Surgical Treatment of Advanced-Stage Carcinoid Tumors

Boudreaux, J. Philip; Putty, Bradley; Frey, Daniel; Woltering, Eugene A.; Anthony, Lowell; Daly, Ivonne; Thiagarajan, Ramcharan; Lopera, Jorge E.; Castañeda, Wilfrido R.; Townsend, Courtney M.; Blumgart, Leslie H.; Martin, Robert C.G.; Choti, Michael A.

doi:10.1097/01.sla.0000164073.08093.5d

Cited by 116 publications

(67 citation statements)

References 12 publications

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“…17 Additionally, surgery can be of benefit in cases of small intestinal neuroendocrine tumor to avoid potential life-threatening complications such as bowel obstruction or ischemic bowel secondary to mesenteric fibrosis. 18 Resection of the primary tumor may also result in better progression-free survival and overall survival even in patients with metastatic disease. 19 Despite the availability of various imaging modalities, the primary tumor is not identified in 20-50% of gastroenteropancreatic neuroendocrine tumors.…”

Section: Discussionmentioning

confidence: 99%

Value of Islet 1 and PAX8 in identifying metastatic neuroendocrine tumors of pancreatic origin

et al. 2012

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Neuroendocrine tumors can present as liver metastases before discovery of the primary tumor. Islet 1 and PAX8 have recently been proposed as markers for neuroendocrine tumors of pancreatic origin. In this study, we compared the utility of Islet 1 and PAX8 in distinguishing pancreatic neuroendocrine tumors from neuroendocrine tumors of other sites and determined the usefulness of an immunohistochemical panel, including TTF1, CDX2, Islet 1 and/or PAX8, in identifying metastatic pancreatic neuroendocrine tumors. A total of 110 primary neuroendocrine tumors (33 pancreatic, 31 pulmonary, 23 ileal, 14 rectal, and 9 gastric) and 73 metastatic neuroendocrine tumors (28 pancreatic, 5 pulmonary, 37 ileal, 1 rectal, 1 colonic, and 1 duodenal) were studied. Islet 1 and PAX8 were positive in 27/33 (82%) and 29/33 (88%), respectively, of primary pancreatic neuroendocrine tumors, and in 19/28 (68%) and 15/28 (54%), respectively, of metastatic pancreatic neuroendocrine tumors. No cases of primary (0/23) or metastatic (0/37) ileal neuroendocrine tumors were positive with either Islet 1 or PAX8. There was Islet 1 positivity in 2/31 (6%) primary pulmonary, 12/14 (86%) primary rectal, and 1/1 metastatic rectal neuroendocrine tumors, and PAX8 positivity in 7/31 (23%) primary pulmonary, 11/14 (79%) primary rectal, and 2/9 (22%) primary gastric neuroendocrine tumors. ROC curve analysis incorporating sensitivity and specificity data of immunohistochemical panels for metastatic pancreatic neuroendocrine tumors showed that a four-stain panel, including Islet 1, PAX8, TTF1, and CDX2 significantly outperformed a three-stain panel composed of PAX8, TTF1, and CDX2 (P ¼ 0.019), and also showed a trend for better performance compared with a three-stain panel composed of Islet 1, TTF1, and CDX2 (P ¼ 0.072). Both Islet 1 and PAX8 are reliable immunohistochemical markers for pancreatic neuroendocrine tumors and would be useful adjuncts to other markers (TTF1, CDX2) currently used to work up a metastatic neuroendocrine tumor of unknown primary.

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Section: Discussionmentioning

confidence: 99%

Value of Islet 1 and PAX8 in identifying metastatic neuroendocrine tumors of pancreatic origin

et al. 2012

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“…Studies on survival have revealed favorable outcome in patients subjected to radical resection of mesenteric metastases, with survival benefit also in presence of LM (Makridis et al 1997, Hellman et al 2002. Several authors have reported marked palliation of abdominal symptoms after removal of the mesenteric tumor burden (Makridis et al 1996, Wangberg et al 1996, Ohrvall et al 2000, Hellman et al 2002, Boudreaux et al 2005. Early surgical intervention may avoid abdominal complications and should be done before mesenteric tumor growth exacerbates and renders local inoperability (Makridis et al 1996).…”

Section: Midgut Nensmentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

147

106

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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) represent a heterogenous group of tumors arising from a variety of neuroendocrine cell types. The incidence and prevalence of GEPNENs have markedly increased over the last three decades. Symptoms are often absent in early disease, or vague and nonspecific even in advanced disease. Delayed diagnosis is thus common. Chromogranin A is the most commonly used biomarker but has limitations as does the proliferative marker Ki-67%, which is often used for tumor grading and determination of therapy. The development of a multidimensional prognostic nomogram may be valuable in predicting tumor behavior and guiding therapy but requires validation. Identification of NENs that express somatostatin receptors (SSTR) allows for SSTR scintigraphy and positron emission tomography imaging using novel radiolabeled compounds. Complete surgical resection of limited disease or endoscopic ablation of small lesions localized in stomach or rectum can provide cure; however, the majority of GEP-NENs are metastatic (most frequently the liver and/or mesenteric lymph nodes) at diagnosis. Selected patients with metastatic disease may benefit from advanced surgical techniques including hepatic resection or liver transplantation. Somatostatin analogs are effective for symptomatic treatment and exhibit some degree of antiproliferative activity in small intestinal NENs. There is a place for streptozotocin, temozolomide, and capecitabine in the management of pancreatic NENs, while new agents targeting either mTOR (everolimus) or angiogenic (sunitinib) pathways have shown efficacy in these lesions.

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“…The use of long-acting analogs of somatostatin should be considered when the patient presents carcinoid syndrome and high levels of biochemical markers. One group of authors (17) used routine therapy with intravenous octreotide preoperatively, intraoperatively, and postoperatively in 82 patients with advanced carcinoid tumors submitted to surgery. None of the patients presented carcinoid syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of chemotherapy is controversial, although there are reports that chemotherapy, used in cases of locoregional and distant disease, affects survival. (16,17) The most common cause of death in such patients is progression to advanced metastatic disease. The overall survival rate in patients receiving aggressive surgical treatment is 50 to 80%.…”

Section: Discussionmentioning

confidence: 99%

Teratoma de mediastino com degeneração maligna

Squeff¹,

Gerace²,

Júnior³

et al. 2008

J. bras. pneumol.

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slowly progressing anterior mediastinal teratoma. This is an extremely rare case, not only in terms of the presence of this type of tumor in an elderly patient but also in terms of its evolution to malignancy. This, together with the fact that, in the literature, we have found only three studies of carcinoid tumors arising within mediastinal teratomas, has motivated us to write this article. Case reportA 66-year-old male patient, born in the city of São Luiz (in the state of Maranhão) and a resident of the city of São Paulo (in the state of São Paulo), was admitted to IntroductionTeratomas are germ cell tumors originating from the three embryonic germ layers. These tumors can be found at multiple sites, and most are benign. They are the second most common tumors of the anterior mediastinum, after thymomas, and are most often seen in young adults.(1) They account for 8 to 13% of all tumors occurring in this region. If they are treated surgically, the prognosis is quite favorable. Although there is little data in the literature regarding the evolution of a teratoma to malignancy, it is known to be an extremely rare occurrence. (2,3) We report the case of a 66-year-old patient submitted to resection of a carcinoid tumor (revealed by anatomopathological examination) that had arisen within a AbstractHere, we report the case of a patient with a slowly-progressing anterior mediastinal teratoma submitted to surgical resection. The anatomopathological examination of the sample revealed malignant degeneration to carcinoid tumor. Such evolution is very rare, and we have found only three related studies in the literature. We describe the clinicopathological features of the tumor and discuss the treatment administered. The evolution was satisfactory, and the patient was submitted to oncological treatment.Keywords: Mediastinal neoplasms; Teratoma; Carcinoid tumor; Mediastinum/surgery. ResumoNo presente artigo, relatamos o caso de um paciente portador de teratoma de mediastino anterior, de evolução lenta, o qual foi submetido à ressecção cirúrgica. O exame anatomopatológico da peça revelou degeneração maligna para tumor carcinóide. Tal evolução é extremamente rara, sendo encontrados na literatura apenas três artigos correlatos. Apresentamos uma descrição clínico-patológica do tumor e, por fim, discutimos a conduta terapêutica. Houve evolução satisfatória, e o paciente foi submetido a tratamento oncológico.Descritores: Neoplasias do mediastino; Teratoma; Tumor carcinóide; Mediastino/cirurgia.

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Surgical Treatment of Advanced-Stage Carcinoid Tumors

Cited by 116 publications

References 12 publications

Value of Islet 1 and PAX8 in identifying metastatic neuroendocrine tumors of pancreatic origin

Value of Islet 1 and PAX8 in identifying metastatic neuroendocrine tumors of pancreatic origin

Neuroendocrine tumor disease: an evolving landscape

Teratoma de mediastino com degeneração maligna

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