Poorly Differentiated Carcinomas of the Foregut (Gastric, Duodenal and Pancreatic)

Nilsson, Ola; Cutsem, E. Van; Fave, Gianfranco Delle; Yao, James C.; Pavel, Marianne; McNicol, Anne Marie; Garcia, Manuel Muñoz; Knapp, Wolfram H.; Keleştimur, Fahrettin; Sauvanet, Alain; Pauwels, Stanislas; Kwekkeboom, Dik J.; Caplin, Martyn

doi:10.1159/000098013

Cited by 105 publications

(110 citation statements)

References 40 publications

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“…Poorly differentiated, neuroendocrine carcinomas comprise less than 5% of all NET of the small bowel and occur mainly in the ampulla region [20,57] . Primarily, men over 60 years are affected.…”

Section: Carcinoid Syndrome (Seen With Functional Ileal Nets Very Ramentioning

confidence: 99%

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Scherübl

Jensen²,

Cadiot³

et al. 2010

WJGE

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Neuroendocrine tumors of the small bowel are on the rise. In the US they have increased by 300%-500% in the last 35 years. At the same time their prognosis is much improved. Today, most neuroendocrine tumors (NETs) of the duodenum are detected "incidentally" and therefore recognized at an early stage. Duodenal NETs which are well differentiated, not larger than 10 mm and limited to the mucosa/submucosa can be endoscopically resected. The management of duodenal NETs ranging between 10 and 20 mm needs an interdisciplinary discussion. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is recommended for welldifferentiated duodenal NET tumors greater than 20 mm, for localized sporadic gastrinomas (of any size) and for localized poorly differentiated NE cancers. Surgery is recommended for any ileal NET. Advanced ileal NETs with a carcinoid syndrome are treated with longacting somatostatin analogs. This treatment significantly improves (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management, tumor biology, type, localization and stage of the neoplasm, as well as the patient's individual circumstances have to be taken into account.

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Section: Carcinoid Syndrome (Seen With Functional Ileal Nets Very Ramentioning

confidence: 99%

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Scherübl

Jensen²,

Cadiot³

et al. 2010

WJGE

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“…PDEC tumor cells are strongly positive for cytosolic markers such as neuron-specific enolase (NSE) and PGP9.5 but show weak positivity or negativity for chromogranin A. Positive staining for synaptophysin may be the only marker of neuroendocrine differentiation in those cases 6 . As regards carcinoid of "unknown type" (vague atrophy of gastric mucosa) mentioned by Kim BS et al 19 , this entity is not recently classified in this new nomenclature.…”

Section: Discussionmentioning

confidence: 99%

“…Somatostatin analogs are not effective in type 3 neuroendocrine carcinomas; palliative chemotherapy should be tried but response rate is rather low with shorttime duration 6 .…”

Section: Discussionmentioning

confidence: 99%

“…A more conservative approach is preferred in type 1 gastric neuroendocrine tumours, in contrast to the clearly malignant type 3 gastric neuroendocrine carcinomas in which surgery is the method of choice, if feasible, and palliative chemotherapy in advanced cases 6 . Type 1 is associated with diffuse corporal atrophic gastritis with hypergastrinemia.…”

Section: Introductionmentioning

confidence: 99%

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Neuroendocrine neoplasms of the stomach

Louthan¹

2014

BIOMED PAP

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Background. Gastric neuroendocrine neoplasms of type 1 and type 3 are different entities and as such require different therapeutical strategies. The aim of this study was to define and distinguish these two tumour subtypes with clearly different biological properties and patient survival. As shown, serum gastrin is an important diagnostic tool for differentiating the less malignant type 1 "hypergastrinemia non-related" tumor from malignant type 3, along with other parameters of malignant potential such as proliferation index and depth of invasion. Methods. The biological behaviour, tumour marker status, symptomatology, survival and therapeutical strategy were assessed and compared in 18 consecutive patients with type 1 and 7 with type 3 gastric neuroendocrine tumours. Results. All 18 patients with type 1 gastric carcinoids survived long-term. 17/18 patients were treated with endoscopic tumour removal. The prognosis for patients with generalized type 3 neuroendocrine neoplasms was poor, with shortterm survival. No statistically significant differences between the types were found in urine 5-hydroxyindolacetic acid concentration or serum chromogranin A concentration. Significant differences were found in serum gastrin with high levels even in localized type 1 tumors and normal levels in generalized type 3 neoplasm. Further, high neuron-specific enolase levels were found in type 3. Conclusions. Type 1 tumour should be preferably treated with endoscopic tumour removal. Recently, favourable tumoristatic effects have been reported in somatostatin analogs. Surgery is a treatment option for type 3 neuroendocrine carcinoma with normal gastrinemia. Serum gastrin is suitable for assessment of the biological properties of both neuroendocrine neoplasm types. It serves, among other factors, as a predictor of prognosis and an indicator for the selection of optimal therapeutical strategy.

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“…El tipo I es el más común y de mejor pronóstico, siendo su diagnóstico el hallazgo de varios pólipos pequeños a nivel del fondo gástrico durante una endoscopía digestiva alta, mientras que el tipo II es similar pero en el contexto de un síndrome de Zollinger Ellison y neoplasia endocrina múltiple tipo I. Por otro lado, el tipo III se comporta más parecido a un cáncer gástrico correspondiendo a una lesión única, de ubicación también proximal, con un peor grado de diferenciación y un mayor riesgo de metástasis. Posteriormente, se ha reconocido un cuarto tipo, de características similares al tipo III, pero de peor pronóstico, cuyo origen sería un adenocarcinoma gástrico con diferenciación neuroendocrina 5 .…”

Section: Introductionunclassified

Gastrectomía laparoscópica en carcinoide gástrico

et al. 2013

Rev Chil Cir

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Laparoscopic gastrectomy in gastric carcinoidIntroduction: Gastric carcinoid is a very low frequency tumor. A proportion of them require surgery to control the disease. The ideal surgical treatment is controversial. Aim: To describe the perioperative and follow-up course of patients with gastric carcinoid subjected to laparoscopic gastrectomy. Materials and Methods: Retrospective study of patients undergoing some type of laparoscopic gastrectomy for gastric carcinoid the last 10 years. We collected demographic background, preoperative evaluation, type of surgery, complications and follow-up. Results: During the study period were operated 7 patients, 5 were men. The average age was 54 years. In three patients the diagnosis was a finding, while the rest had abdominal pain associated with nonspecific symptoms. Four patients had a type I gastric carcinoid associated with chronic gastritis and hypergastrinemia, and the others had a type III gastric carcinoid. Six patients underwent laparoscopic total gastrectomy while in the remaining patient (type III) was subtotal. There were no postoperative complications. During follow-up one patient required a reoperation for mechanical ileus secondary to adhesions and one patient required endoscopic dilatation because esophagoyeyunostomy stenosis. At 32 months of median follow-up (1-52) no patient has relapsed. Conclusion: Laparoscopic gastrectomy is an alternative in the surgical treatment of patients with gastric carcinoid. It´s safe and represent adequate oncological results in the short and medium term.

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Poorly Differentiated Carcinomas of the Foregut (Gastric, Duodenal and Pancreatic)

Cited by 105 publications

References 40 publications

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Neuroendocrine neoplasms of the stomach

Gastrectomía laparoscópica en carcinoide gástrico

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