scholarly journals Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma

2019 ◽  
Vol 104 (12) ◽  
pp. 6129-6138 ◽  
Author(s):  
Mikkel Andreassen ◽  
Emma Ilett ◽  
Dominik Wiese ◽  
Emily P Slater ◽  
Marianne Klose ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Somatostatin Receptor ◽  
Diagnostic Procedures ◽  
Benign Tumors ◽  
Receptor Subtype ◽  
Receptor Imaging ◽  
Venous Sampling ◽  
Transabdominal Ultrasonography ◽  
Positron Emission

Abstract Introduction Diagnosis and pathological classification of insulinomas are challenging. Aim To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma. Methods Patients with surgically resected sporadic insulinoma were included. Results Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n = 33; sensitivity, 58%), CT (n = 55; sensitivity, 47%), transabdominal ultrasonography (US; n = 45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a. Conclusion Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.

scholarly journals Multimodality imaging review of focal renal lesions

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Jonathan Lyske ◽  
Rishi Philip Mathew ◽  
Christopher Hutchinson ◽  
Vimal Patel ◽  
Gavin Low
Keyword(s):  
Malignant Tumors ◽  
Multimodality Imaging ◽  
Lymphoproliferative Disease ◽  
Benign Tumors ◽  
Main Body ◽  
Imaging Features ◽  
Focal Lesions ◽  
Renal Lesions ◽  
Positron Emission ◽  
Neoplastic Lesions

Abstract Background Focal lesions of the kidney comprise a spectrum of entities that can be broadly classified as malignant tumors, benign tumors, and non-neoplastic lesions. Malignant tumors include renal cell carcinoma subtypes, urothelial carcinoma, lymphoma, post-transplant lymphoproliferative disease, metastases to the kidney, and rare malignant lesions. Benign tumors include angiomyolipoma (fat-rich and fat-poor) and oncocytoma. Non-neoplastic lesions include infective, inflammatory, and vascular entities. Anatomical variants can also mimic focal masses. Main body of the abstract A range of imaging modalities are available to facilitate characterization; ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET), each with their own strengths and limitations. Renal lesions are being detected with increasing frequency due to escalating imaging volumes. Accurate diagnosis is central to guiding clinical management and determining prognosis. Certain lesions require intervention, whereas others may be managed conservatively or deemed clinically insignificant. Challenging cases often benefit from a multimodality imaging approach combining the morphology, enhancement and metabolic features. Short conclusion Knowledge of the relevant clinical details and key imaging features is crucial for accurate characterization and differentiation of renal lesions.

scholarly journals Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences

2013 ◽  
Vol 61 (8) ◽  
pp. 435-447 ◽  
Author(s):  
Jun Amano ◽  
Jun Nakayama ◽  
Yasuo Yoshimura ◽  
Uichi Ikeda
Keyword(s):  
Malignant Tumors ◽  
Cardiac Myxoma ◽  
World Health ◽  
Benign Tumors ◽  
Cardiac Tumors ◽  
New Classification ◽  
Metastatic Tumors ◽  
Great Vessels ◽  
Tumor Like Lesions

Abstract Tumors of the heart and the great vessels are very rare disease, and there are many disorders such as tumors originated from the heart and great vessels, metastatic tumors, and tumor-like lesions which do not fit into the usual concept of tumor or neoplasm; thus, it is very difficult to classify these tumors. We proposed a new classification of cardiovascular tumors for clinical use based on the accumulated biological analyses and clinical data of the reported literatures and our own study as benign tumors, malignant tumors, ectopic hyperplasia/ectopic tumors/others, and tumors of great vessels, with reference to the series of Atlas of tumor pathology of the Armed Forces Institute of Pathology and the recent World Health Organization classification of cardiac tumors issued in 2004. More than 50 disorders have been reported as tumors originated from the cardiovascular system, and various metastatic tumors from nearby organs, distant lesions, and intravascular extension tumors to the heart were reported. Based on the new classification, we reviewed epidemiology and incidence of cardiovascular tumors. Metastatic tumors are more frequent than tumors originated from the heart and great vessels, and cardiac myxoma is the most frequent tumors in all cardiac tumors.

scholarly journals Somatostatin receptor expression in parathyroid neoplasms

2019 ◽  
Vol 8 (8) ◽  
pp. 1213-1223 ◽  
Author(s):  
Sara Storvall ◽  
Helena Leijon ◽  
Eeva Ryhänen ◽  
Johanna Louhimo ◽  
Caj Haglund ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Somatostatin Receptor ◽  
Somatostatin Receptors ◽  
Receptor Expression ◽  
Benign Tumors ◽  
Receptor Subtypes ◽  
Receptor Imaging ◽  
Somatostatin Receptor Subtypes ◽  
Parathyroid Adenomas

Introduction Parathyroid carcinoma represents a rare cause of primary hyperparathyroidism. Distinguishing carcinoma from the benign tumors underlying primary hyperparathyroidism remains challenging. The diagnostic criteria for parathyroid carcinoma are local and/or metastatic spreading. Atypical parathyroid adenomas share other histological features with carcinomas but lack invasive growth. Somatostatin receptors are commonly expressed in different neuroendocrine tumors, but whether this also holds for parathyroid tumors remains unknown. Aim Our aim is to examine the immunohistochemical expression of somatostatin receptor 1–5 in parathyroid typical adenomas, atypical adenomas and carcinomas. Methods We used a tissue microarray construct from a nationwide cohort of parathyroid carcinomas (n = 32), age- and gender-matched typical parathyroid adenomas (n = 72) and atypical parathyroid adenomas (n = 27) for immunohistochemistry of somatostatin receptor subtypes 1–5. We separately assessed cytoplasmic, membrane and nuclear expression and also investigated the associations with histological, biochemical and clinical characteristics. Results All parathyroid tumor subgroups expressed somatostatin receptors, although membrane expression appeared negligible. Except for somatostatin receptor 1, expression patterns differed between the three tumor types. Adenomas exhibited the weakest and carcinomas the strongest expression of somatostatin receptor 2, 3, 4 and 5. We observed the largest difference for cytoplasmic somatostatin receptor 5 expression. Conclusions Parathyroid adenomas, atypical adenomas and carcinomas all express somatostatin receptor subtypes 1–5. Somatostatin receptor 5 may serve as a potential tumor marker for malignancy. Studies exploring the role of somatostatin receptor imaging and receptor-specific therapies in patients with parathyroid carcinomas are needed.

scholarly journals Effective localization in tumor-induced osteomalacia using 68Ga-DOTATOC-PET/CT, venous sampling and 3T-MRI

2017 ◽  
Vol 2017 ◽  
Author(s):  
Shintaro Kawai ◽  
Hiroyuki Ariyasu ◽  
Yasushi Furukawa ◽  
Reika Yamamoto ◽  
Shinsuke Uraki ◽  
...  
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
Somatostatin Receptor ◽  
List Type ◽  
Conventional Imaging ◽  
Imaging Studies ◽  
Venous Sampling ◽  
3T Mri ◽  
Positron Emission ◽  
Pet Ct ◽  
The Right

Summary Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by renal phosphate wasting leading to hypophosphatemia due to excessive actions of fibroblast growth factor 23 (FGF23) produced by the tumors. Although the best way of curing TIO is complete resection, it is usually difficult to detect the culprit tumors by general radiological modalities owing to the size and location of the tumors. We report a case of TIO in which the identification of the tumor by conventional imaging studies was difficult. Nonetheless, a diagnosis was made possible by effective use of multiple modalities. We initially suspected that the tumor existed in the right dorsal aspect of the scapula by 68Ga-DOTATOC positron emission tomography/computed tomography (68Ga-DOTATOC-PET/CT) and supported the result by systemic venous sampling (SVS). The tumor could also be visualized by 3T-magnetic resonance imaging (MRI), although it was not detected by 1.5T-MRI, and eventually be resected completely. In cases of TIO, a stepwise approach of 68Ga-DOTATOC-PET/CT, SVS and 3T-MRI can be effective for confirmation of diagnosis. Learning points: TIO shows impaired bone metabolism due to excessive actions of FGF23 produced by the tumor. The causative tumors are seldom detected by physical examinations and conventional radiological modalities. In TIO cases, in which the localization of the culprit tumors is difficult, 68Ga-DOTATOC-PET/CT should be performed as a screening of localization and thereafter SVS should be conducted to support the result of the somatostatin receptor (SSTR) imaging leading to increased diagnosability. When the culprit tumors cannot be visualized by conventional imaging studies, using high-field MRI at 3T and comparing it to the opposite side are useful after the tumor site was determined.

scholarly journals Somatostatin receptor-based imaging and therapy of gastroenteropancreatic neuroendocrine tumors

2010 ◽  
Vol 17 (1) ◽  
pp. R53-R73 ◽  
Author(s):  
Dik J Kwekkeboom ◽  
Boen L Kam ◽  
Martijn van Essen ◽  
Jaap J M Teunissen ◽  
Casper H J van Eijck ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Pet Imaging ◽  
Tumor Regression ◽  
Somatostatin Receptor ◽  
Somatostatin Analogs ◽  
Receptor Subtype ◽  
Receptor Imaging ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Pet Tracer ◽  
First Choice

Somatostatin receptor imaging (SRI) with [111In-DTPA0]octreotide has proven its role in the diagnosis and staging of gastroenteropancreatic neuroendocrine tumors (GEPNETs). Newer radiolabeled somatostatin analogs which can be used in positron emission tomography (PET) imaging, and which have a higher affinity for the somatostatin receptor, especially receptor subtype-2, have been developed. It would be desirable, however, if one radiolabeled analog became the new standard for PET imaging, because the current application of a multitude of analogs implies a fragmented knowledge on the interpretation of the images that are obtained in clinical practice. In our view, the most likely candidates for such a universal PET tracer for SRI are [68Ga-DOTA0,Tyr3]octreotate or [68Ga-DOTA0,Tyr3]octreotide. Treatment with radiolabeled somatostatin analogs is a promising new tool in the management of patients with inoperable or metastasized neuroendocrine tumors. Symptomatic improvement may occur with all 111In-, 90Y-, or 177Lu-labeled somatostatin analogs that have been used for peptide receptor radionuclide therapy (PRRT). The results that were obtained with [90Y-DOTA0,Tyr3]octreotide and [177Lu-DOTA0,Tyr3]octreotate are very encouraging in terms of tumor regression. Also, if kidney protective agents are used, the side effects of this therapy are few and mild, and the median duration of the therapy response for these radiopharmaceuticals is 30 and 40 months respectively. The patients' self-assessed quality of life increases significantly after treatment with [177Lu-DOTA0,Tyr3]octreotate. Lastly, compared to historical controls, there is a benefit in overall survival of several years from the time of diagnosis in patients treated with [177Lu-DOTA0,Tyr3]octreotate. These data compare favorably with the limited number of alternative treatment approaches. If more widespread use of PRRT can be guaranteed, such therapy may well become the therapy of first choice in patients with metastasized or inoperable GEPNETs.

INITIAL EXPERIENCE 13N-AMMONIA APPLICATION AND PERSPECTIVES FOR ITS CLINICAL USE IN NEUROONCOLOGY

2018 ◽  
Vol 64 (4) ◽  
pp. 515-521
Author(s):  
Nikolay Kostenikov ◽  
Olga Mirolyubova ◽  
Violetta Dubrovskaya ◽  
Yuriy Ilyushchenko ◽  
Andrey Stanzhevskiy
Keyword(s):  
Malignant Tumors ◽  
Emission Tomography ◽  
Benign Tumors ◽  
Initial Experience ◽  
Tumor Vascularization ◽  
Positron Emission ◽  
Pet Ct ◽  
Hypervascular Tumors ◽  
Malignant And Benign Tumors ◽  
Intravenous Introduction

Materials and methods. A group of 19 patients with suspected of recurrent growth malignant and benign tumors and postoperative cysts on PET-CT with 13N-ammonium were examined in the postoperative period. The RPH 13N-ammoniа was injected intravenously at the dose of 350-370MBq/m2 of body surface. It is shown, that PET with 13N-ammonia allows to clearly visualize benign and malignant hypervascular tumors, as well as to assess the efficiency of their treatment. The tendency was detected for prevalence of the increased accumulation of 13N-ammonia in benign hypervascular neoplasms of a vascular line as compared to malignant tumors. That is explained by the dependence of the uptake of the drug both upon the degree of tumor vascularization and upon the presence and concentration of glutamine in tumor cells. It is stated in the paper that the level of the uptake of 13N-ammonium in the tumor is in direct ratio to its perfusion and inversely to the degree of its malignancy. In case of effective treatment the level of accumulation of 13N-ammonia in malignant tumors is nonlinearly increased since the rate of metabolic processes is decreased that leads to accumulation of glutamine, however perfusion in the tumor is also nonlinearly decreased. Conclusion. Ultrashort half-life of the radionuclide [13N] (of 9.96 min) and the low radiation exposure that occurs with intravenous introduction of 13N-ammonium create a unique opportunity for diagnosis and assessment of the efficiency of treatment of brain tumors by the method of positron emission tomography.

scholarly journals Classification of Breast Ultrasound Tomography by Using Textural Analysis

2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Chih-Yu Liang ◽  
Tai-Been Chen ◽  
Nan-Han Lu ◽  
Yi-Chen Shen ◽  
Kuo-Ying Liu ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Malignant Tumors ◽  
Rapid Development ◽  
Ultrasound Image ◽  
Breast Ultrasound ◽  
Image Features ◽  
Benign Tumors ◽  
Ultrasound Images ◽  
The Mean

Background: Ultrasound imaging has become one of the most widely utilized adjunct tools in breast cancer screening due to its advantages. The computer-aided detection of breast ultrasound is rapid development via significant features extracted from images. Objectives: The main aim was to identify features of breast ultrasound image that can facilitate reasonable classification of ultrasound images between malignant and benign lesions. Patients and Methods: This research was a retrospective study in which 85 cases (35 malignant [positive group] and 50 benign [negative group] with diagnostic reports) with ultrasound images were collected. The B-mode ultrasound images have manually selected regions of interest (ROI) for estimated features of an image. Then, a fractal dimensional (FD) image was generated from the original ROI by using the box-counting method. Both FD and ROI images were extracted features, including mean, standard deviation, skewness, and kurtosis. These extracted features were tested as significant by t-test, receiver operating characteristic (ROC) analysis and Kappa coefficient. Results: The statistical analysis revealed that the mean texture of images performed the best in differentiating benign versus malignant tumors. As determined by the ROC analysis, the appropriate qualitative values for the mean and the LR model were 0.85 and 0.5, respectively. The sensitivity, specificity, accuracy, positive predicted value (PPV), negative predicted value (NPV), and Kappa for the mean was 0.77, 0.84, 0.81, 0.77, 0.84, and 0.61, respectively. Conclusion: The presented method was efficient in classifying malignant and benign tumors using image textures. Future studies on breast ultrasound texture analysis could focus on investigations of edge detection, texture estimation, classification models, and image features.

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