Misleading clinical presentation of carcinoid syndrome

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, 68 Ga-DOTATATE PET 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.

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Anaplastic Wilms' tumor: clinical and pathologic studies.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.4.513 ◽

1985 ◽

Vol 3 (4) ◽

pp. 513-520 ◽

Cited By ~ 91

Author(s):

J F Bonadio ◽

B Storer ◽

P Norkool ◽

V T Farewell ◽

J B Beckwith ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastases ◽

Clinical Presentation ◽

Wilms Tumor ◽

Response To Therapy ◽

Tumor Study ◽

Localized Disease ◽

Node Metastases

A review of almost 1,200 children participating in the first and second National Wilms' Tumor Study (NWTS-1 and -2) has demonstrated a number of significant differences in the clinical presentation and response to therapy of anaplastic and nonanaplastic Wilms' tumor. Compared to their counterparts, children with anaplastic Wilms' tumor were generally one to two years older at diagnosis, more were non-white, and more had lymph node metastases at diagnosis. Consistent with previous studies, children with anaplastic Wilms' tumor survived for a significantly shorter time than those with non-anaplastic Wilms' tumor. A hopeful outlook, however, was suggested by the NWTS-2 experience since the more aggressive chemotherapies used in this study appear to have substantially improved the survival of patients with diffusely anaplastic tumors. Also, the survival of NWTS-2 patients with anaplastic Wilms' tumor was determined in part by clinicopathologic stage. It may be possible therefore to refine therapy according to stage so as to provide children with localized disease a chance for cure with fewer untoward treatment-related sequelae.

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Sensitivity rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases to reduce the need for surgical sentinel node (SN) staging in melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8535 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8535-8535 ◽

Cited By ~ 1

Author(s):

Christiane A. Voit ◽

Alexander Christopher Jonathan Van Akkooi ◽

Saskia Gooskens ◽

Petra Siegel ◽

Gregor Schaefer-Hesterberg ◽

...

Keyword(s):

Lymph Node ◽

Clin Oncol ◽

Lymph Node Metastases ◽

High Sensitivity ◽

Needle Aspiration ◽

Tumor Burden ◽

Maximum Diameter ◽

Node Metastases ◽

Rotterdam Criteria

8535 Background: US-guided-FNAC prior to surgical SN staging is emerging as a possible cost-effective addition to the staging of melanoma patients (pts). Formerly, sensitivity (sens) rates of lymph node US in melanoma were disappointing (20–40%). The introduction of the Berlin Morphology Criteria has significantly improved sens rates for US-FNAC (J Clin Oncol 2010;28(5):847-52). The aim of the current study was to report on 1000 patients the sens, specificity (spec), positive (PPV) and negative (NPV) predictive value rates of US-FNAC from our prospective database with prolonged follow-up. Methods: Since 2001, >1000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) were the Berlin Morphology Criteria which were registered. FNAC was performed in case of presence of any of these factors. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/median Breslow thickness was 2.56 / 1.57 mm (0.2 – 44 mm).Mean/median follow-up was 39 / 32 months (0 – 115). Ulceration was present in 24 %. SN positivity rates were 20 % (202 / 1000). Sens was 51 %. Spec, PPV and NPV were 99%, 91% and 89%. Sensitivity was highest for T4 tumors (77%). PP, LCE, BS had sens of 69%, 24%, 25%. SN tumor burden > 1 mm in largest diameter according to the Rotterdam Criteria was identified by US-FNAC in 86%. Threshold for positive FNAC was 0.4 mm in maximum diameter. Conclusions: The new criterion of Periferal Perfusion is of key importance to achieve the high sensitivity of US-FNAC according to the Berlin Morphology Criteria (J Clin Oncol 2010; 28:847-852) to identify lymph node metastases. Especially for T4 patients and in patients with advanced SN tumor burden it can reduce significantly the need for surgical SN staging. The EORTC Melanoma Group will launch the prospective validation study, USE FNAC, in 2012.

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Successful Treatment with Proton Beam Therapy Alone for Postoperative Esophageal Squamous Cell Carcinoma with Liver and Lymph Node Metastases After Failure of First-Line Chemotherapy

10.21203/rs.3.rs-960347/v1 ◽

2021 ◽

Author(s):

Yojiro Ishikawa ◽

Motohisa Suzuki ◽

Hisashi Yamaguchi ◽

Ichiro Seto ◽

Masanori Machida ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Liver Metastasis ◽

Cell Carcinoma ◽

Squamous Cell ◽

Lymph Node Metastases ◽

Proton Beam Therapy ◽

First Line ◽

Node Metastases ◽

Line Chemotherapy

Abstract Background: Cisplatin (CDDP) and 5-fluorouracil (5-FU) are used in first-line chemotherapy for recurrent esophageal squamous cell carcinoma (ESCC) after radical esophagectomy; however, patients have a poor prognosis after failure of first-line treatment. We herein report the achievement of long-term survival after proton therapy in an ESCC patient in whom the first-line chemotherapy failed. Case presentation: A 60-year-old man was diagnosed as having squamous cell carcinoma of the lower thoracic esophagus (cT2N0M0, Stage IIA). He underwent two courses of neoadjuvant chemotherapy with CDDP and 5-FU, and esophagectomy with three-field lymphadenectomy was performed. Microscopic findings after resection showed two lymph node metastases (ypT2N1M0, Stage IIB). Five months after surgery, a computed tomography scan revealed a solitary liver metastasis in the S4 area. He underwent three courses of chemotherapy with CDDP and 5-FU. Although surgeons decided to perform resection for the liver metastasis, preoperative positron emission tomography (PET) revealed two lymph node metastases. Surgeons recommended second-line chemotherapy or chemoradiotherapy, bud the patient refused second-line chemotherapy and requested proton beam therapy (PBT). We performed PBT without chemotherapy for the liver metastasis and lymph node metastases with total dose of 79.2 and 60Gy relative biological effectiveness, respectively, according to the tumor location. The PBT resulted in a complete response as shown by PET. An acute side effect of grade 1 dermatitis occurred after PBT, but there was no acute or late complication of more than grade 2. The patient remains in complete remission 5 years after treatment without surgery or chemotherapy. Conclusions: PBT exerted a curative effect on postoperative recurrence of ESCC. This is the first report about PBT for postoperative ESCC with liver and lymph node metastases after failure of first-line chemotherapy for metastases in distant organs.

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