ABSTRACT
BACKGROUND: In the management of solid tumours, routine concepts are increasingly being transformed into individualized patient treatment. Endocrine surgery is traditionally characterized by resection strategies that are adapted to phenotype and genotype of the underlying disease. As complication rates in surgery correlate with the extent of resection, continuous efforts are made to identify selection criteria in order to limit the extent of surgery without compromising the oncological outcome. The aim is to design risk-stratified precision endocrine surgery. MATERIALS AND METHODS: A search was carried out in PubMed for new and modern strategies and approaches for oncological endocrine surgery. RESULTS: Several developments in surgical technique and technology, molecular pathology, medical therapy, and study data identify the potential to adapt the surgical strategy in all areas of endocrine surgery. CONCLUSION: According to prevalent data, limited extent of resection in thyroid cancer surgery shows a reduction in complication rates while preserving oncological outcome when adequate selection criteria are implemented. New insights and innovative technologies also influence additional areas in oncological endocrine surgery for parathyroid, adrenal, and neuroendocrine neoplasia. However, the broad practice of these new concepts needs to be evaluated with regard to long-term oncological outcome.
Subject(s)
Endocrine Gland Neoplasms , Humans , Endocrine Gland Neoplasms/surgery , Endocrine Gland Neoplasms/pathology , Endocrine Surgical Procedures/methods , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Adrenal Gland Neoplasms/surgery , Adrenal Gland Neoplasms/pathologyABSTRACT
BACKGROUND: Paediatric appendiceal neuroendocrine tumours (appNET) are very rare tumours, mostly detected incidentally by histopathological evaluation after appendectomy. Treatment recommendations are based on adult data considering high-risk NET as defined by European Neuroendocrine Tumour Society (ENETS) guidelines for completion right-sided hemicolectomy (RHC). Recent data suggest that less aggressive therapy may be justified. PROCEDURE: Analysis of children and adolescents with appNET prospectively registered with the German Malignant Endocrine Tumour (MET) studies between 1997 and 2022. RESULTS: By December 2022, 662 patients (64.7% females, 35.3% male) had been reported. Median age was 13.3 years [4.5-17.9], median duration of follow-up 2.2 years [0-10.9]. No distant metastases were reported. Tumour size was <1 cm in 63.5%, 1-2 cm in 33.2%, and >2 cm in 3.2% of patients. WHO grade 1 and 2 tumours were diagnosed in 76.9% and 23.1% of patients, respectively. Lymphovascular invasion and lymph node metastases were associated with tumour size ≥1.5 cm. 27.0% of patients presented with high-risk NET according to ENETS criteria. Of those, only 55.9% underwent secondary oncological right hemicolectomy. Neither distant metastases, nor recurrences or disease-related deaths occurred in patients with appendectomy only as well as in patients with completion RHC. Overall and event-free survival were both 100%. CONCLUSIONS: Internationally harmonized consensus recommendations on treatment of children and adolescents with appendiceal NET are urgently needed to avoid completion RHC in high-risk patients.
Subject(s)
Appendiceal Neoplasms , Endocrine Gland Neoplasms , Intestinal Neoplasms , Neuroendocrine Tumors , Pancreatic Neoplasms , Stomach Neoplasms , Adult , Female , Adolescent , Humans , Male , Child , Lymphatic Metastasis , Neuroendocrine Tumors/pathology , Appendiceal Neoplasms/pathology , Appendectomy , Endocrine Gland Neoplasms/surgery , Colectomy , Retrospective StudiesSubject(s)
COVID-19 , Endocrine Gland Neoplasms/surgery , Pandemics , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Elective Surgical Procedures , Endocrine Gland Neoplasms/therapy , Female , Humans , Male , Middle Aged , Surgical Procedures, OperativeABSTRACT
In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting "elective" operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.
Subject(s)
Clinical Decision-Making , Coronavirus Infections/epidemiology , Neoplasms/surgery , Patient Selection , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Betacoronavirus , Breast Neoplasms/surgery , COVID-19 , Digestive System Neoplasms/surgery , Endocrine Gland Neoplasms/surgery , Humans , Melanoma/surgery , Neuroendocrine Tumors/surgery , Pandemics , Patient Care Team , Peritoneal Neoplasms/surgery , SARS-CoV-2 , Sarcoma/surgery , Surgical OncologyABSTRACT
In recent years, a significantly increased incidence of endocrine tumours has been observed worldwide, not least papillary thyroid cancer - with improved diagnostics and various biological factors being two possible causes of the upsurge. In this material from the Karolinska University Hospital, to date the largest tertiary endocrine surgery unit in the Nordic region, we see a near five-fold increase in the number of diagnosed thyroid cases and a distinct rise in the incidence of tumour cases in the thyroid, parathyroid and adrenal glands. The increase can only partly be explained by an accommodation of patients to tertiary units and should therefore be considered as a true increase in incidence across the Swedish population. Our findings therefore verify the international reports regarding a surge in endocrine tumours and highlight the need for efficient patient care - from diagnosis to treatment.
Subject(s)
Endocrine Gland Neoplasms/epidemiology , Adenocarcinoma/epidemiology , Adenocarcinoma/surgery , Adenoma/epidemiology , Adenoma/surgery , Adolescent , Adrenal Cortex Neoplasms/epidemiology , Adrenal Cortex Neoplasms/surgery , Adrenal Gland Neoplasms/epidemiology , Adrenal Gland Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Endocrine Gland Neoplasms/surgery , Humans , Incidence , Middle Aged , Parathyroid Neoplasms/epidemiology , Parathyroid Neoplasms/surgery , Parathyroidectomy/statistics & numerical data , Pheochromocytoma/epidemiology , Pheochromocytoma/surgery , Retrospective Studies , Sweden/epidemiology , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/surgery , Thyroidectomy/statistics & numerical data , Young AdultSubject(s)
Adenocarcinoma/surgery , Bile Duct Neoplasms/surgery , Endocrine Gland Neoplasms/surgery , Gallbladder Neoplasms/surgery , Adenocarcinoma/complications , Bile Ducts/abnormalities , Endocrine Gland Neoplasms/complications , Gallbladder Neoplasms/complications , Humans , Male , Middle Aged , Pancreas/abnormalities , Treatment OutcomeABSTRACT
The patient was a 73-year-old man who visited our department with black stools as the chief complaint. Upper digestive tract endoscopy revealed three type 2 lesions in the lesser curvature of the gastric antrum and the gastric angle and the posterior wall of the upper gastric body, which were diagnosed by biopsy as tub2, por, and sig, respectively. Total gastrectomy was performed. The final pathological diagnosis was quintuple gastric cancer with a main lesion of large-cell endocrine carcinoma and four adenocarcinoma sublesions. We report this extremely rare case of gastric endocrine cell carcinoma complicated by adenocarcinoma.
Subject(s)
Adenocarcinoma , Endocrine Gland Neoplasms , Neoplasms, Multiple Primary/pathology , Stomach Neoplasms/pathology , Adenocarcinoma/surgery , Aged , Biopsy , Endocrine Gland Neoplasms/surgery , Gastrectomy , Gastroscopy , Humans , Male , Neoplasms, Multiple Primary/surgery , Stomach Neoplasms/surgeryABSTRACT
Some tumors are a relatively rare and amendable cause of hypertension, often associated with a higher cardiovascular morbidity and mortality, as compared with that of both general population and patients with essential hypertension. This worse prognosis is not entirely related to blood pressure increase, because the release of substances from the tumor can directly influence blood pressure behavior. Diagnostic approach is challenging and needs a deep knowledge of the different neuro-hormonal and genetic mechanisms determining blood pressure increase. Surgical tumor removal can, but not always, cause blood pressure normalization, depending on how early was tumor detection, since a long-standing history of hypertension is often associated with a much weaker effect on blood pressure. Moreover, target organ damage can be affected by the substances themselves released by the tumors as well as by tumor removal. In this review we consider the phenotype and genetic features of patients with tumor-induced hypertension and focus on their diagnostic work-up.
Subject(s)
Arterial Pressure , Endocrine Gland Neoplasms/complications , Hypertension/etiology , Antihypertensive Agents/therapeutic use , Arterial Pressure/drug effects , Biomarkers, Tumor/blood , Endocrine Gland Neoplasms/blood , Endocrine Gland Neoplasms/diagnosis , Endocrine Gland Neoplasms/surgery , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Hypertension/therapy , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: Patients with metastatic RCC can undergo metastasectomy to improve survival time. Our goal was to provide and compare characteristics and oncological outcomes of RCC patients who underwent complete metastasectomy at a single organ site. METHODS: A total of 138 RCC patients were identified as undergoing complete metastasectomy at a single organ site including adrenal, lung, liver, pancreas, or thyroid. Competing risk regression analysis was used to assess RFS and CSS adjusting for several covariates. RESULTS: In this highly selected cohort, RFS and CSS was 27% and 84% at 5 years following metastasectomy, respectively. Univariate analysis revealed that removal of multiple tumors, younger age, and a shorter interval between nephrectomy and metastasis was associated with worse RFS. Larger tumors and sarcomatoid histology at nephrectomy was associated with worse CSS. We found no evidence that metastases at the time of RCC diagnosis influenced recurrence or survival. Tumor size, number of metastases resected, and time from nephrectomy to first recurrence was significantly different, but recurrence rates were not found to be significantly different, when compared across all organ sites. CONCLUSIONS: These findings inform clinical and surgical management of select RCC patients with isolated metastasis to one of several organ sites. J. Surg. Oncol. 2016;114:375-379. © 2016 Wiley Periodicals, Inc.
Subject(s)
Carcinoma, Renal Cell/secondary , Carcinoma, Renal Cell/surgery , Endocrine Gland Neoplasms/surgery , Liver Neoplasms/surgery , Lung Neoplasms/surgery , Metastasectomy , Aged , Carcinoma, Renal Cell/mortality , Cohort Studies , Endocrine Gland Neoplasms/mortality , Endocrine Gland Neoplasms/secondary , Female , Humans , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Liver Neoplasms/mortality , Liver Neoplasms/secondary , Lung Neoplasms/mortality , Lung Neoplasms/secondary , Male , Middle Aged , Nephrectomy , Treatment OutcomeABSTRACT
OBJECTIVES/HYPOTHESIS: Surgeon experience has been recognized in several clinical fields as a significant element of superior management outcomes. In this study, we seek to assess the association between surgeon volume and patients' community health status with the outcomes of thyroid and parathyroid surgery indicated for primary malignancies. STUDY DESIGN: A cross-sectional study utilizing the State Inpatient Databases, 2010-2011, for Florida, New York, and Washington was merged with the County Health Rankings database. METHODS: International Classification of Diseases, Ninth Revision codes were used to identify adult (≥18 years) patients who underwent thyroidectomy or parathyroidectomy indicated for primary malignancies. RESULTS: A total of 6,347 records were included. Compared to high-volume surgeons, patients treated by low-volume surgeons were more likely to develop postoperative complications in the 1-month period after the operation (odds ratio: 4.34, 95% confidence interval: 3.31-5.70, P < .001). Furthermore, both low- and intermediate-volume surgeons were associated with a longer hospital stay (>2 days) and a higher risk of admission to the intensive care unit (P < .01 each). Cost of health services was significantly in the highest quartile (>$10,254.66) for patients treated by low-volume surgeons (P < .001). Patients who lived in communities of poor health measures had a higher risk of postoperative complications (16.3% vs. 11.8%, P = .030) independent of the clinical presentation and management type. Patients living in high health-risk communities and those of black and Hispanic backgrounds were more likely to be treated by low-volume surgeons (P < .001 each). CONCLUSIONS: The surgeon's volume and the patient's living conditions are crucial and independent factors in multiple aspects of endocrine cancer management. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:775-781, 2016.
Subject(s)
Endocrine Gland Neoplasms/surgery , Healthcare Disparities/statistics & numerical data , Outcome Assessment, Health Care , Parathyroidectomy/methods , Thyroidectomy/methods , Adult , Aged , Cross-Sectional Studies , Databases, Factual , Demography , Endocrine Gland Neoplasms/mortality , Endocrine Gland Neoplasms/pathology , Female , Florida , Hospitals, High-Volume/statistics & numerical data , Hospitals, Low-Volume , Humans , Male , Middle Aged , Parathyroid Neoplasms/mortality , Parathyroid Neoplasms/pathology , Parathyroid Neoplasms/surgery , Parathyroidectomy/mortality , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Racism , Risk Assessment , Socioeconomic Factors , Survival Analysis , Thyroid Neoplasms/mortality , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Thyroidectomy/mortalityABSTRACT
PURPOSE OF REVIEW: Although the advent of the robot has revolutionized the modern treatment of endocrine neoplasia, substantial controversies exist on its applicability, safety and benefits over the conventional laparoscopic operations. The present review aims to review the recent literature on various robotic approaches in treating thyroid, parathyroid, adrenal and pancreatic endocrine neoplasia and see whether its continued use should be supported. RECENT FINDINGS: In summary, the role of robotic thyroidectomy has been clearly established and should be continued by experienced surgeons on selected patients. Because of the limited availability of evidence, the feasibility of robotic parathyroidectomy has yet to be elucidated. With proven favorable perioperative outcomes, robotic adrenalectomy and pancreatectomy should be continued as potential alternatives to conventional surgery. SUMMARY: Robotic endocrine procedures still play a pivotal role in minimally invasive endocrine surgery with demonstrable safety and effectiveness. Future research should embark on prospective randomized-controlled trials on robotic endocrine procedures to collect higher level of evidence and long-term survival data.
Subject(s)
Endocrine Gland Neoplasms/surgery , Robotic Surgical Procedures/methods , Adrenalectomy/methods , Humans , Laparoscopy/methods , Pancreatectomy/methods , Parathyroidectomy/methods , Thyroidectomy/methods , Treatment OutcomeABSTRACT
A 77-year-old man who complained of melena was admitted to our department. Colonoscopy revealed a type 2 tumor in the hepatic flexure of the ascending colon. Biopsy examination revealed a poorly differentiated adenocarcinoma. Abdominal computed tomography(CT)revealed 3 tumors within the posterior segment of the right hepatic lobe. Initially, a right hemicolectomy was performed. Immunohistochemically, the tumor was diagnosed as an endocrine cell carcinoma. After surgery, a capecitabine, oxaliplatin, and bevacizumab(CapeOX/BEV)regimen was administered. However, after 5 chemotherapy courses, abdominal CT revealed enlargement of the 3 tumors in the posterior segment of the right hepatic lobe. There was no metastasis besides the liver metastasis. The patient underwent a radical hepatectomy of the posterior segment. At 8 months post-surgery, the patient remains alive and well. Endocrine cell carcinoma of the colon and rectum is usually malignant and is associated with a very poor prognosis because of rapid hematogenous or lymphogenous metastasis. Effective multimodal treatment regimens, including surgery and new chemotherapies such as molecular targeted therapies, should be established to improve the prognosis of patients with endocrine cell carcinomas of the colon and rectum.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colon, Ascending/pathology , Colonic Neoplasms/drug therapy , Endocrine Gland Neoplasms/drug therapy , Liver Neoplasms/surgery , Aged , Antibodies, Monoclonal, Humanized/administration & dosage , Bevacizumab , Capecitabine , Colon, Ascending/surgery , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Combined Modality Therapy , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Endocrine Gland Neoplasms/surgery , Fluorouracil/administration & dosage , Fluorouracil/analogs & derivatives , Hepatectomy , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Male , Organoplatinum Compounds/administration & dosage , OxaliplatinABSTRACT
UNLABELLED: The aim of the study was to evaluate the effectiveness of intraoperative ultrasonography (IOUS) during operations of endocrine glands tumors. MATERIAL AND METHODS: The study was conducted in patients who underwent endocrine operation in Department of Endocrine, General and Vascular Surgery, Medical University in Lódz in 2008-2011. RESULTS: Patients with thyroid cancer recurrences:in study group we managed shorter lesion access time (10 ± 4.47 min vs 16.78 ± 8.9 min; p=0.04). Time of surgery was also shorter in study group (75 ± 30.17 minvs 85,71 ± 38.92 min), but it was not significant (p=0.46). The use of IOUS did not affect the hospitalization time (2.91 ± 1.64 days vs 3 ± 1.66 days; p=0.820), intraoperative blood loss (45.45 ± 105.96 ml vs 40 ± 82.89 ml; p=0.972) and the rate of intraoperative complications (1/11 - 9.09% vs 2/14 - 14.29%; p=1). Patients with primary hyperparathyroidism: the time of surgery (58 ± 22.74 min vs 65 ± 19.6 min; p=0.336) and the lesion access time (13.33 ± 7,94 min vs 17.25 ± 8.19 min; p=0.169) were shorter in study group. Hospitalization time was longer in study group (6.13 ± 5.3 days vs 4.45 ± 4.58 days; p=0.079). The rate of intraoperative complications was higher in study group (3/15 - 20% vs 2/20 - 10%; p=0.631). None of this results were statistically significant (p≤0.05). Patients who underwent open adrenalectomy: in study group we managed significantly shorter time of surgery (70 ± 44.35 min vs 80.12 ± 29.60 min; p=0.033) and shorter lesion access time (12 ± 8.88 min vs 17.37 ± 7.42 min; p=0.045). The use of IOUS did not affect the hospitalization time (5.6 ± 1.65 days vs 6.35 ± 2.38 days; p=0.429), intraoperative blood loss (110 ± 164.65 ml vs 172.5 ± 226.35 ml; p=0.442) and rate of intraoperative complications (0/10 vs 1/40; p=1). Patients who underwent videoscopicadrenalectomy: in study group we managed to get shortertime of surgery (89.44 ± 27.11 min vs 109.12 ± 33.88 min; p=0.034) and shorter lesion access time (28.61 ± 14.93 min vs 45.98 ± 20.44 min; p=0.002). Intraoperative blood loss was also significantly lower in study group (86.11 ± 157 ml vs 169.27 ± 201.04 ml; p=0.037). The use of IOUS did not affect the hospitalization time (4.39 ± 3.27 days vs 3.83 ± 3.67 days; p=0.227), the rate of intraoperative complications (0/18 vs. 2/41; p=1) and the conversion rate (2/20-10% vs. 5/46- 10.87%; p=1). CONCLUSIONS: 1.During adrenalectomies this technique facilitates finding the pathological lesion shortening the time of access to the tumor and procedure duration. 2. IOUS is useful for determining the tumor relationship with the surrounding anatomical structures. 3. IOUS isa useful technique in the assessment of adrenal tumor infiltration of vena cava. 4. The use of IOUS allows the surgeon to assess anatomical relationships in the real time, after incision and retraction of tissues. 5. During operations of thyroid cancer recurrences using this technique makes easier to find a lesion in the operated area and it is possible to asses radical of surgery. 6. The use of IOUS allows to find pathological parathyroid glands inside thyroid gland. 7. IOUS is useful in the detection of thyroid pathology during parathyroidectomy.
Subject(s)
Endocrine Gland Neoplasms/diagnostic imaging , Endocrine Gland Neoplasms/surgery , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/surgery , Surgery, Computer-Assisted/methods , Adenoma/diagnostic imaging , Adenoma/surgery , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Humans , Incidence , Length of Stay/statistics & numerical data , Lymphatic Metastasis , Operative Time , Postoperative Complications/epidemiology , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/surgery , Treatment Outcome , UltrasonographyABSTRACT
We report a case of concomitant pancreatic endocrine neoplasm (PEN) and intraductal papillary mucinous neoplasm (IPMN). A 74-year-old man had been followed-up for mixed-type IPMN for 10 years. Recent magnetic resonance images revealed an increase in size of the branch duct IPMN in the pancreas head, while the dilation of the main pancreatic duct showed minimal change. Although contrast-enhanced computed tomography and magnetic resonance imaging did not reveal any nodules in the branch duct IPMN, endoscopic ultrasound indicated a suspected nodule in the IPMN. A malignancy in the branch duct IPMN was suspected and we performed pylorus-preserving pancreatoduodenectomy with lymphadenectomy. The resected specimen contained a cystic lesion, 10 x 10 mm in diameter, in the head of the pancreas. Histological examination revealed that the dilated main pancreatic duct and the branch ducts were composed of intraductal papillary mucinous adenoma with mild atypia. No evidence of carcinoma was detected in the specimen. Incidentally, a 3-mm nodule consisting of small neuroendocrine cells was found in the main pancreatic duct. The cells demonstrated positive staining for chromogranin A, synaptophysin, and glucagon but negative staining for insulin and somatostatin. Therefore, the 3-mm nodule was diagnosed as a PEN. Since the mitotic count per 10 high-power fields was less than 2 and the Ki-67 index was less than 2%, the PEN was pathologically classified as low-grade (G1) according to the 2010 World Health Organization (WHO) criteria. Herein, we review the case and relevant studies in the literature and discuss issues related to the synchronous occurrence of the relatively rare tumors, PEN and IPMN.
Subject(s)
Adenocarcinoma, Mucinous/pathology , Carcinoma, Pancreatic Ductal/pathology , Carcinoma, Papillary/pathology , Endocrine Gland Neoplasms/pathology , Neoplasms, Multiple Primary/pathology , Pancreatic Neoplasms/pathology , Adenocarcinoma, Mucinous/diagnostic imaging , Adenocarcinoma, Mucinous/surgery , Aged , Carcinoma, Pancreatic Ductal/diagnostic imaging , Carcinoma, Pancreatic Ductal/surgery , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/surgery , Endocrine Gland Neoplasms/diagnostic imaging , Endocrine Gland Neoplasms/surgery , Endosonography , Humans , Magnetic Resonance Imaging , Male , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Multiple Primary/surgery , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Prognosis , Review Literature as Topic , Tomography, X-Ray ComputedABSTRACT
Little is known about patients with malignant digestive neuroendocrine tumours (MD-NETs). Although their incidence is increasing, MD-NETs remain a rare cancer, representing 1% of digestive cancers. Most MD-NETs are well-differentiated. MD-NET poorly differentiated carcinomas account for 20% of cases on average. Anatomical localisation of MD-NETs varied according to geographic region. Stage at diagnosis and prognosis for patients with MD-NETs in the general population are considerably worse than often reported from small hospital case series. Prognosis varies with tumour differentiation, anatomic site and histological subtype. There are significant differences in survival from MD-NETs among European countries, independent of other prognostic factors. Early diagnosis is difficult; new therapeutic options appear to represent the best approach to improving prognosis.
Subject(s)
Endocrine Gland Neoplasms , Gastrointestinal Neoplasms , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Animals , Endocrine Gland Neoplasms/diagnosis , Endocrine Gland Neoplasms/epidemiology , Endocrine Gland Neoplasms/surgery , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/epidemiology , Gastrointestinal Neoplasms/surgery , Humans , Neuroendocrine Tumors/surgeryABSTRACT
A 57-year-old male patient was referred to our department with a diagnosis of #3 lymph node recurrence of early gastric cancer after treatment of endoscopic submucosal dissection (ESD). The pathological diagnosis of the ESD specimen was neuroendocrine cell carcinoma of the stomach with positive immunohistochemical staining of chromogranin A. The diameter of the tumor was 10 mm and the depth of invasion was pSM2. Distal partial gastrectomy with standard lymph node dissection (D2) was performed. The pathological findings were negative for malignancy in the resected stomach and positive in 2 of the #3 lymph nodes. Adjuvant chemotherapy of S-1 was administered, but a recurrence in the paraaortic lymph nodes was revealed by follow up X-ray computed tomography (X-CT) 3 months later. The case was considered as a S-1 failure, and the chemotherapy was changed to the irinotecan(CPT-11) +cisplatin(CDDP). A clinical complete response (CR) was obtained after two courses and maintained for up to twenty months.