Abdominal Manifestations of Neuroendocrine Tumors

AbstractDespite being rare, the incidence and prevalence of gastroenteropancreatic neuroendocrine tumors (NETs) is rising. They are a heterogeneous group of tumors with differences in clinical presentations, genetics, and imaging features. Advances in pathological classification, imaging (including recent radiotracer approval for functional imaging in the Unites States), and therapy have impacted management of these tumors. It is important in the multidisciplinary approach to patient care to be familiar with the tumor biology, imaging techniques for diagnosis and staging, and therapeutic options. This article will discuss these new developments, particularly focusing on pancreatic and small bowel NETs.

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A multidisciplinary approach to the management of gastroenteropancreatic neuroendocrine tumors - a case report

Medicinski pregled ◽

10.2298/mpns2004116k ◽

2020 ◽

Vol 73 (3-4) ◽

pp. 116-120

Author(s):

Dijana Kosijer ◽

Zeljka Savic ◽

Dragomir Damjanov ◽

Dimitrije Damjanov ◽

Djuro Macut ◽

...

Keyword(s):

Case Report ◽

Neuroendocrine Tumor ◽

Neuroendocrine Tumors ◽

Multidisciplinary Approach ◽

Imaging Techniques ◽

Medical Center ◽

Endocrine System ◽

Watery Diarrhea ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Facial Swelling

Introduction. Gastroenteropancreatic neuroendocrine tumors comprise a heterogeneous group of neoplasms that originate from the cells of the diffuse endocrine system within the gastrointestinal tract and pancreas. The diagnostic procedures and therapy of patients with gastroenteropancreatic neuroendocrine tumors is complex and requires a multidisciplinary approach. Case Report. A 51-year-old patient visited a Gastroenterology Outpatient Clinic for examination complaining of redness, facial swelling and frequent watery diarrhea since the age of 48 years. The clinical examination revealed subicterus, systolic murmur, and hepatomegaly. The patient received an extensive examination that included specific laboratory tests and various imaging techniques (endoscopy, radiology, cardiology, nuclear imaging) at the regional medical center. He was referred to a tertiary medical center, including the national Center for the Treatment of Neuroendocrine Tumors, and a metastatic neuroendocrine tumor, most likely affecting the ileum, was established. After preoperative cardiac and anesthesiological assessments, an elective surgical procedure was performed, with a pathohistological/immunohistochemical confirmation of a grade 1 neuroendocrine tumor of the ileum. Conclusion. The process of diagnosing gastroenteropancreatic neuroendocrine tumors, after the onset of symptoms, is often long, associated with comorbidities, and requires a multidisciplinary approach to diagnosis, treatment and monitoring.

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Gastroenteropancreatic neuroendocrine tumors: multimodality imaging features with pathological correlation

Japanese Journal of Radiology ◽

10.1007/s11604-010-0522-1 ◽

2011 ◽

Vol 29 (2) ◽

pp. 85-91 ◽

Cited By ~ 12

Author(s):

Daichi Hayashi ◽

Jaroslaw N. Tkacz ◽

Stephen Hammond ◽

Brooke C. Devenney-Cakir ◽

Souhil Zaim ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Multimodality Imaging ◽

Imaging Features ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Pathological Correlation

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Localization of Neuroendrocrine Tumors Using Somatostatin Receptor Imaging with Indium-111-Pentetreotide (OctreoScan)

Cancer Control ◽

10.1177/107327489700400105 ◽

1997 ◽

Vol 4 (1) ◽

pp. 1-3 ◽

Cited By ~ 7

Author(s):

E. Christopher Ellison ◽

William J. Schirmer ◽

John O. Olsen ◽

Rodney V. Pozderac ◽

George Hinkle ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Imaging Techniques ◽

Somatostatin Receptor ◽

Somatostatin Receptors ◽

Receptor Imaging ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Primary Tumors ◽

Duodenal Tumor ◽

Computed Tomography Scanning ◽

Indium 111

Background Many imaging methods have been used to detect neuroendocrine tumors of the gastrointestinal system. There is no gold standard for identifying the location of primary tumors and their potential metastases, and most conventional imaging techniques cannot detect tumors less than 1.0 cm in size. Methods The authors have investigated the use of 111In-pentetreotide as an imaging agent for abdominal neuroendocrine tumors. Results The agent is cleared rapidly by the kidneys and is primarily excreted intact with a biologic half-life of six hours. The largest radiation burden is to the spleen and kidneys. A nine-center study conducted in Europe involved 365 patients with gastroenteropancreatic neuroendocrine tumors that were also imaged by other methods. The results of 111In-pentetreotide were in agreement with those obtained by other methods for 79% of tumor locations. An additional 110 tumor localizations were detected that were not seen with conventional methods. The smallest gastrinoma imaged by 111In-pentetreotide was a 4-mm duodenal tumor. Conclusions Scintigraphy with 111In-pentetreotide is effective in visualizing various somatostatin receptors characteristic of neuroendocrine tumors of the gastrointestinal tract. Insulinomas, however, are not well imaged. Concurrent computed tomography scanning is advised to minimize the risk of missing liver metastases.

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Role of Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors and Update on Their Treatment

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1056 ◽

2013 ◽

Vol 47 (1) ◽

pp. 54-60

Author(s):

Vishal Sharma ◽

Surinder Singh Rana ◽

Deepak Kumar Bhasin

Keyword(s):

Neuroendocrine Tumors ◽

Endoscopic Ultrasound ◽

Imaging Techniques ◽

Somatostatin Analogs ◽

Neuroendocrine Cells ◽

Molecular Therapy ◽

Long Term Results ◽

Gi Tract ◽

Gastroenteropancreatic Neuroendocrine Tumors

ABSTRACT The gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are rare tumors and include all tumors arising from the gastrointestinal (GI) or pancreatic neuroendocrine cells. They can occur anywhere in the GI tract with the small intestine, pancreas and rectum being the common GI sites. Because of nonspecific symptoms they are difficult to diagnose and diagnosis is often delayed by years. Advancement in cross-sectional imaging techniques and advent of radionuclide-labeled somatostatin analogs have improved our accuracy of diagnosis and staging GEP NETs. Endoscopic ultrasound (EUS) with its unique combination of endoscopy and ultrasound provides high resolution images of GI tract wall as well as the surrounding solid parenchymal organs and therefore is an important investigation for the diagnosis and staging of GEP NETs. Surgery is the treatment of choice with good long-term results in patients with localized GEP-NETs. Control of symptoms in functional NETs is warranted to improve the quality of life of the patient. Somatostatin and its analogs like octreotide and lanreotide have been used to control symptoms because of functional NETs. The management of metastatic GEP NETs includes control of symptoms and therapy to decrease/stop tumor growth that includes somatostatin and its analogs and chemotherapy. Newer therapeutic modalities like peptide receptor radionuclide therapy (PRRT) and molecular therapy hold considerable promise. How to cite this article Rana SS, Sharma V, Bhasin DK. Role of Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors and Update on Their Treatment. J Postgrad Med Edu Res 2013;47(1):54-60.

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Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria: Multidisciplinary Approach to Improve Outcome

ISRN Hepatology ◽

10.1155/2014/706945 ◽

2014 ◽

Vol 2014 ◽

pp. 1-25 ◽

Cited By ~ 11

Author(s):

A. Kornberg

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Multidisciplinary Approach ◽

Early Stage ◽

Selection Process ◽

Imaging Techniques ◽

Tumor Biology ◽

Critical Discussion ◽

Milan Criteria ◽

Immunosuppressive Medications

The implementation of the Milan criteria (MC) in 1996 has dramatically improved prognosis after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Liver transplantation has, thereby, become the standard therapy for patients with “early-stage” HCC on liver cirrhosis. The MC were consequently adopted by United Network of Organ Sharing (UNOS) and Eurotransplant for prioritization of patients with HCC. Recent advancements in the knowledge about tumor biology, radiographic imaging techniques, locoregional interventional treatments, and immunosuppressive medications have raised a critical discussion, if the MC might be too restrictive and unjustified keeping away many patients from potentially curative LT. Numerous transplant groups have, therefore, increasingly focussed on a stepwise expansion of selection criteria, mainly based on tumor macromorphology, such as size and number of HCC nodules. Against the background of a dramatic shortage of donor organs, however, simple expansion of tumor macromorphology may not be appropriate to create a safe extended criteria system. In contrast, rather the implementation of reliable prognostic parameters of tumor biology into selection process prior to LT is mandatory. Furthermore, a multidisciplinary approach of pre-, peri-, and posttransplant modulating of the tumor and/or the patient has to be established for improving prognosis in this special subset of patients.

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Imaging in Pancreatic Neuroendocrine Tumors

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1708070 ◽

2020 ◽

Vol 3 (01) ◽

pp. 053-063

Author(s):

Savinay Kapur ◽

Raju Sharma ◽

Ankur Goyal

Keyword(s):

Neuroendocrine Tumors ◽

Pancreatic Neoplasms ◽

Imaging Techniques ◽

Discrete Subgroup ◽

Pancreatic Tumors ◽

Imaging Features ◽

Pancreatic Neuroendocrine Tumors ◽

Radiological Features ◽

Grading Systems ◽

Different Types

AbstractPancreatic neuroendocrine tumors (NETs) form a discrete subgroup of pancreatic neoplasms. They are rarer than pancreatic adenocarcinomas but need to be differentiated from other pancreatic tumors and pathologies as they carry a better prognosis. Imaging plays a central role in detecting, characterizing, and staging of pancreatic NETs as they tend to have typical radiological features. A lot of advancements have taken place in the field of imaging and theranostics which have revolutionized their detection and management. In this article we shall review the various imaging techniques available to the radiologist, salient imaging features of different types of pancreatic NETs, staging and grading systems, as well as a brief overview of their management.

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Quantitative nano-characterization of heterogeneous catalysts

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100138361 ◽

1995 ◽

Vol 53 ◽

pp. 398-399

Author(s):

P.A. Crozier ◽

M. Pan

Keyword(s):

Heterogeneous Catalysts ◽

Low Dose ◽

Imaging Techniques ◽

Structural Features ◽

Catalyst Characterization ◽

New Developments ◽

Double Phase ◽

Phase Systems ◽

Dose Imaging

Heterogeneous catalysts can be of varying complexity ranging from single or double phase systems to complicated mixtures of metals and oxides with additives to help promote chemical reactions, extend the life of the catalysts, prevent poisoning etc. Although catalysis occurs on the surface of most systems, detailed descriptions of the microstructure and chemistry of catalysts can be helpful for developing an understanding of the mechanism by which a catalyst facilitates a reaction. Recent years have seen continued development and improvement of various TEM, STEM and AEM techniques for yielding information on the structure and chemistry of catalysts on the nanometer scale. Here we review some quantitative approaches to catalyst characterization that have resulted from new developments in instrumentation.HREM has been used to examine structural features of catalysts often by employing profile imaging techniques to study atomic details on the surface. Digital recording techniques employing slow-scan CCD cameras have facilitated the use of low-dose imaging in zeolite structure analysis and electron crystallography. Fig. la shows a low-dose image from SSZ-33 zeolite revealing the presence of a stacking fault.

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