THE GASTROINTESTINAL NEUROENDOCRIN TUMORS

Objectives. The gastrointestinal neuroendocrin tumors are rare events with clinical presentation widely variable and surgical management that is often challenging. Material and methods. We performed a retrospective study in the First Surgical Clinic, St Spiridon University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania, in the 2005-2019 period, which included all the patients diagnosed with gastrointestinal neuroendocrin tumors by immunehistochemistry. Results. There were 37 cases diagnosed with gastrointestinal neuroendocrin tumors. The ratio male/female was 15/22 and mean age was de 42±4.365 years old (range 27-79 years). The gastrointestinal neuroendocrin tumors were: 13 – gastric, one – duodenal, 10 cases – small intestine, 10 cases – appendicular, 7 cases – large intestine and hepatic metastases – 4 cases. The carcinoid syndrome was present in 7 cases. The biological diagnosis included biological markers (e.g. serotonine, 5-HIAA). Diagnosis of the tumor site and dimension was done by ultrasound exam, Computed Tomography scan, Positron Emission Tomography scan, Octreoscan and intraoperative ultrasonography. Surgical procedures for gastric neuroendocrin tumors were: wedge tumor resection – one case; subtotal gastrectomy – one case, total gastrectomies – 3 cases. For neuroendocrin tumors of small bowel we performed 6 enterectomies and 4 ileocolectomies with lymphadenectomy. We also performed 7 appendectomies and 3 right colectomies for appendicular carcinoids. We performed 4 right colectomies, 2 left colectomies and one low anterior resection of the rectum for colorectal neuroendocrin tumors. For neuroendocrin tumors with hepatic metastases disease we performed one hepatectomy and 3 termoablations. Conclusions. The gastrointestinal neuroendocrin tumors are rare tumors, and their management is always challenging. Immunohistochemistry is mandatory for confirmation, appreciation of the proliferation and biological behavior, and permissible to use specific therapy. Aggressive surgical treatment is indicated, even in advanced stages. The treatment in patients with advanced gastrointestinal neuroendocrin tumors with metastatic disease include chemotherapy, biological therapies, and peptide receptor radionuclide therapy

THE GASTROINTESTINAL NEUROENDOCRIN TUMORS

Objectives. The gastrointestinal neuroendocrin tumors are rare events with clinical presentation widely variable and surgical management that is often challenging. Material and methods. We performed a retrospective study in the First Surgical Clinic, St Spiridon University Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania, in the 2005-2019 period, which included all the patients diagnosed with gastrointestinal neuroendocrin tumors by immunehistochemistry. Results. There were 37 cases diagnosed with gastrointestinal neuroendocrin tumors. The ratio male/female was 15/22 and mean age was de 42±4.365 years old (range 27-79 years). The gastrointestinal neuroendocrin tumors were: 13 – gastric, one – duodenal, 10 cases – small intestine, 10 cases – appendicular, 7 cases – large intestine and hepatic metastases – 4 cases. The carcinoid syndrome was present in 7 cases. The biological diagnosis included biological markers (e.g. serotonine, 5-HIAA). Diagnosis of the tumor site and dimension was done by ultrasound exam, Computed Tomography scan, Positron Emission Tomography scan, Octreoscan and intraoperative ultrasonography. Surgical procedures for gastric neuroendocrin tumors were: wedge tumor resection – one case; subtotal gastrectomy – one case, total gastrectomies – 3 cases. For neuroendocrin tumors of small bowel we performed 6 enterectomies and 4 ileocolectomies with lymphadenectomy. We also performed 7 appendectomies and 3 right colectomies for appendicular carcinoids. We performed 4 right colectomies, 2 left colectomies and one low anterior resection of the rectum for colorectal neuroendocrin tumors. For neuroendocrin tumors with hepatic metastases disease we performed one hepatectomy and 3 termoablations. Conclusions. The gastrointestinal neuroendocrin tumors are rare tumors, and their management is always challenging. Immunohistochemistry is mandatory for confirmation, appreciation of the proliferation and biological behavior, and permissible to use specific therapy. Aggressive surgical treatment is indicated, even in advanced stages. The treatment in patients with advanced gastrointestinal neuroendocrin tumors with metastatic disease include chemotherapy, biological therapies, and peptide receptor radionuclide therapy

Improved personalised neuroendocrine tumours’ diagnosis predictive power by new receptor somatostatin image processing quantification

Although neuroendocrine tumours (NETs) are intensively studied, their diagnosis and consequently personalised therapy management is still puzzling due to their tumoral heterogeneity. In their theragnosis algorithm, receptor somatostatin scintigraphy takes the central place, the diagnosis receptor somatostatin analogue (RSA) choice depending on laboratory experience and accessibility. However, in all cases, the results depend decisively on correct radiotracer tumoral uptake quantification, where unfortunately there are still unrevealed clues and lack of standardization. We propose an improved method to quantify the biodistribution of gamma-emitting RSA, using tissular corrected uptake indices. We conducted a bi-centric retrospective study on 101 patients with different types of NETs. Three uptake indices obtained after applying new corrections to areas of interest drawn for the tumour and for three reference organs (liver, spleen and lung) were statistically analysed. For the corrected pathological uptake indices, the results showed a significant decrease in the error of estimating the occurrence of errors and an increase in the diagnostic predictive power for NETs, especially in the case of lung-referring corrected index. In conclusion, these results support the importance of corrected uptake indices use in the analysis of99m TcRSA biodistribution for a better personalised diagnostic accuracy of NETs patients