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Management of Gastric Neuroendocrine Tumors

Year 2020, Volume: 25 Issue: 3, 187 - 191, 29.10.2020
https://doi.org/10.21673/anadoluklin.687259

Abstract

Aim: The widespread use of endoscopy has led to a marked increase in the reported incidence and prevalence of gastric neuroendocrine tumors (NETs). In this study, we aimed to investigate these rare and poorly understood tumors in patients from a single center.


Materials and Methods:
We retrospectively reviewed the medical records of patients who were treated with a diagnosis of gastric NET between January 2010 and December 2018. Data on patient demographic characteristics, diagnostic work-up, endoscopic and surgical treatment patterns, histopathological features, and outcome parameters were documented. The Ki-67 proliferation index, mitosis ratio, and immunohistochemical staining with chromogranin A and synaptophysin were evaluated by histopathological examination.


Results:
The study included 17 patients (9 males, 8 females), with a mean age of 61.7 years. Nine patients had a tumor located in the fundus, 5 in the antrum, and 3 in the corpus. Histopathological evaluation diagnosed 6 well-differentiated type I NETs and 11 poorly differentiated type III NETs. Seven (41%) patients underwent surgery (with adjuvant chemotherapy when indicated), 6 (35%) only endoscopic treatment, and 4 only chemotherapy. Seven (41%) of the 17 patients had distant metastases at the time of diagnosis, with the liver being the most commonly involved organ.



Discussion and Conclusion:
Gastric NETs are categorized into three groups according to mitotic activity and the Ki-67 index. Data on serum gastrin levels and endoscopic and radiological work-up are required for this categorization. Treatment approach varies according to the type and stage of the disease.

References

  • 1. Modlin IM, Shapiro MD, Kidd M. Siegfried Oberndorfer: origins and perspectives of carcinoid tumors. Hum Pathol. 2004;35(12):1440–51.
  • 2. Rindi G, Arnold R, Bosman FT, Capella C, Klimstra DS, Klöppel G, et al. Nomenclature and classification of neuroendocrine neoplasms of the digestive system. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (ed.), WHO Classification of Tumours of the Digestive System. Lyon: IARC; 2010:13–14.
  • 3. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in United States. J Clin Oncol. 2008;26:3063–72.
  • 4. Mougey AM, Adler DG. Neuroendocrine tumors: review and clinical update. Hosp Physician. 2007;51:12–20.
  • 5. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97:934–59.
  • 6. Matsubayashi H, Takagaki S, Otsubo T, Iiri T, Kobayashi Y, Yokota T, et al. Advanced gastric glandular-endocrine cell carcinoma with 1-year survival after gastrectomy. Gastric Cancer. 2000;3:226–33.
  • 7. La Rosa S, Inzani F, Vanoli A, Klersy C, Dainese L, Rindi G, et al. Histologic characterization and improved prognostic evaluation of 209 gastric neuroendocrine neoplasms. Hum Pathol. 2011;42:1373–84.
  • 8. Massironi S, Sciola V, Spampatti MP, Peracchi M, Conte D. Gastric carcinoids: between underestimation and overtreatment. World J Gastroenterol. 2009;15:2177–83.
  • 9. Maggard MA, O’Connell JB, Ko CY. Updated population-based review of carcinoid tumors. Ann Surg. 2004;240:117–22.
  • 10. Basuroy R, Srirajaskanthan R, Prachalias A, Quaglia A, Ramage JK. Review article: the investigation and management of gastric neuroendocrine tumours. Aliment Pharmacol Ther. 2014;39(10):1071–84.
  • 11. Merola E, Sbrozzi-Vanni A, Panzuto F, D’Ambra G, Di Giulio E, Pilozzi E, et al. Type I gastric carcinoids: a prospective study on endoscopic management and recurrence rate. Neuroendocrinology. 2012;95(3):207–13.
  • 12. Delle Fave G, Kwekkeboom DJ, van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, et al. ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology. 2012;95(2):74–87.
  • 13. Hosokawa O, Kaizaki Y, Hattori M, Douden K, Hayashi H, Morishita M, et al. Long-term follow up of patients with multiple gastric carcinoids associated with type A gastritis. Gastric Cancer. 2005;8(1):42–6.
  • 14. Sato Y, Imamura H, Kaizaki Y, Koizumi W, Ishido K, Kurahara K, et al. Management and clinical outcomes of type I gastric carcinoid patients: retrospective, multicenter study in Japan. Dig Endosc. 2014;26(3):377–84.
  • 15. Ravizza D, Fiori G, Trovato C, Fazio N, Bonomo G, Luca F, et al. Long-term endoscopic and clinical follow-up of untreated type 1 gastric neuroendocrine tumours. Dig Liver Dis. 2007;39(6):537–43.
  • 16. Ozao-Choy J, Buch K, Strauchen JA, Warner RR, Divino CM. Laparoscopic antrectomy for the treatment of type I gastric carcinoid tumors. J Surg Res. 2010;162(1):22–5.
  • 17. Gladdy RA, Strong VE, Coit D, Allen PJ, Gerdes H, Shia J, et al. Defining surgical indications for type I gastric carcinoid tumor. Ann Surg Oncol. 2009;16:3154–60.
  • 18. Nikou GC, Toubanakis C, Nikolaou P, Giannatou E, Marinou K, Safioleas M, et al. Gastrinomas associated with MEN-1 syndrome: new insights for the diagnosis and management in a series of 11 patients. Hepatogastroenterology. 2005;52(66):1668–76.
  • 19. Pavel M, Baudin E, Couvelard A, Krenning E, Öberg K, Steinmüller T, et al. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2012;95(2):157–76.
  • 20. Vogl TJ, Naguib NN, Zangos S, Eichler K, Hedayati A, Nour-Eldin NE. Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation. Eur J Radiol. 2009;72:517–28.
  • 21. Wolin EM. The expanding role of somatostatin analogues in the management of neuroendocrine tumors. Gastrointest Cancer Res. 2012;5(5):161–8.

Gastrik Nöroendokrin Tümörlerin Yönetimi

Year 2020, Volume: 25 Issue: 3, 187 - 191, 29.10.2020
https://doi.org/10.21673/anadoluklin.687259

Abstract

Amaç: Endoskopinin yaygın kullanımı, gastrik nöroendokrin tümörler (NET) için bildirilen insidans ve prevalansta belirgin bir artışa yol açmıştır. Çalışmamızda bu nadir ve az anlaşılmış tümörleri tek bir merkezden hastalarda incelemek amaçlanmıştır.



Gereç ve Yöntemler
: Ocak 2010—Aralık 2018 döneminde gastrik NET tanısı konarak tedavi edilen hastaların tıbbi kayıtları retrospektif olarak değerlendirildi. Demografik hasta özelliklerine, tanı çalışmalarına, endoskopik ve cerrahi tedavi yöntemlerine, histopatolojik özelliklere ve sonuç parametrelerine dair veriler kaydedildi. Ki-67 proliferasyon indeksi, mitoz oranı, ve de kromogranin A ve sinaptofizin ile immünohistokimyasal boyanma, histopatolojik incelemeyle değerlendirildi.



Bulgular:
Çalışmaya yaş ortalaması 61,7 yıl olan 17 hasta (9 erkek, 8 kadın) dahil edildi. Tümör 9 hastada fundus, 5 hastada antrum, 3 hastada korpus yerleşimliydi. Histopatolojik değerlendirme tanıları, 6 iyi diferansiye tip I NET ve 11 kötü diferansiye tip III NET şeklindeydi. Yedi (%41) hastada (gerektiğinde adjuvan kemoterapiyle beraber) cerrahi, 6 (%35) hastada sadece endoskopik tedavi ve 4 hastada sadece kemoterapi uygulandı. On yedi (%41) hastanın 7’sinde tanı anında uzak metastaz mevcuttu ve karaciğer en sık metastaz görülen organdı.



Tartışma ve Sonuç:
Gastrik NET’ler mitotik aktivite ve Ki-67 indeksine göre üç gruba ayrılmaktadır. Bu ayrım için serum gastrin düzeyi verileri ile endoskopik ve radyolojik çalışmalar gereklidir. Tedavi yaklaşımı hastalığın tipine ve evresine göre değişir.

References

  • 1. Modlin IM, Shapiro MD, Kidd M. Siegfried Oberndorfer: origins and perspectives of carcinoid tumors. Hum Pathol. 2004;35(12):1440–51.
  • 2. Rindi G, Arnold R, Bosman FT, Capella C, Klimstra DS, Klöppel G, et al. Nomenclature and classification of neuroendocrine neoplasms of the digestive system. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (ed.), WHO Classification of Tumours of the Digestive System. Lyon: IARC; 2010:13–14.
  • 3. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in United States. J Clin Oncol. 2008;26:3063–72.
  • 4. Mougey AM, Adler DG. Neuroendocrine tumors: review and clinical update. Hosp Physician. 2007;51:12–20.
  • 5. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97:934–59.
  • 6. Matsubayashi H, Takagaki S, Otsubo T, Iiri T, Kobayashi Y, Yokota T, et al. Advanced gastric glandular-endocrine cell carcinoma with 1-year survival after gastrectomy. Gastric Cancer. 2000;3:226–33.
  • 7. La Rosa S, Inzani F, Vanoli A, Klersy C, Dainese L, Rindi G, et al. Histologic characterization and improved prognostic evaluation of 209 gastric neuroendocrine neoplasms. Hum Pathol. 2011;42:1373–84.
  • 8. Massironi S, Sciola V, Spampatti MP, Peracchi M, Conte D. Gastric carcinoids: between underestimation and overtreatment. World J Gastroenterol. 2009;15:2177–83.
  • 9. Maggard MA, O’Connell JB, Ko CY. Updated population-based review of carcinoid tumors. Ann Surg. 2004;240:117–22.
  • 10. Basuroy R, Srirajaskanthan R, Prachalias A, Quaglia A, Ramage JK. Review article: the investigation and management of gastric neuroendocrine tumours. Aliment Pharmacol Ther. 2014;39(10):1071–84.
  • 11. Merola E, Sbrozzi-Vanni A, Panzuto F, D’Ambra G, Di Giulio E, Pilozzi E, et al. Type I gastric carcinoids: a prospective study on endoscopic management and recurrence rate. Neuroendocrinology. 2012;95(3):207–13.
  • 12. Delle Fave G, Kwekkeboom DJ, van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, et al. ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology. 2012;95(2):74–87.
  • 13. Hosokawa O, Kaizaki Y, Hattori M, Douden K, Hayashi H, Morishita M, et al. Long-term follow up of patients with multiple gastric carcinoids associated with type A gastritis. Gastric Cancer. 2005;8(1):42–6.
  • 14. Sato Y, Imamura H, Kaizaki Y, Koizumi W, Ishido K, Kurahara K, et al. Management and clinical outcomes of type I gastric carcinoid patients: retrospective, multicenter study in Japan. Dig Endosc. 2014;26(3):377–84.
  • 15. Ravizza D, Fiori G, Trovato C, Fazio N, Bonomo G, Luca F, et al. Long-term endoscopic and clinical follow-up of untreated type 1 gastric neuroendocrine tumours. Dig Liver Dis. 2007;39(6):537–43.
  • 16. Ozao-Choy J, Buch K, Strauchen JA, Warner RR, Divino CM. Laparoscopic antrectomy for the treatment of type I gastric carcinoid tumors. J Surg Res. 2010;162(1):22–5.
  • 17. Gladdy RA, Strong VE, Coit D, Allen PJ, Gerdes H, Shia J, et al. Defining surgical indications for type I gastric carcinoid tumor. Ann Surg Oncol. 2009;16:3154–60.
  • 18. Nikou GC, Toubanakis C, Nikolaou P, Giannatou E, Marinou K, Safioleas M, et al. Gastrinomas associated with MEN-1 syndrome: new insights for the diagnosis and management in a series of 11 patients. Hepatogastroenterology. 2005;52(66):1668–76.
  • 19. Pavel M, Baudin E, Couvelard A, Krenning E, Öberg K, Steinmüller T, et al. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2012;95(2):157–76.
  • 20. Vogl TJ, Naguib NN, Zangos S, Eichler K, Hedayati A, Nour-Eldin NE. Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation. Eur J Radiol. 2009;72:517–28.
  • 21. Wolin EM. The expanding role of somatostatin analogues in the management of neuroendocrine tumors. Gastrointest Cancer Res. 2012;5(5):161–8.
There are 21 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORIGINAL ARTICLE
Authors

Mehmet Fatih Daşıran 0000-0003-1358-0158

Ahmet Akbaş 0000-0002-6333-4919

Publication Date October 29, 2020
Acceptance Date May 20, 2020
Published in Issue Year 2020 Volume: 25 Issue: 3

Cite

Vancouver Daşıran MF, Akbaş A. Management of Gastric Neuroendocrine Tumors. Anatolian Clin. 2020;25(3):187-91.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.