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Shakir MH, Abdul Basit S, Ray BK, Zaidi SMH, Chaudhary T, Amjad MA. Idiopathic Pulmonary Fibrosis Comorbid With Mediastinal Small Cell Carcinoma: A Clinical Dilemma. Cureus 2024; 16:e53578. [PMID: 38449967 PMCID: PMC10915904 DOI: 10.7759/cureus.53578] [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: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
We present an interesting case of mediastinal small cell carcinoma (MSCC), an exceedingly rare entity, comorbid with idiopathic pulmonary fibrosis (IPF). A 66-year-old female was first seen in the pulmonology office for abnormal chest computed tomography (CT) findings of right apical bronchiectasis and subpleural fibrotic changes with focal pleural thickening along the fissures, along with a right lower lobe nodule. Pulmonary function testing (PFT) showed an obstructive pattern with modest bronchodilator response, although subsequent PFT showed a worsening restrictive pattern with a worsening DLCO. On a follow-up CT one year later, a soft tissue density with peripheral calcification was found in the anterior mediastinum, later found to be hypermetabolic on a PET scan. Radiographically, fibrosis worsened with the appearance of worsening diffuse bilateral coarse reticular interstitial changes with lower lobe predominance, honeycombing, and areas of ground-glass opacity. A biopsy of the mediastinal lesion showed a high-grade neuroendocrine tumor. Cam5.2, insulinoma-associated protein-1, synaptophysin, and thyroid transcription factor-1 immunostains were positive. She underwent four cycles of chemotherapy with cisplatin and etoposide with a total of 60 Gy of radiation. Mediastinal mass started to decrease in size. Her respiratory status, imaging, and PFTs continued to show evidence of IPF progression. Prednisone resulted in modest clinical and radiographic response. Steroid-sparing therapy with mycophenolate mofetil, although effective, had to be discontinued due to GI bleeding. Anti-fibrotic therapy was deferred due to evidence showing a lack of clinical improvement. We discuss the existing evidence available on IPF management and proceed to highlight the deficiencies in existing data available on the management of IPF and MSCC in these patients. Most of the cases of MSCC reported in the past have managed MSCC using guidance from treatment practices for small cell lung cancer. No reported cases discuss or describe the management of IPF and MSCC in the very rare cohort of patients our case represents.
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Affiliation(s)
- Muhammad Hassan Shakir
- Internal Medicine, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Salman Abdul Basit
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Barun K Ray
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | | | - Taibah Chaudhary
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Mohammad Asim Amjad
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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2
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Nagpal S, Daoud A, Taylor KA, Parvez MA, Mckinney J. Case Report: Unveiling an Incidentally Diagnosed Extrapulmonary Small Cell Carcinoma of the Rectum. Cureus 2023; 15:e46920. [PMID: 38021819 PMCID: PMC10640916 DOI: 10.7759/cureus.46920] [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: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Extrapulmonary small cell carcinoma (EPSCC) is a rare malignancy with distinct clinical and pathological characteristics. We present the case of a 72-year-old male diagnosed with EPSCC of the rectum during a routine screening colonoscopy. The patient was asymptomatic, and pathological examination revealed a rectal mass displaying features of small cell carcinoma (SCC) associated with tubular adenoma. The treatment comprised radiation therapy and cisplatin/etoposide chemotherapy. This case underscores the importance of considering EPSCC as a potential diagnosis in patients with rectal masses, necessitating further studies to optimize treatment strategies.
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Affiliation(s)
- Sagar Nagpal
- Department of Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Amro Daoud
- Division of Gastroenterology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Katrina A Taylor
- Department of Pathology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Mohammad A Parvez
- Department of Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Jason Mckinney
- Division of Gastroenterology, East Tennessee State University Quillen College of Medicine, Johnson City, USA
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3
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Frame MT, Gohal J, Mader K, Goodman J. Primary Small Cell Carcinoma of the Breast: An Approach to Medical and Surgical Management. Cureus 2023; 15:e47981. [PMID: 38034272 PMCID: PMC10685056 DOI: 10.7759/cureus.47981] [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: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Primary small cell carcinoma of the breast (PSCCB) is a rare and aggressive tumor. Due to the small number of PSCCB cases, there are no established treatment protocols. We report a case of a 55-year-old perimenopausal woman who presented with a palpable left breast mass. A breast mass biopsy was performed, and pathology was consistent with poorly differentiated neuroendocrine small cell carcinoma. Imaging with magnetic resonance imaging (MRI) and positron emission tomography (PET) excluded metastatic disease. Due to recurrent positive margins, the patient underwent two lumpectomies and received neoadjuvant chemotherapy in between procedures. She ultimately underwent a left mastectomy and received postoperative radiation therapy. This case report aims to highlight the challenges that ensue following a diagnosis of PSCCB and underscores the need for creating a standardized treatment model for these vulnerable patients.
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Affiliation(s)
- Megan T Frame
- Internal Medicine, University of Kentucky, Lexington, USA
| | - Jaskaren Gohal
- Internal Medicine, Trinity Health Oakland/Wayne State University Program, Pontiac, USA
| | - Kelsey Mader
- Medicine, Ross University School of Medicine, Pontiac, USA
| | - Judie Goodman
- Hematology and Oncology, Trinity Health IHA Medical Group, Hematology Oncology - Oakland Campus, Pontiac, USA
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4
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Alía Navarro V, Martínez Delfrade Í, De Frutos González B, Morón García B, Barrill Corpa AM, Sotoca Rubio P, Peñas García B, Ferrer Gómez A, Perna Monroy C, Ferreiro Monteagudo R. Localized Colonic Small-Cell Carcinoma with Pathological Complete Response after Neoadjuvant Cisplatin and Etoposide: A Case Report. Curr Oncol 2023; 30:8426-8433. [PMID: 37754528 PMCID: PMC10528221 DOI: 10.3390/curroncol30090613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Extrapulmonary small-cell carcinoma (SCC) is a rare neoplasm that shares certain features with its pulmonary counterpart and occurs predominantly in the gastrointestinal tract (GIT). It is a high-grade and poorly differentiated neuroendocrine tumor, usually diagnosed in advanced stages, with a poor prognosis and few therapeutic options in that setting. This is a case report of a 77-year-old Spanish male patient with localized SCC of the colon, who presented a pathological complete response in the surgical specimen after neoadjuvant chemotherapy with cisplatin and etoposide. To date, 5 years after surgery, the patient remains without evidence of tumor recurrence. As clinical guidelines for the management of this entity are lacking, and therefore its management has not been standardized, an attempt to summarize the current evidence in the literature was made.
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Affiliation(s)
- Víctor Alía Navarro
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
| | - Íñigo Martínez Delfrade
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Belén De Frutos González
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Blanca Morón García
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Ana María Barrill Corpa
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
| | - Pilar Sotoca Rubio
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
| | - Beatriz Peñas García
- Gastroenterology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Ana Ferrer Gómez
- Pathology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | | | - Reyes Ferreiro Monteagudo
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain (R.F.M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Biomedical Research Network in Cancer (CIBERONC), 28029 Madrid, Spain
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5
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Simões de Carvalho F, de Brito Marques F, Gomes V, Sottomayor C, Amaro T, Marques AP. Active surveillance in lymph node small cell neuroendocrine carcinoma. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2023; 70:224-226. [PMID: 37030903 DOI: 10.1016/j.endien.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/07/2022] [Indexed: 04/08/2023]
Affiliation(s)
| | | | - Vânia Gomes
- Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Carlos Sottomayor
- Department of Oncology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Teresina Amaro
- Department of Pathology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Ana Paula Marques
- Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
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6
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Pandey L, Elhence A, Gupta S, Joseph D, Pasricha R, Gupta M. Small-cell carcinoma of the gall bladder: Report of three cases and review of the literature. Med J Armed Forces India 2022; 78:S330-S334. [PMID: 36147409 PMCID: PMC9485769 DOI: 10.1016/j.mjafi.2020.04.003] [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: 05/12/2019] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Gallbladder (GB) Small Cell Carcinoma (SCC) is an uncommon entity with very poor prognosis. There is a paucity of literature regarding its natural history and management, with only 73 prior cases reported in the world literature. In this case report, we present three cases of SCC of the GB with varied presentations, clinical course, management, and outcomes along with a brief review of the available literature on this subject.
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Affiliation(s)
- Laxman Pandey
- Senior Resident (Radiation Oncology), All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya Elhence
- Senior Resident (Radiation Oncology), All India Institute of Medical Sciences, Rishikesh, India
| | - Sweety Gupta
- Assistant Professor (Radiation Oncology), All India Institute of Medical Sciences, Rishikesh, India
| | - Deepa Joseph
- Associate Professor (Radiation Oncology), All India Institute of Medical Sciences, Rishikesh, India
| | - Rajesh Pasricha
- Additional Professor (Radiation Oncology), All India Institute of Medical Sciences, Rishikesh, India
| | - Manoj Gupta
- Professor (Radiation Oncology), All India Institute of Medical Sciences, Rishikesh, India
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7
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Xie K, Li XY, Liao BJ, Wu SC, Chen WM. Primary renal small cell carcinoma: A case report. World J Clin Cases 2022; 10:5884-5892. [PMID: 35979130 PMCID: PMC9258382 DOI: 10.12998/wjcc.v10.i17.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 04/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Small cell carcinoma (SCC) is a malignant tumour that is frequently accompanied by extensive metastasis. Primary renal SCC has typical characteristics related to SCC and is extremely rare, with no uniform treatment standard. Clinical treatment is mainly based on the literature. Here we report the diagnosis and treatment of an interesting case of primary renal SCC.
CASE SUMMARY We report a tortuous course of treatment for a 68-year-old man. Four years before diagnosis, the patient developed continuous gross haematuria, during which he underwent several ureteral biopsies, ureteral stricture relief, and urine exfoliated cell examinations; however, SCC was not confirmed. One month before radical resection of the renal pelvic carcinoma, the severe haematuria recurred. Computed tomography revealed transitional cell carcinoma in the right kidney and right upper ureter. A preoperative examination exluded the possibility of a pulmonary origin of the tumour, and primary renal SCC was diagnosed. The postoperative pathology findings were suggestive of SCC. The patient was treated with combined chemotherapy but died of tumour progression at 7 mo postoperative.
CONCLUSION Our patient's disease onset in the context of a succession of regular testing and the fact that it occurred so quickly with perirenal encroachment immediately after diagnosis reveals the cruel and unforgiving side of the disease. Furthermore, patients with poor comprehensive treatment results require new treatment regimens.
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Affiliation(s)
- Kun Xie
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330036, Jiangxi Province, China
| | - Xi-Ya Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330036, Jiangxi Province, China
| | - Bang-Jie Liao
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330036, Jiangxi Province, China
| | - Si-Cheng Wu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330036, Jiangxi Province, China
| | - Wei-Min Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330036, Jiangxi Province, China
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8
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Hou W, Zhou B, Hou G, Pang Y, Sang J, Li N. Small cell neuroendocrine carcinoma expressing alpha fetoprotein in the endometrium. Open Life Sci 2021; 16:1219-1224. [PMID: 34805530 PMCID: PMC8580041 DOI: 10.1515/biol-2021-0122] [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: 08/02/2021] [Revised: 09/18/2021] [Accepted: 09/25/2021] [Indexed: 11/15/2022] Open
Abstract
Rare small cell neuroendocrine carcinoma (SCNEC) cases showed alpha fetoprotein (AFP) expression in the endometrium. In this study, we reported a case of uterine SCNEC expressing AFP. In addition, a literature review was performed to investigate the potential mechanism and the clinicopathological features of SCNEC to provide clinical guidance. A 65-year-old female was referred to our hospital due to vaginal bleeding for 1 month in November 2020. The clinical features were summarized. After total hysterectomy and removal of bilateral appendages, the histological examination and immunohistochemistry examination were performed. Histological findings showed that the cancer cells were arranged in a nest-like pattern distributed in a lamellar manner. The smooth muscles of the uterus were invaded by cancer cells. Cancer cells were relatively consistent in size. Small glandular duct-like and rosettes-like structures were distinguished, together with necrotic tissues. The deep staining showed that the amount of cytoplasm was lower in the nucleus. Partial cancer cells had small nucleolus with an irregular profile. There were some mitotic figures. Immunohistochemistry examination indicated that there was a diffuse expression of CK, Syn, CgA, CD56, CK8/18, P16, AFP, HepPar-1, Glypican-3, and Ki67 (90%). In this case, we reported a SCNEC patient expressing AFP, Glypican-3, and HepPar-1.
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Affiliation(s)
- Weiwei Hou
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Bin Zhou
- Traditional Chinese Medicine Gynecology Department, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Gang Hou
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Yu Pang
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Jing Sang
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
| | - Ning Li
- Department of Pathology, Tai'an Central Hospital, No. 29, Longtan Road, Tai'an District, Tai'an 271000, China
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9
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Atchison L, Hardy T, Mancl T, Quaranta BP, Madan A. Locally Advanced Primary Small Cell Carcinoma of the Breast: A Case Report and Review of Current Evidence. Case Rep Oncol 2021; 14:761-766. [PMID: 34177527 PMCID: PMC8215941 DOI: 10.1159/000515505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022] Open
Abstract
Small-cell breast carcinoma (SCBC) is a very rare type of aggressive breast cancer constituting less than 1% of all breast cancers. The WHO classification categorizes this tumor as small-cell neuroendocrine carcinoma, and its prognosis is usually worse as compared to invasive breast cancers. We report a 64-year-old Caucasian female who presented with a large fungating left breast mass. Biopsy of the mass revealed small-cell carcinoma of the breast, negative for all 3 receptors (estrogen, progesterone, and Her2/neu). Imaging studies were negative for distant metastasis. She was subsequently treated after multidisciplinary discussion utilizing neoadjuvant chemotherapy with platinum agents and etoposide, modified radical mastectomy with axillary lymph node dissection, and adjuvant radiation therapy. Since she has triple-negative small-cell breast cancer, she will be followed with active surveillance without hormonal therapy. With less than 100 cases reported and in the absence of evidence-based standard treatment guidelines, we have reviewed various case series reported in the literature. We further discuss various chemotherapy regimens used previously, adverse prognostic factors of breast neuroendocrine tumors, common receptor status, and genetic mutations found in SCBC.
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Affiliation(s)
- Linsey Atchison
- Department of Internal Medicine Residency, SOVAH, Danville, Virginia, USA
| | - Thomas Hardy
- Department of Pathology, SOVAH, Danville, Virginia, USA
| | - Tara Mancl
- Department of General Surgery, SOVAH, Danville, Virginia, USA
| | | | - Ankit Madan
- Department of Internal Medicine, Medical Oncology, SOVAH, Danville, Virginia, USA
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10
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Li T, Chen S, Zhang Z, Lin L, Wu Q, Li J, Lin Q. Chemotherapy Plus Radiotherapy Versus Radiotherapy in Patients With Small Cell Carcinoma of the Esophagus: A SEER Database Analysis. Cancer Control 2021; 28:1073274821989321. [PMID: 33517712 PMCID: PMC8482724 DOI: 10.1177/1073274821989321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Small cell carcinoma of the esophagus is a rare malignant tumor. We aimed to explore the chemotherapeutic efficacy on the prognosis of patients with small cell carcinoma of the esophagus who received radiotherapy. Methods: To identify the population of interest, Surveillance, Epidemiology, and End Results data from 1996 to 2016 were chosen. Univariate and multivariate analyses were used to probe into prognosis factors. Multivariate Cox regression analysis was conducted to identify factors related to overall survival and cancer-specific survival. Results: Overall, data from 162 patients were analyzed in this study. Tumor size (P = 0.014), T staging (P = 0.028), and chemotherapy (P < 0.001) were independent prognostic factors affecting overall survival. Patients with regional disease (hazard ratio = 5.435, P < 0.001) and distant metastasis (hazard ratio = 2.183, P < 0.001) who received radiotherapy alone had worse survival than those receiving chemoradiotherapy. Tumor size (P = 0.004) and chemotherapy (P < 0.001) were independent prognostic factors affecting cancer-specific survival. Tumor size was an independent factor affecting cancer-specific survival for patients receiving chemoradiation. Conclusions: Age, T staging, tumor size, primary site, and chemotherapy are independent prognosis factors affecting overall survival and cancer-specific survival in patients with small cell carcinoma of the esophagus who receive radiotherapy. Chemotherapy might further improve cancer-specific survival in patients with small cell carcinoma of the esophagus receiving radiotherapy at all stages.
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Affiliation(s)
- Tao Li
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Sijia Chen
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Zongkai Zhang
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Limei Lin
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Qian Wu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jinluan Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
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11
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Xu JL, Guo Y. Clinical characteristics and survival of extrapulmonary small cell carcinoma in 11 different primary tumor sites in the United States, 1975-2016. Curr Med Res Opin 2021; 37:71-81. [PMID: 33135938 DOI: 10.1080/03007995.2020.1846024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Few studies have investigated extrapulmonary small cell carcinoma (EPSCC) in a systematic way. This study is to analyze EPSCC in 11 tumor sites from different aspects in the United States (1975-2016). METHODS In total 4397 patients diagnosed with EPSCC in 11 primary tumor locations were selected from the Surveillance, Epidemiology and End Results (SEER) database. The incidence of EPSCC in the last decade, and the 1, 3 and 5 year survival rates of each tumor site were also roughly calculated. Prognostic factors of EPSCC were investigated by Cox regression analysis. RESULTS Statistically, the incidence of EPSCC was on the rise over the past 30 years. Of its 11 primary tumor sites, bladder was the most frequently affected while the stomach and kidney were rarely affected. Males were more susceptible to EPSCC than females. Married patients were more commonly afflicted by EPSCC, but had longer survival. Cases were most intensive in California and an increased trend had been observed. The 5 year overall survival (OS) rate ranged from 2.0% to 42.5% in patients with EPSCC in 11 tumor sites (p < .001). The OS was better for EPSCC in the breast and cervix. However, tumor sites in the colon, esophagus, pancreas, rectum and stomach were all associated with worse survival. Characteristics and prognosis of EPSCC in different tumor sites were statistically significant (p < .001). Age, gender, marital status, stage, surgery, radiotherapy and chemotherapy were equally significant factors of survival of EPSCC patients (p < .05). CONCLUSION There was an increasing trend of EPSCC incidence. The survival of EPSCC in different tumor sites was significantly different. Tumor locations, age, gender, marital status, stage, surgery, radiotherapy and chemotherapy were all important factors of survival. This study has implications for EPSCC prevention and treatment.
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Affiliation(s)
- Ji-Li Xu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Yong Guo
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
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12
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Schizas D, Mastoraki A, Kirkilesis GI, Sioulas AD, Papanikolaou IS, Misiakos EP, Arkadopoulos N, Liakakos T. Neuroendocrine Tumors of the Esophagus: State of the Art in Diagnostic and Therapeutic Management. J Gastrointest Cancer 2018; 48:299-304. [PMID: 28656561 DOI: 10.1007/s12029-017-9978-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms composed of cells containing dense-core neuroendocrine secretory granules in their cytoplasm. NETs of the esophagus are exceedingly uncommon, with a parallel absence of data published on clinical features, prognosis, and proposed treatment strategies. METHODS As relevant classification is not well-established, knowledge acquired in NETs of lung and gastrointestinal sites usually guides esophageal NET management. Associated subtypes are divided based upon shared neuroendocrine features into small and large cell NET, typical and atypical carcinoid. RESULTS Common presenting symptoms include dysphagia, abdominal discomfort, weight loss, melena, and on occasion, signs of carcinoid syndrome. Endoscopic findings describe a polypoid, nodular elevated lesion with an overlying surface depicted as mostly smooth and glistening. Disease metastasis is assessed using anatomical imaging, including computed tomography (CT), endoscopic ultrasonography (EUS), and positron emission tomography (PET)-CT. Prognosis is influenced by the extent of lymph node metastasis and potential lymphovascular invasion. Furthermore, proliferative activity, estimated using mitotic count or Ki-67 immunostaining, has been suggested as a significant prognostic parameter. CONCLUSION Therapeutic approach depends on clinical staging. Nevertheless, currently, a specific treatment algorithm for esophageal NETs has not been elucidated. Endoscopic resection has been proposed in NETs less than 1 cm in size with absence of regional lymph node metastasis, while surgical excision combined with adjuvant chemotherapy remains the treatment of choice.
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Affiliation(s)
- Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece.
| | - George I Kirkilesis
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Athanasios D Sioulas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Ioannis S Papanikolaou
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Evangelos P Misiakos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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13
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Berniker AV, Abdulrahman AA, Teytelboym OM, Galindo LM, Mackey JE. Extrapulmonary small cell carcinoma: imaging features with radiologic-pathologic correlation. Radiographics 2015; 35:152-63. [PMID: 25590395 DOI: 10.1148/rg.351140050] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Extrapulmonary small cell carcinoma (EPSCC) refers to small cell carcinoma arising outside of the lungs. EPSCC extrapulmonary small cell carcinoma is a rare aggressive neoplasm, representing a minority of all small cell carcinomas. Despite its uncommon occurrence, EPSCC extrapulmonary small cell carcinoma has been described in nearly every organ, most commonly in the gastrointestinal and genitourinary systems. As such, it is important for radiologists to be aware of the entity. Although imaging is neither sensitive nor specific for EPSCC extrapulmonary small cell carcinoma , it plays an important role by helping exclude metastases from a primary pulmonary tumor, establish tumor staging, and assess response to therapy. EPSCC extrapulmonary small cell carcinoma is diagnosed by demonstrating pathologic features of small cell carcinoma in an extrapulmonary site. There are two ways to stage EPSCC extrapulmonary small cell carcinoma . One method uses the Veterans Administration Lung Study Group system developed for small cell lung cancer that allocates patients into limited or extensive disease categories. The second approach is the American Joint Committee on Cancer tumor-node-metastasis system applied to other tumor subtypes arising from the same organ. Because of its rare and varied manifestations, the most effective treatment for EPSCC extrapulmonary small cell carcinoma has not been established. Current management recommendations are derived from retrospective studies and single-institution experiences or are extrapolated from small cell lung cancer data. Regardless of therapy, overall survival rates are poor, with 5-year survival rates around 13%. To help radiologists increase their familiarity with EPSCC extrapulmonary small cell carcinoma , this article provides (a) a background for EPSCC extrapulmonary small cell carcinoma based on the literature and (b) a pictorial review of EPSCC extrapulmonary small cell carcinoma in multiple organs, with radiologic-pathologic correlation.
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Affiliation(s)
- Abigail V Berniker
- From the Departments of Radiology (A.V.B., O.M.T., J.E.M.) and Pathology (A.A.A., L.M.G.), Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023
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Akiyama Y, Iwaya T, Shioi Y, Endo F, Chiba T, Otsuka K, Nitta H, Koeda K, Mizuno M, Uesugi N, Kimura Y, Sasaki A. Effectiveness of neoadjuvant chemotherapy with cisplatin and irinotecan followed by surgery on small-cell carcinoma of the esophagus: A case report. Int J Surg Case Rep 2015; 17:121-5. [PMID: 26615446 PMCID: PMC4701824 DOI: 10.1016/j.ijscr.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/10/2015] [Indexed: 12/18/2022] Open
Abstract
Small-cell carcinoma of the esophagus is a rare disease and a poor prognosis. The optimum treatment strategy for SCCE remains to be established. We report a case of advanced SCCE achieving a pathologically complete response with preoperative chemotherapy using CDDP and CPT-11, and long-term survival followed by surgery. Neoadjuvant chemotherapy following esophagectomy could be a useful treatment option.
Introduction Small-cell carcinoma of the esophagus (SCCE) is a rare disease with aggressive progression and a poor prognosis. A standard treatment strategy for SCCE is yet to be established. Presentation of case A 40-year-old woman with dysphagia was admitted to our hospital. A clinical diagnosis of SCCE (T3N1N0 stage IIIA) was established. She was initially treated with chemotherapy using cisplatin (CDDP) and irinotecan (CPT-11). After two courses of treatment, the primary lesion in the esophagus was not detectable by esophageal endoscopy. Likewise, swelling of the right recurrent nerve lymph node present prior to treatment could not be detected. The chemotherapy resulted in a complete response. One month after the conclusion of chemotherapy, radical esophagectomy with three-field lymph node dissection was performed. Histopathological examination of the excised specimen revealed no residual tumor or lymph node metastasis. The patient was discharged from hospital 29 days after surgery with no complications. The patient is alive and has remained cancer-free for 48 months after the surgery. Discussion Systemic chemotherapy for SCCE in combination with surgery was treated after surgery in most reports. Neoadjuvant chemotherapy is advantageous from three viewpoints, namely achievement of downstaging, increasing complete resection rates, and a better completion of treatment compared with postoperative chemotherapy. Neoadjuvant chemotherapy following esophagectomy could be a useful treatment option for patients with limited disease (LD) of SCCE. Conclusion We report a case of SCCE achieving a pathologically complete response with neoadjuvant chemotherapy using CDDP and CPT-11, and long-term survival followed by surgery.
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Affiliation(s)
- Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yoshihiro Shioi
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Fumitaka Endo
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takehiro Chiba
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masaru Mizuno
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Noriyuki Uesugi
- Division of Molecular Diagnostic Pathology, Department of Pathology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yusuke Kimura
- Department of Palliative Care Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
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15
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Dai W, Liu M, Zhuang X, Li Q, Wang D. Mediastinal small cell carcinoma: a unique clinical entity? Clin Transl Oncol 2015; 18:515-20. [PMID: 26329297 DOI: 10.1007/s12094-015-1398-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/19/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Mediastinal small cell carcinoma (MSCC) is a rare tumor with limited published literature. In view of diagnostic confusion pertaining to this tumor, we investigated its origin, clinical features, management and survival. METHODS Clinical data of MSCC patients were retrospectively reviewed. Eligible patients showed pathologically proven small cell carcinoma (SCC) with the primary lesions confined to the mediastinum. Survival information was collected through follow-up studies. RESULTS Among 25 MSCC patients identified, 22 were classified to have limited disease (LD), while 3 were with extensive disease (ED). The 5 patients (20%) underwent surgery and 20 patients (80%) underwent non-surgical treatment. The 4 patients with LD MSCC received chemotherapy alone, while 13 of them received chemoradiotherapy. Overall median survival time (MST) of all patients was 22 months, and the 1-, 3- and 5-year overall survival rates were 67.4, 16.8, and 8.4%, respectively. The MST of LD and ED patients separately was 23 and 8 months, respectively, with significant difference (P = 0.005). But, the MST of patients who received surgical and non-surgical treatment was 25 and 21 months, respectively, with no significant difference (P = 0.757). The MST of LD patients receiving chemotherapy and chemoradiotherapy was 12 and 29 months, respectively, but somehow did not show significant difference (P = 0.482). CONCLUSIONS Our data suggested that MSCC may be a separate clinical entity like extrapulmonary small cell carcinomas (EPSCCs). Despite, multimodal treatment is currently the main treatment option, but for patients with LD MSCC, chemoradiotherapy is recommended to be preferred treatment modality.
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Affiliation(s)
- W Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - M Liu
- Department of Thoracic Surgery, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - X Zhuang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Q Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - D Wang
- Department of Thoracic Surgery, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100021, China.
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Primary small cell neuroendocrine carcinoma of paranasal sinuses. Case Rep Med 2014; 2014:874719. [PMID: 25057271 PMCID: PMC4095648 DOI: 10.1155/2014/874719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 12/16/2022] Open
Abstract
Small cell neuroendocrine carcinoma of the paranasal sinuses is an extremely rare and aggressive neoplasm. Despite aggressive management, the tumor carries a poor prognosis, with a high risk of local recurrence or distant metastases. The management strategy is based on that for pulmonary small cell cancer and includes platinum-based chemotherapy combined with radiotherapy. We are reporting a case of an 89-year-old female patient diagnosed with small cell carcinoma of right-sided ethmoid and sphenoid sinuses. The tumor was found to have invaded the right orbit and anterior cranial fossa. Metastases to cervical lymph nodes and bone were also found. Due to the extended stage and poor prognosis of the patient, the management plan is palliative chemoradiotherapy.
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Treglia G, Bongiovanni M, Giovanella L. Metastatic small cell neuroendocrine carcinoma of the pelvic floor. Endocrine 2014; 46:164-5. [PMID: 24065309 DOI: 10.1007/s12020-013-0053-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/02/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Via Ospedale, 12, 6500, Bellinzona, Switzerland,
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18
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Tirumani H, Rosenthal MH, Tirumani SH, Shinagare AB, Krajewski KM, Ramaiya NH. Imaging of uncommon esophageal malignancies. Dis Esophagus 2014; 28:552-9. [PMID: 24635682 DOI: 10.1111/dote.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malignant esophageal neoplasms other than squamous cell carcinoma and adenocarcinoma are uncommon and include endocrine tumors, lymphoid malignancies, melanoma, malignant stromal tumors, and secondary tumors (metastases). Imaging, though not diagnostic in many cases, helps in selecting the appropriate treatment strategy by determining the anatomic extent of the tumor and locoregional and distant spread. In this article, we provide a comprehensive review of the imaging features of these uncommon esophageal malignancies.
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Affiliation(s)
- H Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - M H Rosenthal
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - S H Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - A B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - N H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Treglia G, Bongiovanni M, Giovanella L. A rare case of small cell neuroendocrine carcinoma of the urinary bladder incidentally detected by F-18-FDG PET/CT. Endocrine 2014; 45:156-7. [PMID: 23783367 DOI: 10.1007/s12020-013-9995-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/27/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Via Ospedale, 12, 6500, Bellinzona, Switzerland,
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Update on the management of gastroenteropancreatic neuroendocrine tumors with emphasis on the role of imaging. AJR Am J Roentgenol 2013; 201:811-24. [PMID: 24059370 DOI: 10.2214/ajr.12.10240] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purposes of this article are to review the current management of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) based on the 2012 National Comprehensive Cancer Network guidelines and to describe the role of imaging in a multidisciplinary approach. CONCLUSION The management of GEP-NETs has become complex, requiring a multidisciplinary approach. The World Health Organization classification of GEP-NETs has been revised; the U.S. Food and Drug Administration has approved molecular targeted agents (sunitinib, everolimus) for the treatment of pancreatic NETs; and the National Comprehensive Cancer Network clinical practice guidelines have been updated.
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Joyce EA, Kavanagh J, Sheehy N, Beddy P, O'Keeffe SA. Imaging features of extrapulmonary small cell carcinoma. Clin Radiol 2013; 68:953-61. [PMID: 23790688 DOI: 10.1016/j.crad.2013.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/30/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
Small cell carcinoma accounts for approximately 20% of lung cancers; however, it rarely occurs at other sites. Extrapulmonary small cell carcinoma (EPSCC) is notoriously aggressive with a strong propensity for both regional and distant spread. The majority of the literature on these uncommon tumours is from a clinicopathological viewpoint with a relative paucity of detail regarding the radiological findings. This review will focus on the imaging features of EPSCC in its predominant sites of origin: the gastrointestinal tract, genitourinary tract, head, neck, and breast. We will also discuss the role of positron-emission tomography (PET)/computed tomography (CT) in the staging of EPSCC.
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Affiliation(s)
- E A Joyce
- Department of Radiology, St James's Hospital and Trinity College Dublin, Dublin, Ireland.
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Primary small cell carcinoma with neuroendocrine properties of the mandible: A case report and literature review. J Dent Sci 2012; 12:413-416. [PMID: 30895083 PMCID: PMC6395287 DOI: 10.1016/j.jds.2012.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 03/16/2012] [Indexed: 01/27/2023] Open
Abstract
Small-cell carcinomas at extrapulmonary primary sites are rare but they have been documented to arise at various locations. We report a case of small-cell carcinoma arising in the mandible, which has so far not been reported in the literature. A 37-year-old male patient underwent partial resection of the left mandible and adjuvant chemotherapy. Immunohistochemistry confirmed the diagnosis of small-cell carcinoma with neuroendocrine properties. The patient has been free of disease for 18 months after receiving treatment and was alive at the time of writing. We recommend surgical resection followed by chemotherapy for managing small-cell carcinomas in the mandibular region.
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Funakoshi S, Hashiguchi A, Teramoto K, Miyata N, Kurita S, Adachi M, Hamamoto Y, Higuchi H, Takaishi H, Hibi T. Second-line chemotherapy for refractory small cell neuroendocrine carcinoma of the esophagus that relapsed after complete remission with irinotecan plus cisplatin therapy: Case report and review of the literature. Oncol Lett 2012; 5:117-122. [PMID: 23255905 DOI: 10.3892/ol.2012.1008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/04/2012] [Indexed: 12/14/2022] Open
Abstract
Small cell esophageal carcinoma is a type of small cell neuroendocrine carcinoma (SCNEC). SCNEC follows an aggressive clinical course and has a poor prognosis despite multidisciplinary therapies. A standard therapeutic strategy, including surgery, radiation and first-/second-line chemotherapy, has not yet been established for SCNEC. We present a case of SCNEC of the esophagus. A 66-year-old male with SCNEC as extensive disease was treated with 60 mg/m(2) cisplatin on day 1 plus 60 mg/m(2) irinotecan on days 1, 8 and 15 every 4 weeks (IP) with successful complete remission. After the sixth course of IP, increasing pro-gastrin-releasing peptide (ProGRP) and nonspecific enolase (NSE) levels and intense fluorodeoxyglucose (FDG) avidity in a lymph node around the celiac artery (SUV(max), 8.3) indicated a refractory relapse of the disease. The patient was treated with three courses of amrubicin (AMR, 35 mg/m(2)) administered intravenously for 3 consecutive days every 3 weeks as a second-line chemotherapy. The ProGRP and NSE levels returned to the normal range 1 month after the initiation of second-line chemotherapy. However, the ProGRP and NSE levels were elevated after the third course of AMR, and PET-CT revealed progressive disease with liver metastasis and extended lymph node metastasis. As the patient remained asymptomatic, paclitaxel (100 mg/m(2)) was started as third-line chemotherapy. Patients with SCNEC of the esophagus with extensive disease should be treated with aggressive chemotherapy rather than surgery or radiation monotherapy. In the present case, tumor markers such as ProGRP and NSE were predictive of relapse and PET-CT was used to detect relapse. Further research is required to identify and exploit promising agents for resistant SCNEC.
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