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Behi H, Omry A, Dallagi R, Changuel A, Troudi D, Khalifa MB. Diagnosing and managing small bowel neuroendocrine tumors presenting as acute obstruction in an elderly patient: A case report and comprehensive management overview. Int J Surg Case Rep 2024; 122:110126. [PMID: 39126932 PMCID: PMC11363995 DOI: 10.1016/j.ijscr.2024.110126] [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: 07/07/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Neuroendocrine tumors (NETs) of the small bowel are rare but clinically significant due to their challenging diagnostic pathways and potential for insidious progression. Early identification is critical for effective management and improved prognosis in these cases. CLINICAL PRESENTATION Here, we present a case of a 75-year-old patient with no significant medical history who presented acutely with diffuse abdominal pain, vomiting, and signs of bowel obstruction. Diagnostic workup, including CT imaging, revealed a distal ileal neuroendocrine mass with mesenteric lymphadenopathy, necessitating urgent surgical intervention. DISCUSSION This case underscores the diagnostic complexities and therapeutic challenges associated with small bowel NETs. Surgical resection with meticulous lymph node dissection remains the cornerstone of treatment, aimed at achieving complete tumor excision and optimal disease control. The role of imaging modalities and biochemical markers in guiding clinical decisions and postoperative management strategies is discussed considering the patient's clinical course. CONCLUSION Timely recognition and intervention are crucial in the management of small bowel NETs, given their potential for late presentation and nonspecific symptoms. Despite diagnostic and procedural challenges highlighted in this case, early surgical intervention and comprehensive follow-up are essential for achieving favorable outcomes and minimizing recurrence risks in patients with small bowel NETs.
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Affiliation(s)
- Hager Behi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Ahmed Omry
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
| | - Rania Dallagi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Amel Changuel
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Dholkefl Troudi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Med Bachir Khalifa
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
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Chen JS, Bai LY, Cheng HH, Chan SL, Zou JY, Shi X, Houchard A, Truong-Thanh XM, Chen MH. Real-World Study of Lanreotide Autogel in Routine Practice in Patients with Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in Hong Kong and Taiwan. Oncol Ther 2024:10.1007/s40487-024-00302-6. [PMID: 39215958 DOI: 10.1007/s40487-024-00302-6] [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: 05/30/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION There is a lack of data on the efficacy, effectiveness, and safety of lanreotide autogel in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) of Chinese ethnicity. This non-interventional, retrospective study evaluated the effectiveness and safety of lanreotide autogel in patients of Chinese ethnicity with GEP-NETs in clinical practice. METHODS Patient charts were abstracted from five hospitals in Hong Kong and Taiwan (July-September 2021), where lanreotide autogel is approved for treating GEP-NETs. Included patients were adults with unresectable, metastatic, or locally advanced GEP-NETs who received a first injection (index) of lanreotide autogel 120 mg between 01 January 2017 and 30 June 2020 (planned sample size: N = 30). Follow-up ran from index to a maximum of 48 (± 4) weeks or until disease progression, start of new antitumor treatment, or death. The primary endpoint was progression-free survival (PFS) rate at week 48 (±4), and secondary endpoints included PFS rate at week 24 (±4), estimated using Kaplan-Meier analyses. All analyses were descriptive. RESULTS Of 27 patients enrolled, 22 (81.5%) had 48 weeks of follow-up. Tumors of pancreatic origin were the most common (73.9%). PFS rate was 0.96 (95% confidence interval: 0.72 - 0.99) at 24 weeks and 0.82 (0.53-0.94) at 48 weeks. Overall, 74.1% patients experienced ≥ 1 treatment-emergent adverse event; none were serious. No deaths were reported. CONCLUSIONS Lanreotide autogel was well tolerated and showed good tumor control rate in a real-world setting. These findings align with results from previous studies in Caucasian, Japanese, and Korean patients, thus supporting lanreotide autogel for treating patients with GEP-NETs of Chinese ethnicity.
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Affiliation(s)
- Jen-Shi Chen
- Department of Hematology-Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | | | - Stephen Lam Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | - Ming-Huang Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei City, 11217, Taiwan.
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Puia D, Ivanuta M, Pricop C. Appendicular Neuroendocrine Tumours: An Unusual Cause of Hydronephrosis. Cureus 2024; 16:e62774. [PMID: 39036213 PMCID: PMC11260117 DOI: 10.7759/cureus.62774] [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: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Although neuroendocrine tumours (NETs) are predominantly located in the gastrointestinal tract, pancreas, and lungs, they can also occur in uncommon places such as the biliary system, prostate, breast, head, neck, and even the spinal cord. We present the case of a 30-year-old woman who was referred to the urology clinic for right ureterohydronephrosis. Because the contrast-enhanced CT scan did not show signs of kidney stones or an upper urothelial tract cell carcinoma and was combined with renal scintigraphy, the kidney was not functional, and a left nephrectomy was performed. During the surgery, it was observed that the appendix was attached to the ureter by a tiny tumour. In addition, an appendectomy was also conducted. The pathological test indicated the presence of a NET that had invaded the ureter. The diagnosis was confirmed by immunohistochemical staining. The tissue has been positive for chromogranin and synaptophysin staining. Our work highlights the infrequency and difficulty of diagnosing NETs that invade the ureter. Conducting a thorough histological evaluation in patients with uncertain histopathological diagnoses is essential.
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Affiliation(s)
- Dragos Puia
- Urology, University for Medicine and Pharmacy "Grigore T. Popa", Iasi, ROU
| | - Marius Ivanuta
- Urology, University for Medicine and Pharmacy "Grigore T. Popa", Iasi, ROU
| | - Catalin Pricop
- Urology, University for Medicine and Pharmacy "Grigore T. Popa", Iasi, ROU
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Hu W, Zhao J, Wang G, Wang Q, Deng M, Shen J, Hofman P, Urbanska EM, Santoni-Rugiu E, Christopoulos P, Ramirez RA, Hida T, Lu X, He B. A rare case report of a primary lung cancer comprising adenocarcinoma and atypical carcinoid tumor, with the carcinoid component harboring EML4-ALK rearrangement. Transl Lung Cancer Res 2024; 13:1150-1162. [PMID: 38854939 PMCID: PMC11157374 DOI: 10.21037/tlcr-24-352] [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: 04/21/2024] [Accepted: 05/10/2024] [Indexed: 06/11/2024]
Abstract
Background The occurrence of pulmonary adenocarcinoma coexisting with atypical carcinoid tumors is a rare phenomenon. The presence of EML4-ALK fusion in an atypical carcinoid component of a histologically mixed tumor is even more uncommon. Due to their infrequency, the origin and pathogenesis of these mixed tumors remain largely unknown. The advances of therapy development in such patients are still limited and there is no standard treatment. We present a case of collision tumor in the lung consisting of atypical carcinoid and adenocarcinoma to better understand the clinical characteristics of this disease. Case Description We report an extremely rare case of EML4-ALK rearrangement in a pulmonary atypical carcinoid tumor that coexisting with adenocarcinoma. A 58-year-old woman, who was asymptomatic, underwent pulmonary lobectomy due to the detection of a gradually enlarging solitary pulmonary nodule in the right upper lung. Histological examination of the resected tumor revealed the presence of both atypical carcinoid (approximately 80%) and adenocarcinoma (approximately 20%) components. Metastases by the carcinoid component were observed in mediastinal lymph nodes (station 2R and 4R) and in the primary tumor. Anaplastic lymphoma kinase (ALK) rearrangement was detected in both the primary and metastatic lesions of the carcinoid tumor. Four cycles of chemotherapy with etoposide and carboplatin were dispensed after surgery. Conclusions This is the first reported case of coexisting pulmonary adenocarcinoma and atypical carcinoid tumor with an ALK fusion only detected in the carcinoid component. The presence of ALK rearrangement in pulmonary carcinoid tumor is very uncommon, and there is currently no standard treatment for advanced stages. Therefore, comprehensive molecular testing, including ALK rearrangement analysis, should be recommended for mixed tumors exhibiting features of atypical carcinoid. ALK inhibitors could represent a potential treatment strategy for selected patients.
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Affiliation(s)
- Wenbin Hu
- Department of Thoracic Surgery, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Jiaming Zhao
- Department of Thoracic Surgery, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Guoxia Wang
- Department of Thoracic Surgery, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Qihao Wang
- Department of Thoracic Surgery, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Mingming Deng
- Department of Anesthesia Operation, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Jie Shen
- Dagong Law Firm, Shaoxing, China
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, IHU RespirERA, Pasteur Hospital, BB-0033-00025, CHU Nice, University Côte d’Azur, Nice, France
| | - Edyta Maria Urbanska
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Eric Santoni-Rugiu
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik and Translational Lung Research Center (member of the German Center for Lung Research, DZL) at Heidelberg University Hospital, Heidelberg, Germany
| | - Robert A. Ramirez
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Toyoaki Hida
- Lung Cancer Center, Central Japan International Medical Center, Minokamo, Gifu, Japan
| | - Xiaoqing Lu
- Department of Pathology, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Binjun He
- Department of Thoracic Surgery, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
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Emmanuel A. Learning from the past rather than living in it. Clin Med (Lond) 2023; 23:101. [PMID: 36958838 PMCID: PMC11046514 DOI: 10.7861/clinmed.ed.23.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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