcinoid, it is important to determine the depth of invasion and the presence of lymph node metastasis prior to treatment.
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Affiliation(s)
- Seiji Onogawa
- Department of Endoscopy, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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