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1.
Clin Nucl Med ; 47(1): 56-58, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34269726

RESUMO

ABSTRACT: Pineal region metastases are very rare, occurring in 0.4% to 3.8% of patients with solid tumors and most frequently arise from a lung cancer primary tumor. We present a case of a 67-year-old man with a gastric well-differentiated neuroendocrine tumor (NET) metastatic to the pineal gland identified on 68Ga-DOTATATE PET/CT imaging followed by MRI confirmation. To our knowledge, this is the third NET case to be reported in the literature with such presentation and first case to be described on 68Ga-DOTATATE PET/CT. A case of metastatic bronchial NET as well as a case of metastatic esophageal NET to the pineal gland were reported previously.


Assuntos
Tumor Carcinoide , Tumores Neuroendócrinos , Compostos Organometálicos , Glândula Pineal , Idoso , Tumor Carcinoide/diagnóstico por imagem , Humanos , Masculino , Glândula Pineal/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Cintilografia
2.
BMC Gastroenterol ; 21(1): 464, 2021 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-34903169

RESUMO

AIM: We aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors. METHOD: We retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC). RESULT: The mean size of tumors was 6.5 mm (1-25 mm), and the mean follow-up duration was 26 months (6-118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group. CONCLUSION: In the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.


Assuntos
Tumor Carcinoide , Ressecção Endoscópica de Mucosa , Neoplasias Retais , Tumor Carcinoide/cirurgia , Humanos , Mucosa Intestinal/cirurgia , Estudos Prospectivos , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
4.
J Med Case Rep ; 15(1): 491, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34610824

RESUMO

BACKGROUND: Cardiac myxoma is the most common type of primary cardiac tumor, and thymic carcinoid is a rare neuroendocrine tumor. No previous reports have described surgical management of concomitant occurrence of these neoplasms. We report a case of simultaneous surgical resection in a patient with coexisting cardiac myxoma and atypical thymic carcinoid. CASE PRESENTATION: A 44-year-old Japanese woman underwent chest roentgenography revealing an abnormality in the mediastinum. Computed tomography revealed a 100 mm mass in the anterior mediastinum and also a 30 mm mass in the left atrium. The mediastinal tumor was diagnosed as atypical carcinoid by biopsy. Having completed resection of atypical thymic carcinoid, cardiac mass was successfully resected with careful consideration of minimizing operation time and optimizing patient safety and oncological treatment. The histopathological diagnosis of the cardiac mass was myxoma. No adjuvant chemotherapy was administered, and no recurrence was seen as of the 45 month follow-up. CONCLUSIONS: The simultaneous surgery of cardiac myxoma and atypical thymic carcinoid was feasible and effective. To the best of our knowledge, this is the first case report to describe one-stage treatment of these neoplasms.


Assuntos
Tumor Carcinoide , Neoplasias Cardíacas , Mixoma , Neoplasias do Timo , Adulto , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/cirurgia , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Recidiva Local de Neoplasia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia
5.
Medicine (Baltimore) ; 100(39): e27389, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596162

RESUMO

RATIONALE: Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population. PATIENT CONCERNS: We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted. DIAGNOSIS: A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a "coffee bean" appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps. INTERVENTIONS: An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed. OUTCOMES: Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences. LESSONS: Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.


Assuntos
Tumor Carcinoide/etiologia , Neoplasias Intestinais/etiologia , Síndrome de Peutz-Jeghers/complicações , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Criança , Feminino , Humanos , Achados Incidentais , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/etiologia , Doenças do Jejuno/cirurgia , Síndrome de Peutz-Jeghers/diagnóstico , Tomografia Computadorizada por Raios X
6.
Acta Gastroenterol Belg ; 84(3): 501-503, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34599576

RESUMO

Rare cases of carcinoid syndromes can develop from either gastrointestinal neuroendocrine tumors (NETs) without liver metastasis or large retroperitoneal involvement. We report a case of a patient with isolated flushing highly suggestive of carcinoid syndrome caused by an ileal NET with adjacent lymph node metastases but with no liver metastases. The final diagnose was delayed for this patient due to a combination of misleading clinical presentation and negative usual screening tests (urinary 5-HIAA and serum chromogranine A). Given its high sensitivity and specificity, 68Ga-DOTATATE PET/CT confirmed the diagnosis of neuroendocrine tumor. Therefore, this case reminds clinicians that carcinoid syndrome may manifest as flushing only and highlights that imaging is a major aspect of the evaluation and diagnosis of patients with suspected gastrointestinal NETs.


Assuntos
Tumor Carcinoide , Tumores Neuroendócrinos , Tumor Carcinoide/diagnóstico , Humanos , Tumores Neuroendócrinos/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34662004

RESUMO

We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material while fully preserving the parenchyma. We used a biportal VATS approach. The centrally located bronchial tumor at the juncture between the right main bronchus, the right upper lobe bronchus, and the bronchus intermedius was first resected. The right upper lobe bronchus was rotated caudally, toward the bronchus intermedius, together with a slight clockwise rotation posteriorly to facilitate the approximation and tension-free closure of the bronchial defect. This video tutorial demonstrates the operative steps and explains how the rotational aspect is achieved.


Assuntos
Neoplasias Brônquicas , Tumor Carcinoide , Procedimentos Cirúrgicos Reconstrutivos , Brônquios/cirurgia , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Humanos , Cirurgia Torácica Vídeoassistida
8.
Ann Ital Chir ; 102021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34636340

RESUMO

Goblet cell carcinoid or carcinoma (GCC) refers to an extremely rare appendiceal tumor usually diagnosed on post-operative histology as an incidental finding. Primary cancers of the vermiform appendix are quite rare, representing less than 1% of all gastrointestinal malignancies. GCCs are considered as a distinct entity of appendiceal tumors, consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity tends to be more aggressive than typical carcinoid tumors as it often presents with metastatic disease. Therefore, an early recognition and an appropriate grading is essential. The 5-year overall survival is 14-22% in stage III-IV disease. As a matter of fact, GCC warrants more aggressive surgical and medical (chemotherapy) treatments than typical carcinoid tumors. We, hereby, report a case of a 67-year old male presenting with an acute abdominal obstruction and a severe tenderness predominant in his right lower quadrant, together with an endoscopic and radiological suspect of left colonic malignancy and acute appendicitis. Left hemicolectomy and appendicectomy were performed and pathological specimens revealed a lowgrade adenocarcinoma of the descending colon and a high-grade appendiceal goblet cell carcinoid. Subsequent right hemicolectomy was performed according to the current guidelines. GCCs are more aggressive compared with conventional appendiceal tumors but less aggressive compared with adenocarcinomas and they often present with serosal and mesoappendiceal involvement. The lack of a standardized classification system for GCC and the discrepancies in specific reliable markers are responsible for an insufficient prognostic and predictive value at diagnosis. KEY WORDS: Appendiceal neoplasms, Carcinoid tumor, Colectomy, Goblet cells, Immunochemistry.


Assuntos
Neoplasias do Apêndice , Apendicite , Apêndice , Tumor Carcinoide , Idoso , Apendicectomia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Humanos , Masculino
9.
Thorac Surg Clin ; 31(4): 469-476, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34696859

RESUMO

Pulmonary neuroendocrine tumors (NETs) are relatively rare; however, their incidence is steadily increasing. They now comprise 1% to 2% of all lung cancers. Lung NETs are classified based on the World Health Organization classification into low-, intermediate-, and high-grade tumors. Most patients present with nonspecific symptoms that can result in delayed diagnosis. Bronchoscopy and biopsy are essential to diagnose and classify pulmonary NETs. Surgery is the mainstay of therapy and R0 resection is key. Lung preservation surgery, whenever possible, is preferred. There is little role of systemic therapy in NETs. Survival after R0 resection is reasonably good especially in low-grade tumors.


Assuntos
Tumor Carcinoide , Neoplasias Pulmonares , Tumores Neuroendócrinos , Broncoscopia , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia
10.
Zhonghua Zhong Liu Za Zhi ; 43(10): 989-1000, 2021 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-34695888

RESUMO

Lung and thymus neuroendocrine neoplasms (NENs) are rare tumors. According to the fifth edition of the World Health Organization classification of thoracic tumors published in 2021, lung and thymus NENs include typical carcinoids, atypical carcinoids, large cell neuroendocrine carcinomas, and small cell carcinomas. Although the incidence of lung and thymus NENs has gradually increased in recent years, there is a lack of randomized controlled clinical study results to guide clinical practice. The treatment of early-stage lung and thymus NENs is complete surgical resection, and the treatment methods for unresectable advanced diseases include different medical treatments, peptide receptor radionuclide therapy, and local therapy. To improve the standardization of diagnosis and treatment of lung and thymus NENs in China, the Expert Committee of Neuroendocrine Neoplasms, Chinese Society of Clinical Oncology developed the expert consensus after multidisciplinary expert discussions based on existing clinical study evidences and guidelines from different neuroendocrine tumor societies. The contents of the consensus cover the epidemiology, diagnosis, pathological classification, staging, treatment and follow-up of lung and thymus NENs (except small cell lung cancer).


Assuntos
Tumor Carcinoide , Tumores Neuroendócrinos , China , Consenso , Humanos , Pulmão , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/terapia
11.
J Dig Dis ; 22(10): 562-571, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34472210

RESUMO

OBJECTIVE: As there has been so far no consensus on the best endoscopic resection technique, a meta-analysis was conducted to compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for treating rectal carcinoid tumors. METHODS: MEDLINE and EMBASE databases were searched for articles on the treatment of rectal carcinoid tumors using ESD vs EMR published up to October 2020 for outcomes including en bloc and complete resection, margin involvement, procedure time, requirement for additional surgery, bleeding, perforation and recurrence. Risk ratio and weighted mean differences were used for a DerSimonian and Laird random effects pairwise meta-analysis. Single-arm meta-analyses of proportions and random effects meta-regression analysis were also conducted. RESULTS: Twenty-two studies involving 1360 rectal carcinoid tumors were included, in which 655 and 705 rectal carcinoid tumors were resected with ESD and EMR, respectively. The resection efficacy of ESD was comparable to that of EMR for tumors <10 mm. However, there were a significantly higher complete resection rate, and lower rates of vertical margin involvement and requirement for additional surgery using ESD than using EMR for tumors ≤20 mm. ESD had a longer procedure time and an increased likelihood of bleeding than EMR. CONCLUSIONS: ESD is more effective in providing a curative treatment for rectal carcinoid tumors ≤20 mm in size as ESD can achieve a higher complete resection rate with lower vertical margin involvement than EMR. While they are suitable for treating rectal carcinoid tumors <10 mm as both techniques provide similar efficacy.


Assuntos
Tumor Carcinoide , Ressecção Endoscópica de Mucosa , Tumor Carcinoide/cirurgia , Dissecação , Humanos , Mucosa Intestinal/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
12.
Anal Chim Acta ; 1181: 338925, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34556226

RESUMO

An electrochemically synthetized nano-sensor based on molecularly imprinted polypyrrole (MIPPy) was successfully developed for the detection of 5-hydroxyindole-3-acetic acid (5-HIAA) in human biological fluids namely serum, urine, and plasma. The imprinted glassy carbon electrode was prepared by electropolymerisation of pyrrole via cyclic voltammetry (C.V). After completely leaching the imprinted molecules from the polymeric network, complementary cavities are created. The developed MIPPy sensor, under optimized conditions, shows a high sensitivity towards the target molecule (LOQ = 5 × 10-11 M). Moreover, it presents a wide linear response in the range of 5 × 10-11 - 5 × 10-5 M (R2 > 0.999) with a detection limit of 15 × 10-12 M. In order to evaluate the selectivity of the MIPPy film, several structural analogues and compounds forming the real matrices were tested. The obtained results show an excellent recovery rate (between 98.86 and 101.52%) proving the promising application of the proposed nano-sensor in the detection of 5-HIAA in human biological fluids without any significant interference recorded.


Assuntos
Tumor Carcinoide , Impressão Molecular , Acetatos , Biomarcadores Tumorais , Técnicas Eletroquímicas , Eletrodos , Humanos , Ácido Hidroxi-Indolacético , Indóis , Limite de Detecção , Polímeros , Pirróis
13.
Khirurgiia (Mosk) ; (9): 5-11, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480449

RESUMO

OBJECTIVE: To analyze the long-term outcomes of local resections in patients with carcinoid tumors of bronchopulmonary system. MATERIAL AND METHODS: There were 52 patients with tracheal and bronchopulmonary carcinoid for the period 2013-2019. The sample included 21 men and 31 women. Age of patients ranged from 20 to 82 years (mean 62 years). Typical carcinoid was diagnosed in 34 cases, atypical carcinoid - in 18 cases. Central tumor was diagnosed in 26 patients. Tracheal neoplasm was found in 2 patients. Another patient had mediastinal tumor. Five patients underwent resection with broncho- or tracheobronchoplastic reconstruction. RESULTS: Surgical approach for carcinoid is determined by its differentiation, localization and lung tissue lesion following a long-standing tumor. These operations are quite safe. Complications occurred after 4 (7.7%) surgeries. Long-term results were followed-up for the period from 8 months to 7 years. There were no signs of recurrence and disease progression after organ-sparing bronchial resection. Local resection with bronchoplasty is advisable for typical carcinoid.


Assuntos
Neoplasias Brônquicas , Tumor Carcinoide , Adulto , Idoso , Idoso de 80 Anos ou mais , Brônquios , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pneumonectomia , Traqueia , Adulto Jovem
15.
Indian J Pathol Microbiol ; 64(3): 563-567, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34341274

RESUMO

Carcinoid tumors are defined as rare slow-growing neuroendocrine tumors. A majority of primary ovarian carcinoids occur in association with mature cystic teratoma or are metastatic to the ovary. A 48-year-old post-menopausal woman presented with progressive facial puffiness, and intractable diarrhea. Radiological imaging suggested a 10 × 9 × 9.2 cm right ovarian mass. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination revealed primary pure carcinoid tumor of the ovary with the synchronous presence of early invasive squamous cell carcinoma of the cervix, along with the icthyosis uteri. The patient is doing well on 5 years of follow-up post-surgery without any recurrence or metastasis. In this report, we intend to highlight the rare association of cervical carcinoma and ichthyosis uteri with this tumor. In addition, we present a short review of the literature, over a decade of ovarian carcinoids associated with carcinoid heart disease.


Assuntos
Tumor Carcinoide/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias do Colo do Útero/diagnóstico , Feminino , Cardiopatias/complicações , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Salpingo-Ooforectomia
16.
Artigo em Inglês | MEDLINE | ID: mdl-34360112

RESUMO

Carcinosarcoma, leiomyosarcoma, melanoma and carcinoid as primary tumors in the ovary are extremely rare. In this paper, the authors reviewed the literature from 2010 to 2021, based on specific criteria, to analyze the treatment of these rare ovarian neoplasms. We also aimed to verify whether modern therapies have been found in recent years. For this article, 80 papers were finally selected. The vast majority of the articles were clinical case reports. Despite single mentions of new potential pharmacological treatments, surgery (radical or fertility-sparing) is definitely the mainstay of treatment. There are currently no treatment guidelines for these tumors. A review of the literature has revealed the use of various adjuvant treatments. We, therefore, believe that a more detailed understanding of the biology of these tumors is necessary in order to find new target points for treatment. We would like to emphasize the importance of creating an international database of rare ovarian tumors which would make it possible to gather data from various oncological centers and enable further research into these neoplasms.


Assuntos
Tumor Carcinoide , Carcinossarcoma , Leiomiossarcoma , Melanoma , Neoplasias Ovarianas , Carcinossarcoma/terapia , Feminino , Humanos , Leiomiossarcoma/terapia , Melanoma/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico
17.
J Int Med Res ; 49(8): 3000605211034666, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34459278

RESUMO

OBJECTIVE: To investigate the clinicopathological features, diagnosis and differential diagnosis of patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. METHODS: This retrospective case series analysed the data from patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. RESULTS: The study enrolled four patients. Histopathological analysis of the tumours identified the following subtypes: insular (n = 1), trabecular (n = 1) and strumal (n = 2). All four primary ovarian carcinoid tumours originated from a mature teratoma. The morphology of the primary ovarian carcinoids was similar to other neuroendocrine tumours. Strumal carcinoids were composed of different proportions of thyroid tissue intimately admixed with carcinoid tumour. Tumour tissue was arranged in insular and/or trabecular patterns. The nucleus of tumour cells displayed exquisite chromatin without obvious mitotic figures. Tumour tissues were positively stained for neuroendocrine markers chromogranin A, synaptophysin and CD56 to varying degrees. Strumal carcinoid tumours were cytokeratin 19 positive and thyroid transcription factor 1 negative. No recurrence or metastasis occurred during follow-up (12-71 months). CONCLUSION: Primary ovarian carcinoid tumours arising in mature cystic teratomas are rare. Diagnosis and differential diagnosis should be confirmed by clinical features, histopathological characteristics and specific immunophenotyping.


Assuntos
Tumor Carcinoide , Neoplasias Ovarianas , Estruma Ovariano , Teratoma , Tumor Carcinoide/diagnóstico , Feminino , Humanos , Recidiva Local de Neoplasia , Neoplasias Ovarianas/diagnóstico , Estudos Retrospectivos , Estruma Ovariano/diagnóstico , Teratoma/diagnóstico
18.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413045

RESUMO

Three distinct gastric carcinoid (GC) tumour types have been described based on differing biological behaviour and prognoses. Type I GC tumours account for the vast majority (70%-80%), are associated with chronic atrophic gastritis and have a low metastatic potential. Type II carcinoid tumours are the least common (5%-10%), are related to Zollinger-Ellison syndrome and occur in relation to multiple neoplasia type I. Sporadic type III tumours (15%-25%) are the most aggressive type, are unrelated to gastrin over secretion and carry the worst prognosis. In this case report, we present a patient with longstanding gastroesophageal reflux disease (GERD) who presented with epigastric abdominal pain and tarry stools and was found to have a large gastric polyp on endoscopy. Despite current literature recommending surgical resection for larger GC tumours, endoscopic resection was successfully used to excise the tumour with pathology demonstrating complete resection with negative margins.


Assuntos
Tumor Carcinoide , Gastrite Atrófica , Neoplasias Gástricas , Síndrome de Zollinger-Ellison , Tumor Carcinoide/cirurgia , Endoscopia , Humanos , Neoplasias Gástricas/cirurgia
19.
Ann Surg Oncol ; 28(13): 8916-8925, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34409541

RESUMO

BACKGROUND: Appendiceal goblet cell adenocarcinomas (GCC) are rare tumors with clinical behavior between classic carcinoids and adenocarcinomas. Current guidelines recommend right hemicolectomy for all GCCs. PATIENTS AND METHODS: The National Cancer Database was retrospectively queried for appendiceal GCCs undergoing appendectomy or right hemicolectomy between 2004 and 2016. Demographics, tumor characteristics, and post-operative outcomes were collected. The primary outcome was overall survival, which was examined by surgical type and tumor T stage. Multivariate logistic regression was utilized to identify predictors of survival. RESULTS: In total, 1083 GCCs were included, and 81.8% underwent right hemicolectomy. Mean age was 57 years, and 89% were White. Patients undergoing hemicolectomy had higher T-stage tumors (66.6%/14.4% T3/T4 vs. 55.8%/8.1%, p < 0.001). Lymph node positivity increased with T stage (1.1%, 2.1%, 9.9%, and 29.1% for T1-T4). GCCs undergoing colectomy were more frequently moderately or poorly differentiated (16.7%/9.0% vs. 12.2%/6.6%, p = 0.011). Appendectomy surgical margins were positive in 17.3% (3.4% hemicolectomy, p < 0.001). In T3/T4 tumors, a significant survival benefit at 5 years was observed in patients undergoing colectomy as compared with appendectomy (85.4% vs. 82.0%, p = 0.028). On multivariate analysis, lymph node positivity markedly decreased survival overall for the entire cohort (HR 7.58, p < 0.001) and for T3/T4 tumors (HR 7.63, p < 0.001). In patients with T3/T4 tumors, there was a trend towards improved survival with right hemicolectomy (HR 0.42, p = 0.068). CONCLUSION: Omitting right hemicolectomy can be considered for select T1/T2 appendiceal GCCs with negative appendectomy margins, given low rates of lymph node metastases and lack of survival benefit with right hemicolectomy.


Assuntos
Adenocarcinoma , Neoplasias do Apêndice , Tumor Carcinoide , Adenocarcinoma/cirurgia , Apendicectomia , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/cirurgia , Colectomia , Células Caliciformes , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
20.
Clin Endocrinol (Oxf) ; 95(5): 744-751, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34323309

RESUMO

PURPOSE: Neuroendocrine neoplasia (NEN) of the thymus is a very rare entity with a poor prognosis. None of the treatments was proofed by studies. Usually, therapy protocols for bronchopulmonary carcinoids are used. So far no data exist on the effect of mammalian target of rapamycin (mTOR) inhibitors. We describe our long-term experience with everolimus and give a thorough review of the therapeutic strategies used so far. PATIENTS AND METHODS: Four patients (mean age 46 years, range 37-55) with progressing thymic NEN (t-NEN) (two well-differentiated atypical carcinoids and two atypical carcinoids with large cell characteristics) were treated with everolimus 10 mg/day after the failure of at least one previous medical therapy. Everolimus was applied after a mean interval of 32.4 months (range 5-56) after the first diagnosis. The follow-up included clinical examination, imaging and chromogranin A testing in 3 or 6 monthly intervals. RESULTS: We observed stable disease for a mean of 20.8 months. Both patients with large cell characteristics t-NEN (Ki-67 of 20%) had rapid progress after 7 and 10 months and had more previous therapies (three and six) than the patients with well-differentiated t-NEN (Ki-67 5% and 10%, progress after 24 and 42 months, one and two previous therapies). No severe side effects occurred. In three of four patients, everolimus led to stable disease for the longest compared to the other nonsurgical therapies used. CONCLUSION: Comparing the sparse data available everolimus is a promising treatment for t-NEN at least in second-line therapy. A low Ki-67 index was associated with a better outcome.


Assuntos
Tumor Carcinoide , Tumores Neuroendócrinos , Adulto , Tumor Carcinoide/tratamento farmacológico , Cromogranina A , Everolimo/uso terapêutico , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/tratamento farmacológico
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