1
|
Massironi S, Franchina M, Ippolito D, Elisei F, Falco O, Maino C, Pagni F, Elvevi A, Guerra L, Invernizzi P. Improvements and future perspective in diagnostic tools for neuroendocrine neoplasms. Expert Rev Endocrinol Metab 2024; 19:349-366. [PMID: 38836602 DOI: 10.1080/17446651.2024.2363537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Neuroendocrine neoplasms (NENs) represent a complex group of tumors arising from neuroendocrine cells, characterized by heterogeneous behavior and challenging diagnostics. Despite advancements in medical technology, NENs present a major challenge in early detection, often leading to delayed diagnosis and variable outcomes. This review aims to provide an in-depth analysis of current diagnostic methods as well as the evolving and future directions of diagnostic strategies for NENs. AREA COVERED The review extensively covers the evolution of diagnostic tools for NENs, from traditional imaging and biochemical tests to advanced genomic profiling and next-generation sequencing. The emerging role of technologies such as artificial intelligence, machine learning, and liquid biopsies could improve diagnostic precision, as could the integration of imaging modalities such as positron emission tomography (PET)/magnetic resonance imaging (MRI) hybrids and innovative radiotracers. EXPERT OPINION Despite progress, there is still a significant gap in the early diagnosis of NENs. Bridging this diagnostic gap and integrating advanced technologies and precision medicine are crucial to improving patient outcomes. However, challenges such as low clinical awareness, limited possibility of noninvasive diagnostic tools and funding limitations for rare diseases like NENs are acknowledged.
Collapse
Affiliation(s)
- Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marianna Franchina
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Davide Ippolito
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Federica Elisei
- Division of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Olga Falco
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Division of Pathology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alessandra Elvevi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luca Guerra
- Division of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
2
|
Neuroendocrine neoplasm imaging: protocols by site of origin. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4081-4095. [PMID: 36307597 DOI: 10.1007/s00261-022-03713-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 01/18/2023]
Abstract
With the relatively low incidence of neuroendocrine neoplasms (NEN), most radiologists are not familiar with their optimal imaging techniques. The imaging protocols for NENs should be tailored to the site of origin to accurately define local extension of NEN at time of staging. Patterns of spread and recurrence should be taken into consideration when choosing protocols for detection of recurrence and metastases. This paper will present the recommended CT and MRI imaging protocols for gastro-enteric and pancreatic NENs based on site of origin or predominant pattern of metastatic disease, and explain the rationale for MRI contrast type, contrast timing, as well as specific sequences in MRI. We will also briefly comment on PET/CT and PET/MRI imaging protocols.
Collapse
|
3
|
Small bowel neuroendocrine neoplasm: what surgeons want to know. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4005-4015. [PMID: 35312820 DOI: 10.1007/s00261-022-03485-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 01/18/2023]
Abstract
Neuroendocrine neoplasms of the small bowel are a diverse group of tumors with a broad spectrum of imaging findings and clinical implications. Most tumors originate in close proximity to the ileocecal valve and most commonly metastasize to the mesentery and liver. This review will highlight the imaging findings of primary and metastatic small bowel neuroendocrine neoplasm that are most relevant to the surgical team.
Collapse
|
4
|
Ramachandran A, Madhusudhan KS. Advances in the imaging of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:3008-3026. [PMID: 36051339 PMCID: PMC9331531 DOI: 10.3748/wjg.v28.i26.3008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms comprise a heterogeneous group of tumors that differ in their pathogenesis, hormonal syndromes produced, biological behavior and consequently, in their requirement for and/or response to specific chemotherapeutic agents and molecular targeted therapies. Various imaging techniques are available for functional and morphological evaluation of these neoplasms and the selection of investigations performed in each patient should be customized to the clinical question. Also, with the increased availability of cross sectional imaging, these neoplasms are increasingly being detected incidentally in routine radiology practice. This article is a review of the various imaging modalities currently used in the evaluation of neuroendocrine neoplasms, along with a discussion of the role of advanced imaging techniques and a glimpse into the newer imaging horizons, mostly in the research stage.
Collapse
Affiliation(s)
- Anupama Ramachandran
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
5
|
Rashid H, Chung J, Haghshenas MP, Humphries MH, Sarva S. Catching the GIST: Massive Gastrointestinal Stromal Tumor Presenting as Acute Dyspnea. J Radiol Case Rep 2022; 16:11-16. [PMID: 35530420 PMCID: PMC9063817 DOI: 10.3941/jrcr.v16i4.4466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
We present a case of a 55-year-old woman presenting with worsening shortness of breath and constipation over the course of three days. Initial computed tomography scan showed a large, complex abdominal mass with a vascular pedicle and possible pedunculated origin along the inferior aspect of the greater curvature of the stomach. The mass was further evaluated on magnetic resonance imaging showing an active hemorrhage. The patient became hemodynamically unstable and general surgery was consulted for evaluation. Mass resection was performed, and biopsy revealed KIT/CD117+ and DOG1/ANO1+ gastrointestinal stromal tumor staged as T4. Although definitive diagnosis of a gastrointestinal stromal tumor requires biopsy, prompt clinical and radiological recognition is critical for patients to receive definitive treatment of mass resection.
Collapse
Affiliation(s)
- Hytham Rashid
- Department of Internal Medicine, University of Houston/HCA Houston Healthcare Kingwood, TX, USA
| | - Johnathon Chung
- Department of Internal Medicine, University of Houston/HCA Houston Healthcare Kingwood, TX, USA
| | - Mimi Phan Haghshenas
- Department of Internal Medicine, University of Houston/HCA Houston Healthcare Kingwood, TX, USA
| | | | - Sivatej Sarva
- Department of Critical Care, University of Houston/HCA Houston Healthcare Kingwood, TX, USA
| |
Collapse
|
6
|
Kartal İ. Childhood neuroendocrine tumors of the digestive system: A single center experience. Medicine (Baltimore) 2022; 101:e28795. [PMID: 35147110 PMCID: PMC8830841 DOI: 10.1097/md.0000000000028795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/18/2022] [Indexed: 01/04/2023] Open
Abstract
The prevalence and incidence of neuroendocrine tumors (NETs) are increasing in the pediatric population. This increase can be associated with improved diagnostics and increased detection rates of the disease. We aimed to discuss the clinical and pathological characteristics of patients with this rare disease who were followed and treated at our center.The medical records of children (aged 0-18 years) with NETs of the digestive system, followed up and treated between 2007 and 2020 at Ondokuz Mayis University Faculty of Medicine, were reviewed.Overall, 16 patients (8 girls and 8 boys) were analyzed. Fifteen patients had NETs in the appendix; 14 of these had grade I NETs, and 1 had grade II NETs. No additional surgery was performed except for appendectomy. All patients were in complete remission at the last follow-up (median 38 months). The other patient, a 12-year-old girl, had a primary hepatic neuroendocrine carcinoma (grade III NET). Three cycles of neoadjuvant and adjuvant platinum-based chemotherapy were administered, and right hepatectomy was performed to remove the mass. The patient is being followed-up for approximately 3 years without disease recurrence.Most NETs are observed in adults, and most studies have focused on this population. Unlike adults, increasing awareness of the disease in the pediatric population (especially in cases of acute appendicitis), discovering therapeutic treatments, and sharing experiences are crucial for developing an optimal therapeutic approach for pediatric NETs.
Collapse
|
7
|
The hairpin turn. Abdom Radiol (NY) 2020; 45:1218-1219. [PMID: 32008113 DOI: 10.1007/s00261-020-02422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
8
|
Vusqa UT, Patel S, Rashid MU, Sarvepalli D, Khan AH. Carcinoid Tumor: Advances in Treatment Options. Cureus 2020; 12:e6641. [PMID: 32064213 PMCID: PMC7011579 DOI: 10.7759/cureus.6641] [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] [Indexed: 12/03/2022] Open
Abstract
Small bowel neoplasms are rare, accounting for only 3%-6% of all gastrointestinal neoplasms. Carcinoid tumors represent a large portion of these (20%-30%), making them the second most common small bowel malignancy after adenocarcinoma. Gastrointestinal carcinoids constitute 70% of all neuroendocrine tumors, and out of those, 42% originate in the small bowel. They are predominantly seen in older patients around the age of 65 years. From 1973 to 2004, there has been more than a fourfold increase in the incidence of carcinoid tumors. This can be probably due to increased diagnostic accuracy rather than an actual increase in the number of new cases. The workup of a suspicious case of gastrointestinal bleeding consists of esophagogastroduodenoscopy and/or colonoscopy, and other imaging tests including video capsule endoscopy and balloon-assisted endoscopy. Management of the tumors is dependent on the size and location of the lesion. Treatment options include surgery, endoscopic removal of tumors, and various immunotherapy and chemotherapeutic agents.
Collapse
Affiliation(s)
- Urwat T Vusqa
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Stuti Patel
- Internal Medicine, Gujarat Medical Education and Research Society Medical College, Vadodara, IND
| | | | | | - Abu H Khan
- Gastroenterology, AdventHealth, Orlando, USA
| |
Collapse
|
9
|
Farooqui ZA, Chauhan A. Neuroendocrine Tumors in Pediatrics. Glob Pediatr Health 2019; 6:2333794X19862712. [PMID: 31384627 PMCID: PMC6647200 DOI: 10.1177/2333794x19862712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/23/2022] Open
Abstract
Neuroendocrine cells are dispersed diffusely throughout many organ systems in the body and hence neuroendocrine tumors (NETs) can arise from almost anywhere in the body. NETs are considered rare tumors, and the current incidence is reported to be about 6 cases in 100 000 in adults and about 2.8 cases per million in the pediatric age group. Despite the indolent nature of these tumors, they have the potential for metastasis and significant morbidity. NETs can be asymptomatic at the time of diagnosis or can present with flushing, diarrhea, wheezing, weight loss, and fatigue among other symptoms. Due to the ambiguity of presenting symptoms, it is not uncommon for NETs to be diagnosed late in the disease course. Despite low incidence, the prevalence of the disease is high since patients live for many years and sometimes decades. Early detection of well-differentiated NETs has excellent outcomes with the majority of early-stage diseases being cured with surgical resection alone. There have been recent advancements in the management of metastatic progressive NETs with approval of peptide receptor radionuclide therapy, telotristat, and everolimus. Awareness of these rare tumors and its management is crucial for optimal management. This article will focus on pediatric NETs and current advances in its management.
Collapse
Affiliation(s)
| | - Aman Chauhan
- Markey Cancer Center, Lexington, KY, USA
- University of Kentucky, Lexington, KY, USA
| |
Collapse
|
10
|
Kim SW, Kim HC, Oh J, Won KY, Park SJ, Yang DM. Tumors of the jejunum and ileum: a pattern-based imaging approach on CT. Abdom Radiol (NY) 2019; 44:2337-2345. [PMID: 30877330 DOI: 10.1007/s00261-019-01978-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since a broad spectrum of tumors can occur in the small bowels, it is not easy to make a correct differential diagnosis among small bowel tumors on CT findings. Therefore, once a mass is detected on CT, the radiologist needs to analyze the mass based on presenting patterns such as location, multiplicity, morphology, and enhancement patterns. In this article, we will illustrate various kinds of small bowel tumors based on imaging patterns at CT to facilitate making a correct diagnosis.
Collapse
Affiliation(s)
- Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea.
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea
| | - Jiyoung Oh
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea
| | - Kyu Yeoun Won
- Deparment of Pathology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seong Jin Park
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea
| |
Collapse
|
11
|
Yoon S, Lee SK, Lee J, Baek YB, Cho KO, Choi J. Dual-phase computed tomography angiography of intestinal carcinoid tumor as a lead point for cecocolic intussusception in a dog. J Vet Med Sci 2019; 81:928-932. [PMID: 30996205 PMCID: PMC6612499 DOI: 10.1292/jvms.19-0101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In an 8-year-old Labrador Retriever with progressive anorexia, constipation, and depression, CT revealed intussusception of the cecum into the ascending colon and a small cecal mass showing strong enhancement on arterial phase. The ileocecocolic junction was surgically resected and histologically diagnosed as cecocolic intussusception with carcinoid tumor. The carcinoid tumor worked as a lead point of intussusception in this case. Dual phasic CT is useful to assess the presence of gastrointestinal tumors as lead points in old dogs with intussusception.
Collapse
Affiliation(s)
- Sooa Yoon
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, South Korea
| | - Sang-Kwon Lee
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, South Korea
| | - Juhwan Lee
- Chonnam National University Veterinary Teaching Hospital, Gwangju 61186, South Korea
| | - Yeong-Bin Baek
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, South Korea
| | - Kyoung-Oh Cho
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, South Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju 61186, South Korea
| |
Collapse
|
12
|
Abstract
OBJECTIVE. The purpose of this article is to provide a multimodality imaging review of ileal carcinoid tumor. CONCLUSION. Ileal carcinoid tumors display a variety of radiologic findings. Delay in diagnosis is common because of initial nonspecific symptoms and subtle imaging findings. Reviewing the multimodality imaging appearance of the primary tumor, metastatic disease, and associated ancillary findings can help improve patient care.
Collapse
|
13
|
Neuroendocrine tumors of the small intestine causing a desmoplastic reaction of the mesentery are a more aggressive cohort. Surgery 2018; 164:1093-1099. [PMID: 30076029 DOI: 10.1016/j.surg.2018.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/28/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Desmoplastic reaction of the mesentery is commonly seen in patients with neuroendocrine tumors of the small intestine. However, it is not clear whether desmoplastic reaction is associated with tumor-specific characteristics and diminished prognosis. Therefore, the aim of this study was to investigate whether the presence of a desmoplastic reaction correlates with prognostic and molecular markers of neuroendocrine tumors of the small intestine. METHODS Patients with neuroendocrine tumors of the small intestine operated at our department from 2000 to 2016 were analyzed. Patient and tumor characteristics were evaluated. Kaplan-Meier and multivariate analyses were performed. RESULTS In total, 148 patients underwent surgery, and preoperative imaging was available in 113 patients. A total of 45 patients showed desmoplastic reaction of the mesentery and progression-free survival was significantly impaired (26 months versus 65.4 months) compared with patients without desmoplastic reaction. These patients had significantly more often distant metastases (84.4% vs 39.7%), lymphatic vessel (68.9% vs 44.1%), and perineural tissue infiltration (57.8% vs 17.6%) compared with patients without desmoplastic reaction. However, proliferation index (positive desmoplastic reaction 4.1% versus negative desmoplastic reaction 3.3%) and tumor size (positive desmoplastic reaction 2 cm versus negative desmoplastic reaction 1.9 cm) were not diverging significantly. CONCLUSION This study revealed that tumors leading to desmoplastic reaction are more aggressive, despite similar Ki67 indices.
Collapse
|
14
|
The Added Diagnostic Value of 18F-Fluorodihydroxyphenylalanine PET/CT in the Preoperative Work-Up of Small Bowel Neuroendocrine Tumors. J Gastrointest Surg 2018; 22:722-730. [PMID: 29235002 DOI: 10.1007/s11605-017-3645-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/20/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The precise localization of the primary tumor and/or the identification of multiple primary tumors improves the preoperative work-up in patients with small bowel (SB) neuroendocrine tumor (NET). The present study assesses the diagnostic value of 18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography/computed tomography (PET/CT) during the preoperative wok-up of SB NETs. METHODS Between January 2010 and June 2017, all consecutive patients with SB NETs undergoing preoperative 18F-FDOPA PET/CT and successive resection were analyzed. Preoperative work-up included computed tomography (CT), somatostatin receptor scintigraphy (SRS), and 18F-FDOPA PET/CT. Sensitivity and accuracy ratio for primary and multiple tumor detection were compared with data from surgery and pathology. RESULTS There were 17 consecutive patients with SB NETs undergoing surgery. Nine patients (53%) had multiple tumors, 15 (88%) metastatic lymph nodes, 3 (18%) peritoneal carcinomatosis, and 9 patients (53%) liver metastases. A total of 70 SB NETs were found by pathology. Surgery identified the primary in 17/17 (100%) patients and recognized seven of 9 patients (78%) with multiple synchronous SB. Preoperatively, 18F-FDOPA PET/CT displayed a statistically significant higher sensitivity for primary tumor localization (100 vs. 23.5 vs. 29.5%) and multiple tumor detection (78 vs. 22 vs. 11%) over SRS and CT. Compared with pathology, 18F-FDOPA PET/CT displayed the highest accuracy ratio for number of tumor detected over CT and SRS (2.0 ± 2.2 vs. 0.4 ± 0.7 vs. 0.6 ± 1.5, p = 0.0003). CONCLUSION 18F-FDOPA PET/CT significantly increased the sensitivity and accuracy for primary and multiple SB NET identification. 18F-FDOPA PET/CT should be included systematically in the preoperative work-up of SB NET.
Collapse
|
15
|
Mantzoros I, Savvala NA, Ioannidis O, Parpoudi S, Loutzidou L, Kyriakidou D, Cheva A, Intzos V, Tsalis K. Midgut neuroendocrine tumor presenting with acute intestinal ischemia. World J Gastroenterol 2017; 23:8090-8096. [PMID: 29259385 PMCID: PMC5725304 DOI: 10.3748/wjg.v23.i45.8090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/05/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms, which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.
Collapse
Affiliation(s)
- Ioannis Mantzoros
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Natalia Antigoni Savvala
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Styliani Parpoudi
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Lydia Loutzidou
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Despoina Kyriakidou
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Angeliki Cheva
- Department of Pathology, General Hospital “G. Papanikolaou”, Thessaloniki 57010, Greece
| | - Vasileios Intzos
- Department of Radiology, General Hospital “G. Papanikolaou”, Thessaloniki 57010, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| |
Collapse
|
16
|
Pediatric Neuroendocrine Carcinoid Tumors: Review of Diagnostic Imaging Findings and Recent Advances. AJR Am J Roentgenol 2017; 208:868-877. [PMID: 28199138 DOI: 10.2214/ajr.16.17287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Although rare, pediatric neuroendocrine tumors including carcinoid tumor have increased in incidence over the past few decades. Despite increased recognition, survival rates have not significantly improved. Earlier detection of these tumors is necessary to improve clinical outcomes. This article discusses imaging approaches for detecting pediatric carcinoid tumors including anatomic imaging methods such as CT and MRI as well as functional imaging methods targeting the somatostatin receptor including 111In-labeled octreotide and newer 68Ga-based radiotracers that may hold promise in hybrid PET/CT or PET/MRI. CONCLUSION Improvements in functional imaging with novel somatostatin receptor-specific radiotracers along with fused functional and anatomic imaging have substantially improved the clinical detection of carcinoid tumors. Although rare, these tumors are encountered in children, and an awareness of the appropriate use of various imaging methods is essential for pediatric specialists. Further research is needed to ascertain the diagnostic value of newer imaging methods and radiotracer-based treatment approaches, especially in the pediatric population.
Collapse
|
17
|
Fitzgerald E, Lam R, Drees R. IMPROVING CONSPICUITY OF THE CANINE GASTROINTESTINAL WALL USING DUAL PHASE CONTRAST-ENHANCED COMPUTED TOMOGRAPHY: A RETROSPECTIVE CROSS-SECTIONAL STUDY. Vet Radiol Ultrasound 2017; 58:151-162. [DOI: 10.1111/vru.12467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ella Fitzgerald
- Department of Clinical Sciences and Services, Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| | - Richard Lam
- Department of Clinical Sciences and Services, Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| | - Randi Drees
- Department of Clinical Sciences and Services, Royal Veterinary College; University of London; Hertfordshire AL9 7TA UK
| |
Collapse
|