Pancreatic Neuroendocrine Tumour in Pregnancy - Diagnosis and Treatment Management

Abstract

Diagnosis and Treatment Management Chirurgia, 114 (5), 2019 www.revistachirurgia.ro 551 investigaţii sau alteia revenind trimestrului de graviditate. Precauţia legată de "compromiterea" fetală în indicarea unei explorări invazive (imagistice, endoscopice, etc) întârzie de asemenea diagnosticul. Caracterul puţin agresiv, mai de curând cu potenţial benign face ca prognosticul insulinoamelor să fie în general unul favorabil iar posibilităţile terapeutice uşor de administrat şi controlat la gravide. Tratamentul medical se adresează pacientelor atunci când există diagnostic pozitiv dar nu putut identifica topografia insulinomului, când simptomatologia este uşor controlată prin terapie conservatoare până când se obţine o vârstă convenabilă a fătului fie imediat postpartum, la gravidele care refuză intervenţia chirurgicală, fie în stadiul metastatic al insulinomului malign. Tratamentul chirurgical rămâne cu adevărat singura modalitate de rezolvare terapeutică dar, cel mai adesea, sub forma unei chirurgii programate, de regulă post-partum, sau dacă situaţia "forţează" indicaţia, cât mai târziu după o vârstă fetală convenabilă (după 28 săptămâni). Cuvinte cheie: neoplazia neuroendocrinã pancreaticã, sarcinã, managementul de diagnostic şi tratament

First-generation somatostatin ligand receptor treatment in a pregnant patient with a neuroendocrine tumor with liver metastases

“…A few ( n = 39) cases of pancreatic neuroendocrine tumors during pregnancy have been published ( 3 ), however, information about SLR treatment is lacking ( 3 ). Some cases in pregnancies in NEN of the lung ( n = 6), appendix ( n = 7), and various others (ovary ( n = 3), GIT ( n = 2), pelvic, trachea, and uterus (all n = 1) are reported.…”

“…First-generation somatostatin ligand receptor treatment is first-line medical therapy, and the treatment is in general well tolerated ( 2 , 3 ).…”

“…Patients with NETs typically exhibit a less aggressive disease course ( 1 ) and may survive for several years with disseminated disease. Gastrointestinal NENs in pregnancy are rare and only sporadically reported and, accordingly, information about both pregnancy outcomes and SLR treatment are scarce ( 3 , 4 , 5 ).…”

Pancreatic neuroendocrine carcinoma in a pregnant woman: A case report and review of the literature

“…Treatment requires a multidisciplinary approach that results in an appropriate, balanced, and optimal treatment plan, covering oncology, gynecology, surgery, psychology, anesthesiology, neonatology, and that considers ethical, family, and other relevant factors. Foreign scholars generally seem to agree that the treatment of pregnant women is the priority, followed by ensuring the healthy development of the fetus[ 37 ]. The basic criteria for the treatment decision are imaging identification of the tumor location, characteristics of the tumor behavior, severity of symptoms, duration of pregnancy, and preference of the family.…”

A case of insulinoma diagnosed postpartum with hypoglycemic symptoms that were masked during pregnancy

“…35 However, surgery during pregnancy should be avoided whenever possible, as it increases risks to the mother and fetus. 36 Although there have been several previous reports of successful surgery in pregnant women with insulinoma [3][4][5]16 (Table 4), the surgery should usually be scheduled after birth, or as late as possible after the fetus has reached a suitable age (ie, after 28 weeks), 36 unless hypoglycemic symptoms are progressive or the tumor is suspected to be malignant. Insulinoma usually occurs as a solitary mass, but multiple insulinomas are seen in about 10% of cases, most often in association with MEN1.…”