A well differentiated neuroendocrine tumor of the jejunum with peritoneal carcinomatosis: A case report

Antoniadou,Foteini; Korkolis,Dimitrios; Koufopoulos,Nektarios; Manatakis,Dimitrios; Sakellariou,Stratigoula

doi:10.3892/mco.2018.1734

A well differentiated neuroendocrine tumor of the jejunum with peritoneal carcinomatosis: A case report

Authors:
- Foteini Antoniadou
- Dimitrios Korkolis
- Nektarios Koufopoulos
- Dimitrios Manatakis
- Stratigoula Sakellariou
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Affiliations: Department of Pathology, Saint Savvas Cancer Hospital of Athens, 11522 Athens, Greece, First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
Published online on: October 4, 2018 https://doi.org/10.3892/mco.2018.1734
Pages: 651-655

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Abstract

Neuroendocrine tumors (NETs), belong to a group of neoplasms that arise from neuroendocrine cells and express markers such as synaptophysin and chromogranin A. The digestive system (DS) is the most common site of NET development. The World Health Organization classification divides NETs into low grade (G1-G2) tumors (NETs) and high grade carcinomas [neuroendocrine carcinomas (NECs)], based on mitotic index and histological criteria. NET prognosis depends on tumor stage and grade. Low grade G1 NETs are characterized by a low proliferative rate and an indolent clinical course with a 5-year survival rate ranging between 38% (pancreas) and 88% (rectum). The present study reports a case of a low grade (G1) multifocal jejunal tumor with histologically confirmed features of aggressiveness, namely peritoneal carcinomatosis, lymph node metastasis and vascular carcinomatous emboli. Prediction of clinical behavior and survival in such a case is challenging. Although multiplicity and nodal metastases is not unusual for low grade NETs in this part of the gastrointestinal tract, peritoneal carcinomatosis is an extremely rare finding. Surgeons and histopathologists should be familiar with such eventualities and tumor boards are required in order to conclude whether aggressive therapeutic interventions may have any impact on patients' long term survival.

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1	Rehfeld JF: The new biology of gastrointestinal hormones. Physiol Rev. 78:1087–108. 1998. View Article : Google Scholar : PubMed/NCBI
2	Hauso O, Gustafsson B, Kidd M, Waldum H, Drozdov I, Chan A and Modlin I: Neuroendocrine tumour epidemiology. Cancer. 113:2655–2664. 2008. View Article : Google Scholar : PubMed/NCBI
3	Rindi G, Petrone G and Inzani F: The 2010 WHO classification of digestive neuroendocrine neoplasms: a critical appraisal four years after its introduction. Endocr Pathol. 25:186–192. 2014. View Article : Google Scholar : PubMed/NCBI
4	Rindi G, Arnoid R, Bosman FT, Capella C, Klimstra DS, Kloppel G, Komminorth P and Solcia E: Nomeclature and classification of the neuroendocrine neoplasms of the digestive system. In: WHO Classification of Tumours of the Digestive System. 4th. IARC Press; Lyon, France: pp. 13–14. 2010
5	Yamaguchi T, Fujimori T, Tomita S, Ichikawa K, Mitomi H, Ohno K, Shida Y and Kato H: Clinical validation of the gastrointestinal NET grading system: Ki67 index criteria of the WHO 2010 classification is appropriate to predict metastasis or recurrence. Diagn Pathol. 8(65)2013.
6	Karakuş E, Helvacı A, Ekinci O and and Dursun A: Comparison of WHO 2000 and WHO 2010 classifications of gastroenteropancreatic neuroendocrine tumours. Turk J Gastroenterol. 25:81–87. 2014. View Article : Google Scholar
7	Celotti A, Pulcini G, Schieppati M, Ministrini S, Berruti A and and Ronconi M: An unususal case of a well-differentiated neuroendocrine tumor of the ileum with peritoneal carcinomatosis : A case report. World J Surg Oncol. 13:1353–1361. 2015. View Article : Google Scholar
8	Langley K: The neuroendocrine consept today. Ann NY Acad Sci. 733:1–17. 1994. View Article : Google Scholar : PubMed/NCBI
9	Warner RR: Enteroendocrine tumors other than carcinoid. A review of clinically significant advances. Gastroenterology. 128:1668–1684. 2005. View Article : Google Scholar : PubMed/NCBI
10	Uberg K: Carcinoid tumors: Current concepts in diagnosis and treatment. The Oncologist. 3:339–45. 1998.PubMed/NCBI
11	Griniatsos J and Michail O: Appendiceal neuroendocrine tumors. Resent insights and clinical implications. World J Gastrointest Oncol. 2:192–96. 2010. View Article : Google Scholar : PubMed/NCBI
12	Ni S and Sheng W, Du X and Sheng W: Pathologic research update of colorectal neuroendocrine tumors. World J Gastroenterol. 16:1713–19. 2010. View Article : Google Scholar : PubMed/NCBI
13	Konishi T, Watahabe T, Nagawa H, Oya H, Ueno M, Kuroyanagi H, Fujimoto Y, Akiyoshi T, Yamaguchi T and Muto T: Treatment of colorectal carcinoids. A new paradigm. World J Gastrointest Surg. 2:153–56. 2010. View Article : Google Scholar : PubMed/NCBI
14	Begum N, Maasberg S, Plockinger U, Anlauf M, Rinke A, Popperl G, Lehnert H, Izbicki HR, Krausch M, Vashist YK, et al: Zentralbl Chir. 139:276–283. 2014.PubMed/NCBI
15	Modlin I. M, Shapiro MD and Kidd M: Signified Oberdorfer. Origins and perspectives of carcinoid tumors. Human Pathology. 35:1440–51. 2004. View Article : Google Scholar : PubMed/NCBI
16	Krols LK: Carcinoid tumors and the carcinoid syndrome. What is new in therapeutic pipeline. The carcinoid cancer foundation: carcinoid symposium 2002. http://www.carcinoid.orgJuly 8–2017
17	Oberg K: The genetics of neuroendocrine tumors. Semin Oncol. 40:37–44. 2013. View Article : Google Scholar : PubMed/NCBI
18	Kaltsas G, Besser M and Grossman A: The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev. 25:458–511. 2004. View Article : Google Scholar : PubMed/NCBI
19	Jamalli M and Chetty R: Predicting prognosis on gastroentero-pancreatic neuroendocrine tumors. An overview and the value of Ki 67 immunostaining. Endocr Pathol. 19:282–288. 2008. View Article : Google Scholar : PubMed/NCBI
20	Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey JN, Rashid A, et al: One hundred years after ‘carcinoid’. Epidemiology of and prognostic factors for neuroendocrine tumors in 38,525 cases in the United States. J Clin Oncol. 26:3063–3072. 2008. View Article : Google Scholar : PubMed/NCBI
21	Well-Differentiated Neuroendocrine Tumours of the Gastrointestinal Tract. Union for International Cancer Control (UICC). TNM Classification of Malignant Tumours. 8th. Wiley-Blackwell; Hoboken, NJ: pp. 96–99. 2017
22	Khan MS, Kirkwood A, Tsigani T, Garcia-Hernnandez I, Hartley JA, Caplin ME and Meyer T: Circulating tumor cells as prognostic markers in neuroendocrine tumors. J Clin Oncol. 31:365–372. 2013. View Article : Google Scholar : PubMed/NCBI
23	Mei D, Alexandria T and James C: New strategies for advanced neuroendocrine tumors. CCR. 18:1830–37. 2012.
24	Burke AP, Thomas RM, Elsayed AM and Sobin H: Carcinoids of jejunum and ileum. Cancer. 79:1086–93. 1997. View Article : Google Scholar : PubMed/NCBI
25	Yantiss RK, Odze RD, Farraye FA and Rosenberg AE: Solitary versus multiple carcinoid tumors. A clinical and pathologic review of 68 cases. Am J Surg Pathol. 27:811–817. 2003. View Article : Google Scholar : PubMed/NCBI
26	Jann H, Roll S, Couverald A, Hentic O, Pavel M, Muller-Nordhorn J, Koch M, Rocken C, Rindi G, Ruszniewski P, et al: Neuroendocrine tumors of midgut- hindgut origin. Tumor-node-metastasis classification determines clinical outcome. Cancer. 117:3332–3341. 2011. View Article : Google Scholar : PubMed/NCBI
27	Shi Ch, Adsay V, Bergsland EM, Berlin J, Branton PA, Fitzgibbons PL, Frankel WL, Kakar S, Klepeis V, Klimstra DS, et al: Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Jejunum and Ileum. Version: Jejunum/Ileum NET 1.0.0.0. Cancer protocol templates. College of American Pathologists (CAP), 2017. http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-jejunal-Ileal-net-17protocol-1000.pdfJuly 8–2017