Management of Gastric Neuroendocrine Tumors

Yıl 2020, Cilt: 25 Sayı: 3, 187 - 191, 29.10.2020

Mehmet Fatih Daşıran Ahmet Akbaş

https://doi.org/10.21673/anadoluklin.687259

Öz

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.

Anahtar Kelimeler

Neuroendocrine tumor, endoscopy, Ki-67 index, gastrin

Gastrik Nöroendokrin Tümörlerin Yönetimi

Öz

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.

Anahtar Kelimeler

Nöroendokrin tümör, endoskopi, Ki-67 indeksi, gastrin

Kaynakça

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