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Neuroendocrine tumors.

December 2012 - January 2013


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TÍTULO / TITLE:  - Prognostic validity of the american joint committee on cancer staging classification for midgut neuroendocrine tumors.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Clin Oncol. 2013 Feb 1;31(4):420-5. doi: 10.1200/JCO.2012.44.5924. Epub 2012 Dec 17.

            ●● Enlace al texto completo (gratuito o de pago) 1200/JCO.2012.44.5924

AUTORES / AUTHORS:  - Strosberg JR; Weber JM; Feldman M; Coppola D; Meredith K; Kvols LK

INSTITUCIÓN / INSTITUTION:  - Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Faculty Office Bldg, 2nd Floor, Tampa, FL 33612; jonathan.strosberg@moffitt.org.

RESUMEN / SUMMARY:  - PURPOSE The American Joint Committee on Cancer (AJCC) staging manual has introduced a TNM staging classification for jejunal-ileal (midgut) neuroendocrine tumors (NETs). This classification has not been validated in a population consisting solely of midgut NETs. The purpose of this study was to test the prognostic validity of the classification in such a population. METHODS Patients  with jejunal and ileocecal NETs who were treated at the Moffitt Cancer Center between 2000 and 2010 were assigned stages (I through IV). Kaplan-Meier analyses  for overall survival (OS) were performed on the basis of TNM stage and pathologic grade. Multivariate modeling was performed using Cox proportional hazards regression. Results We identified 691 patients with jejunal-ileocecal NETs. The AJCC classification in aggregate was highly prognostic for OS (P < .001). Five-year OS rates for stages I through IV were 100%, 100%, 91%, and 72%, respectively. The survival difference between stages III and IV was significant (P < .001); the difference between stages I/II versus III was not statistically significant (P = .1). Among patients with stage IIIB tumors, 5-year survival rates were 95% for resectable tumors versus 78% for unresectable mesenteric tumors (P = .02). A proliferative threshold of five mitoses per 10 high-power fields (HPF) was of greater prognostic value than a threshold of two mitoses per  10 HPF for discriminating between low- and intermediate-grade tumors. CONCLUSION  Stage I and II midgut NETs are associated with identical survival rates. Stage IIIB tumors are heterogeneous, with significant differences in survival observed  between resectable mesenteric lymph nodes versus unresectable masses in the root  of the mesentery. A higher mitotic cutoff of five per 10 HPF may lead to improved prognostic differentiation between low- and intermediate-grade tumors. Revisions  to the current AJCC staging and grading classification may be warranted.




TÍTULO / TITLE:  - Regression and local control rates after radiotherapy for jugulotympanic paragangliomas: Systematic review and meta-analysis.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Radiother Oncol. 2013 Jan 15. pii: S0167-8140(12)00492-6. doi: 10.1016/j.radonc.2012.11.002.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.radonc.2012.11.002

AUTORES / AUTHORS:  - van Hulsteijn LT; Corssmit EP; Coremans IE; Smit JW; Jansen JC; Dekkers OM

INSTITUCIÓN / INSTITUTION:  - Leiden University Medical Center, Leiden, The Netherlands. Electronic address: Leonie.T.van_Hulsteijn@lumc.nl.

RESUMEN / SUMMARY:  - The primary treatment goal of radiotherapy for paragangliomas of the head and neck region (HNPGLs) is local control of the tumor, i.e. stabilization of tumor volume. Interestingly, regression of tumor volume has also been reported. Up to the present, no meta-analysis has been performed giving an overview of regression rates after radiotherapy in HNPGLs. The main objective was to perform a systematic review and meta-analysis to assess regression of tumor volume in HNPGL-patients after radiotherapy. A second outcome was local tumor control. Design of the study is systematic review and meta-analysis. PubMed, EMBASE, Web of Science, COCHRANE and Academic Search Premier and references of key articles were searched in March 2012 to identify potentially relevant studies. Considering the indolent course of HNPGLs, only studies with 12months follow-up were eligible. Main outcomes were the pooled proportions of regression and local control after radiotherapy as initial, combined (i.e. directly post-operatively or post-embolization) or salvage treatment (i.e. after initial treatment has failed) for HNPGLs. A meta-analysis was performed with an exact likelihood approach using a logistic regression with a random effect at the study level. Pooled proportions with 95% confidence intervals (CI) were reported. Fifteen studies were included, concerning a total of 283 jugulotympanic HNPGLs in 276 patients. Pooled regression proportions for initial, combined and salvage treatment were respectively 21%, 33% and 52% in radiosurgery studies and 4%, 0% and 64% in external beam radiotherapy studies. Pooled local control proportions for radiotherapy as initial, combined and salvage treatment ranged from 79% to 100%. Radiotherapy for jugulotympanic paragangliomas results in excellent local tumor control and therefore is a valuable treatment for these types of tumors. The effects of radiotherapy on regression of tumor volume remain ambiguous, although the data suggest that regression can be achieved at least in some patients. More research is needed to identify predictors for treatment success.




TÍTULO / TITLE:  - Treatment of multiple endocrine neoplasia ½ tumors: case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Oncology. 2013;84(3):127-34. doi: 10.1159/000342961. Epub 2012 Dec 8.

            ●● Enlace al texto completo (gratuito o de pago) 1159/000342961

AUTORES / AUTHORS:  - Gulati AP; Krantz B; Moss RA; Moyal WN; Tsushima DA; Mowatt KB; Schreibman S; Fine RL

INSTITUCIÓN / INSTITUTION:  - Experimental Therapeutics Program, Division of Medical Oncology, New York Presbyterian-Columbia University Medical Center, New York, N.Y., USA.

RESUMEN / SUMMARY:  - Background: Neuroendocrine tumors are uncommon tumors that are histopathologically and biologically heterogeneous and include the multiple endocrine neoplasia (MEN) 1 and 2 syndromes. The morbidity of MEN-1 and MEN-2 is  often due to the symptomatology of the endocrine hormones produced, and the mortality mainly occurs from hepatic dysfunction incurred by liver metastases. At present, there is essentially no effective cure once the tumor has metastasized to the liver. Patient: We present a patient with progressive, metastatic MEN-1 with the classic ‘3 P’s’ triad of neuroendocrine tumor of the pancreas, parathyroid adenoma and a pituitary adenoma. Results: After progression on high-dose Sandostatin LAR (60 mg/month) and multiple surgeries, the patient had a partial response (40% decrease) to a novel regimen of capecitabine and temozolomide (CAPTEM) and progression-free survival of 18 months. He had minor grade 1 toxicities and no grade 2, 3 or 4 toxicities. Discussion: The history and treatment options for MEN-1/2 cancers are reviewed, as well as the data behind our novel regimen, CAPTEM. Conclusion: The CAPTEM regimen is a tolerable, safe, easy to administer oral regimen with possible efficacy for MEN-1 tumors.




TÍTULO / TITLE:  - Systemic Treatment in Unresectable Metastatic Well-Differentiated Carcinoid Tumors: Consensus Results From a Modified Delphi Process.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Pancreas. 2012 Dec 1.

            ●● Enlace al texto completo (gratuito o de pago) 1097/MPA.0b013e31826d3a17

AUTORES / AUTHORS:  - Strosberg JR; Fisher GA; Benson AB; Malin JL; Cherepanov D; Broder MS

INSTITUCIÓN / INSTITUTION:  - From the *Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; daggerDivision of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, CA; double daggerRobert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; section signDavid Geffen School of Medicine, University of California, Los Angeles; and parallelPartnership for Health Analytic Research, LLC, Beverly Hills, CA.

RESUMEN / SUMMARY:  - OBJECTIVES: This study aimed to develop expert consensus for the use of systemic  treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid  tumors using the RAND/UCLA modified Delphi process. METHODS: After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence. RESULTS: Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2)  In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids. CONCLUSIONS: The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the  appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.




TÍTULO / TITLE:  - Single photon emission computed tomography/computed tomography in the evaluation  of neuroendocrine tumours: a review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Nucl Med Commun. 2013 Feb;34(2):98-107. doi: 10.1097/MNM.0b013e32835bd59d.

            ●● Enlace al texto completo (gratuito o de pago) 1097/MNM.0b013e32835bd59d

AUTORES / AUTHORS:  - Lu SJ; Gnanasegaran G; Buscombe J; Navalkissoor S

INSTITUCIÓN / INSTITUTION:  - Department of Nuclear Medicine, Guy’s and St Thomas’ Hospital NHS Foundation Trust, Lambeth Palace Road, London SE1 7 EH, UK. suat_jin_lu@yahoo.com

RESUMEN / SUMMARY:  - The scintigraphic investigation of neuroendocrine tumours such as carcinoids has  depended on standard techniques such as I-metaiodobenzylguanidine and In-pentetreotide imaging. More recently, the use of PET techniques such as Ga-DOTATATE has been advocated. An alternative improved modality is high-quality  single photon emission computed tomography/computed tomography (SPECT/CT), which  has the advantages of better sensitivity and specificity and has shown improved localization in up to 60% of cases. These advantages are especially true for pancreatic and lymph node lesions. Overall, SPECT/CT can result in a change in clinical management in 25% of patients. Although it is possible to combine SPECT  and CT performed at different time points, there is better anatomical localization and improved reporter confidence when SPECT and CT are performed simultaneously.




TÍTULO / TITLE:  - Neurofibromatosis type 1, gastrointestinal stromal tumor, leiomyosarcoma and osteosarcoma: Four cases of rare tumors and a review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Crit Rev Oncol Hematol. 2012 Dec 3. pii: S1040-8428(12)00214-4. doi: 10.1016/j.critrevonc.2012.11.001.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.critrevonc.2012.11.001

AUTORES / AUTHORS:  - Afsar CU; Kara IO; Kozat BK; Demiryurek H; Duman BB; Doran F

INSTITUCIÓN / INSTITUTION:  - Cukurova University Medical Faculty, Department of Medical Oncology, Adana, Turkey. Electronic address: cigdemusul@yahoo.com.

RESUMEN / SUMMARY:  - BACKGROUND: Neurofibromatosis type 1 (NF1) is a genetic syndrome that predisposes patients to benign and malignant tumor development. Patients with NF1 develop multiple neurofibromas that can transform into aggressive sarcomas known as malignant peripheral nerve sheath tumors. In contrast, malignant tumors unrelated to the nervous system rarely coexist with neurofibromatosis. The aim of this article was to present four cases of adult NF1 patients with malignant tumors unrelated to the nervous system as well as a bibliographic search for papers describing these tumors in NF1, focusing on osteosarcomas, gastrointestinal stromal tumors (GISTs), leiomyosarcomas and somatostatinomas and their genetic alterations in NF1. METHODS: Search engines such as PubMed and MEDLINE were browsed for English-language articles since 1989 using a list of keywords, as well as references from review articles. Search terms were NF1, osteosarcoma, leiomyosarcoma, somatostatinoma and GIST. Data were summarized in a table at the  end of the Results section. RESULTS: In our four NF1 cases, there were one osteosarcoma, one leiomyosarcoma, one somatostatinoma and GIST and one GIST. NF1  was diagnosed at an adult age when these patients were admitted to our oncology department. The results generated by the literature search yielded 75 articles about NF and GIST. We summarized the clinical characteristics of 43 patients with NF1 and somatostatinoma. Forty-five articles involving NF and osteosarcoma were found, and of these, 26 involved NF1; from these articles, we identified the clinical features of 8 patients. Twenty-five articles were found concerning NF1 and leiomyosarcoma, and of those, we summarized the clinical features of 15 patients. CONCLUSIONS: Here we reviewed somatostatinomas, GISTs, osteosarcomas and leiomyosarcomas occurring in NF1 patients. Patients with NF1 who present with gastrointestinal symptoms, should be carefully evaluated carefully with a high index of suspicion of potential GISTs, periampullary and duodenal tumors. Patients with pathological fractures or bone pain along with NF1 should be carefully screened for malignant bone tumors. Patients with NF1 can develop leiomyosarcoma less frequently than other malignancies, but the association of uterine leiomyoma and NF1 may not be fortuitous. Somatic mutations were defined for frequent tumors, including neurogenic tumors and GISTs but not for sarcomas due to the complexity of underlying mechanisms of the disease and tumorigenesis.  Based on the findings; all NF patients can develop malignant tumors, including the less frequently observed ones. Therefore, we recommend that new genetic studies should be performed for rare malignancies in cases of NF1.




TÍTULO / TITLE:  - Medullary thyroid carcinoma in ethnic Chinese with MEN2A: A case report and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Pediatr Surg. 2013 Jan;48(1):e43-6. doi: 10.1016/j.jpedsurg.2012.10.065.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.jpedsurg.2012.10.065

AUTORES / AUTHORS:  - Sim Y; Yap F; Soo KC; Low Y

INSTITUCIÓN / INSTITUTION:  - Department of Paediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore S229899, Singapore.

RESUMEN / SUMMARY:  - Medullary Thyroid Carcinoma (MTC) is the most common cause of death in MEN patients. It is curative by prophylactic total thyroidectomy, but controversies remain as to the optimal timing for prophylactic thyroidectomy. The current recommendation is for prophylactic total thyroidectomy before age 5, but a recent study suggested that in the ethnic Chinese, even “high risk” mutations did not result in early malignant change, and it was suggested that prophylactic thyroidectomy may be performed at a later age. We report a case of an ethnic Chinese girl with MEN2A codon 634 (C634R) mutation, whose operative specimen at prophylactic thyroidectomy at 4years 8months showed MTC. We advocate that management of MEN2A patients should be codon-directed, regardless of ethnicity.




TÍTULO / TITLE:  - Sonographic appearance of a neuroendocrine tumor arising in the axilla: Case report and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Clin Ultrasound. 2012 Dec 12. doi: 10.1002/jcu.22024.

            ●● Enlace al texto completo (gratuito o de pago) 1002/jcu.22024

AUTORES / AUTHORS:  - Koo HS; Sohn YM; Park YK

INSTITUCIÓN / INSTITUTION:  - Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, South Korea.

RESUMEN / SUMMARY:  - Neuroendocrine tumors (NETs) are tumors that originate from neuroendocrine cells  throughout the body. NETs are most commonly found in the appendix, followed by the rectum, ileum, lungs, and bronchi. NETs arising in soft tissues are rare. Here we describe the sonographic appearance of a NET in the axilla. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012.





TÍTULO / TITLE:L’octreotide intraveineux en mega-dose pour le traitement d’une crise carcinoide: une revue methodique.

TÍTULO / TITLE:  - Mega-dose intravenous octreotide for the treatment of carcinoid crisis: a systematic review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Can J Anaesth. 2013 Jan 18.

            ●● Enlace al texto completo (gratuito o de pago) 1007/s12630-012-9879-1

AUTORES / AUTHORS:  - Seymour N; Sawh SC

INSTITUCIÓN / INSTITUTION:  - School of Pharmacy, University of Waterloo, 10 Victoria St S, Kitchener, ON, N2G  2B2, Canada.

RESUMEN / SUMMARY:  - PURPOSE: Carcinoid crises are rare life-threatening events involving cardiac instability when carcinoid tumours release vasoactive peptides. Such events can occur in the perioperative setting. Octreotide, a somatostatin analogue, is administered as a bolus dose of 100-500 mug iv or by infusion to treat carcinoid  crises. Due to the apparent low risk-to-benefit profile, a much higher dose is sometimes used in urgent situations. The purpose of this study was to assess the  evidence for administering doses or hourly infusions of octreotide that exceeded  1,500 mug iv to treat carcinoid crises. We also sought to identify which patients may require large doses and to describe the adverse effects of such doses. SOURCE: We systematically searched Medline, EMBASE, and Cochrane databases and hand-searched reference lists of relevant articles in 2006 and again in 2010 and  2011. All study designs were included in our search. Resolution of crisis symptoms was the primary outcome. PRINCIPAL FINDINGS: Eighteen articles were included. No patient died during a carcinoid crisis. A retrospective chart review of 89 patients with carcinoid heart disease reported octreotide doses of 25-54,000 mug to treat carcinoid crises, although neither crisis symptoms nor outcomes were described. CONCLUSION: In the included case reports, carcinoid crises were managed effectively using octreotide 25-500 mug iv. Previous exposure to octreotide and carcinoid heart disease may warrant the need for higher doses.  In addition to the low quality of the articles and the small sample size, inconsistent use of the term “carcinoid crisis” and paucity of reported outcomes  were also limitations of this systematic review. These findings highlight the need for further investigation into dose-response relationships of octreotide for the treatment of carcinoid crisis.




TÍTULO / TITLE:  - Gastric metastasis of merkel cell cancer—uncommon complication of a rare neoplasm.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Ark Med Soc. 2012 Dec;109(7):134-6.

AUTORES / AUTHORS:  - Syal NG; Dang S; Rose J; Chen C; Aduli F

RESUMEN / SUMMARY:  - Merkel cell cancer is an aggressive cutaneous malignancy of neuroendocrine cell lineage which carries a poor prognosis. It usually affects elderly Caucasians and presents as a firm, painless, nodular lesion on the sun exposed areas of the body. Though it is highly metastatic, metastasis to the gastrointestinal tract is rarely reported. We describe a case of gastric metastasis from merkel cell cancer presenting with upper gastrointestinal bleeding. To our knowledge, only 8 such cases have been reported in English literature so far.




TÍTULO / TITLE:  - The rare intracellular RET mutation p.Ser891Ala in an apparently sporadic medullary thyroid carcinoma: a case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Arq Bras Endocrinol Metabol. 2012 Nov;56(8):586-91.

AUTORES / AUTHORS:  - Blom CB; Ceolin L; Romitti M; Siqueira D; Maia AL

INSTITUCIÓN / INSTITUTION:  - Thyroid Section, Endocrine Division, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

RESUMEN / SUMMARY:  - Medullary thyroid carcinoma (MTC) is a malignant tumor originating from parafollicular C-cells and accounts for 4-10% of all thyroid carcinomas. MTC develops in either sporadic (75%) or hereditary form (25%). Mutations in the RET  proto-oncogene are responsible for hereditary MTC and the rate of heritable disease among apparently sporadic MTC (sMTC) cases varies from 6 to 15%. RET genetic testing is now considered fundamental in MTC management but the extent of the molecular analysis required to exclude inherited disease is still controversial. While the screening of all known mutation loci is recommended by some authors, the high costs associated with a full analysis should be also taken into consideration. Here, we illustrate and discuss this controversial issue by reporting a patient who present all characteristic features of sMTC, and in whom  a standard genetic analysis by restriction enzyme restriction excluded hereditary disease. Nevertheless, an extensive molecular analysis that included all codons was prompted by the diagnosis of thyroid neoplasm in a patient’s sister, and identified the rare intracellular RET p.Ser891Ala mutation. Arq Bras Endocrinol Metab. 2012;56(8):586-91.




TÍTULO / TITLE:  - Second-line chemotherapy for refractory small cell neuroendocrine carcinoma of the esophagus that relapsed after complete remission with irinotecan plus cisplatin therapy: Case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Oncol Lett. 2013 Jan;5(1):117-122. Epub 2012 Oct 30.

            ●● Enlace al texto completo (gratuito o de pago) 3892/ol.2012.1008

AUTORES / AUTHORS:  - Funakoshi S; Hashiguchi A; Teramoto K; Miyata N; Kurita S; Adachi M; Hamamoto Y; Higuchi H; Takaishi H; Hibi T

INSTITUCIÓN / INSTITUTION:  - Departments of Gastroenterology, Division of Internal Medicine and.

RESUMEN / SUMMARY:  - Small cell esophageal carcinoma is a type of small cell neuroendocrine carcinoma  (SCNEC). SCNEC follows an aggressive clinical course and has a poor prognosis despite multidisciplinary therapies. A standard therapeutic strategy, including surgery, radiation and first-/second-line chemotherapy, has not yet been established for SCNEC. We present a case of SCNEC of the esophagus. A 66-year-old male with SCNEC as extensive disease was treated with 60 mg/m(2) cisplatin on day 1 plus 60 mg/m(2) irinotecan on days 1, 8 and 15 every 4 weeks (IP) with successful complete remission. After the sixth course of IP, increasing pro-gastrin-releasing peptide (ProGRP) and nonspecific enolase (NSE) levels and intense fluorodeoxyglucose (FDG) avidity in a lymph node around the celiac artery (SUV(max), 8.3) indicated a refractory relapse of the disease. The patient was treated with three courses of amrubicin (AMR, 35 mg/m(2)) administered intravenously for 3 consecutive days every 3 weeks as a second-line chemotherapy. The ProGRP and NSE levels returned to the normal range 1 month after the initiation of second-line chemotherapy. However, the ProGRP and NSE levels were elevated after the third course of AMR, and PET-CT revealed progressive disease with liver metastasis and extended lymph node metastasis. As the patient remained asymptomatic, paclitaxel (100 mg/m(2)) was started as third-line chemotherapy. Patients with SCNEC of the esophagus with extensive disease should be treated with aggressive chemotherapy rather than surgery or radiation monotherapy. In the present case, tumor markers such as ProGRP and NSE were predictive of relapse and PET-CT was used to detect relapse. Further research is required to identify and exploit promising agents for resistant SCNEC.



TÍTULO / TITLE:  - A case of clinically silent giant right pheochromocytoma and review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Can Urol Assoc J. 2012 Dec;6(6):E267-9. doi: 10.5489/cuaj.11195.

            ●● Enlace al texto completo (gratuito o de pago) 5489/cuaj.11195

AUTORES / AUTHORS:  - Li C; Chen Y; Wang W; Teng L

INSTITUCIÓN / INSTITUTION:  - Department of Urology, The Third Affiliated Hospital, Harbin Medical University,  Harbin City, China.

RESUMEN / SUMMARY:  - Clinically silent giant cystic pheochromocytoma is a rare adrenal disease; complete resection is the only curative treatment. Due to the serious surgical risk, successful resection is very difficult. We report a case of a patient with  giant cystic pheochromocytoma, which was successfully resected. There were no intraoperative and postoperative complications. We analyze and report our experience.



TÍTULO / TITLE:  - Surgical treatment of sporadic pancreatic neuroendocrine tumors: a state of the art review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - ScientificWorldJournal. 2012;2012:357475. doi: 10.1100/2012/357475. Epub 2012 Dec 10.

            ●● Enlace al texto completo (gratuito o de pago) 1100/2012/357475

AUTORES / AUTHORS:  - Haugvik SP; Labori KJ; Edwin B; Mathisen O; Gladhaug IP

INSTITUCIÓN / INSTITUTION:  - Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.

RESUMEN / SUMMARY:  - Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically  diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved  long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term  outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to  what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of  high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor  classification.



TÍTULO / TITLE:  - Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Int J Surg. 2012 Dec 23. pii: S1743-9191(12)00854-0. doi: 10.1016/j.ijsu.2012.12.007.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.ijsu.2012.12.007

AUTORES / AUTHORS:  - Conzo G; Musella M; Corcione F; De Palma M; Ferraro F; Palazzo A; Napolitano S; Milone M; Pasquali D; Sinisi AA; Colantuoni V; Santini L

INSTITUCIÓN / INSTITUTION:  - Department of Anaesthesiology, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Gen. Giordano Orsini 42, 80132  Naples, Italy. Electronic address: giovanni.conzo@unina2.it.

RESUMEN / SUMMARY:  - BACKGROUND: Minimally invasive adrenalectomy for pheochromocytoma (PCC) is a complex surgical procedure especially because of the haemodynamic instability due to the excessive secretion of cathecolamines, which may result in a considerable  risk of conversion and complications. AIM: By a multicentric retrospective study, the authors reported the results of laparoscopic adrenalectomies in patients operated for adrenal pheochromocytomas with the aim of investigating the role of  the laparoscopic approach in managing adrenal disease. METHODS: Sixty patients, preoperatively treated with a selective alpha1-blocker, underwent 61 laparoscopic adrenalectomies for PCC smaller or larger than 6 cm - group A (</=6 cm), group B  (>6 cm). We compared the two groups of patients analyzing haemodynamic instability, operative time, conversion rate, incidence of complications, length  of hospital stay and medium and long-term outcomes. RESULTS: In 23 cases tumor was >6 cm in diameter. Average operative time was 165 min, with a 5% conversion rate. There was no mortality and morbidity rate was 8.3%. Intraoperative hypertensive crises were registered in 15% of patients, whereas 5/60 patients had hypotensive crises. After comparing the two groups of patients, no statistically  significant differences in terms of haemodynamic instability, operative time, conversion rate, morbidity and length of hospital stay were observed. CONCLUSIONS: As a surgical treatment of pheochromocytomas, laparoscopic adrenalectomy is an effective and safe approach, in selected cases even for PCCs  >6 cm in diameter, although patients with such large tumors may have a higher conversion rate and more intraoperative hypertensive crises. Preoperative selective adrenergic blockade does not prevent intraoperative hypertensive crises, but by facilitating the pharmacological management of the perioperative haemodynamic instability, may avoid the onset of major adverse cardiovascular complications.



TÍTULO / TITLE:  - Pure large cell neuroendocrine carcinoma of ovary: a rare clinical entity and review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Case Rep Oncol Med. 2012;2012:120727. doi: 10.1155/2012/120727. Epub 2012 Dec 6.

            ●● Enlace al texto completo (gratuito o de pago) 1155/2012/120727

AUTORES / AUTHORS:  - Shakuntala PN; Uma Devi K; Shobha K; Bafna UD; Geetashree M

INSTITUCIÓN / INSTITUTION:  - Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Mari Gowda Road, Bengaluru 560029, India.

RESUMEN / SUMMARY:  - Large cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare tumor and is now included in the World Health Organization tumor classification. Its prognosis is generally very poor even when the diagnosis is made at an early stage. We report a case of pure large cell neuroendocrine tumour of ovary, appearing 9 months following laparoscopic type I hysterectomy, bilateral pelvic lymph node dissection with ovarian preservation of anatomically normal looking ovaries performed for a cervical biopsy diagnosis of cervical intraepithelial neoplasia grade III with foci of invasion. The rarity lies in the rapid onset (9 months) of a large tumor following conservation of an anatomically normal ovaries. Surgical  debulking and five cycles of chemotherapy (Etoposide and Cisplatin) were administered to the woman. She is on followup with no clinical or radiological evidence of disease recurrence for 6 months.



TÍTULO / TITLE:  - Pancreatic paraganglioma: A case report of CT manifestations and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Quant Imaging Med Surg. 2011 Dec;1(1):41-3. doi: 10.3978/j.issn.2223-4292.2011.08.02.

            ●● Enlace al texto completo (gratuito o de pago) 3978/j.issn.2223-4292.2011.08.02

AUTORES / AUTHORS:  - He J; Zhao F; Li H; Zhou K; Zhu B

INSTITUCIÓN / INSTITUTION:  - Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of  Nanjing University Medical School, Nanjing, China;

RESUMEN / SUMMARY:  - Paragangliomas are rare tumors arising from paraganglia (or chromaffin bodies) within the ganglia of the sympathetic trunk and the ganglia of the celiac, renal, suprarenal, aortic and hypogastric plexuses. These tumors can be widely distributed from skull base to the bottom of pelvis. Paraganglioma originating from pancreas is extremely rare. Here we report a 40-year-old female patient with paraganglioma located in the pancreatic head as a solid, well-demarcated mass with substantial enhancement on contrast-enhanced CT examination. Relevant literatures are also reviewed.



TÍTULO / TITLE:  - Small-cell cancer presenting as a tracheal polyp: a case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Bronchology Interv Pulmonol. 2012 Apr;19(2):132-6. doi: 10.1097/LBR.0b013e31824dd182.

            ●● Enlace al texto completo (gratuito o de pago) 1097/LBR.0b013e31824dd182


INSTITUCIÓN / INSTITUTION:  - Department of Medicine, Division of Pulmonary/Critical Care, SUNY/Upstate Medical University, Syracuse, NY 13210, USA. HeikalM@upstate.edu

RESUMEN / SUMMARY:  - Primary tracheal tumors are rare. Malignant tracheal polyps constitute the majority, with very few case reports of small-cell cancer in the literature. Staging of these tumors follows the lung cancer TNM staging system, with little evidence-based guidance for their management. We report a case of small-cell cancer presenting as a tracheal polyp and review the related literature.



TÍTULO / TITLE:  - Is 68Ga-DOTATATE the answer in lung carcinoid? : Case report and review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Lung India. 2012 Oct;29(4):378-80. doi: 10.4103/0970-2113.102839.

            ●● Enlace al texto completo (gratuito o de pago) 4103/0970-2113.102839

AUTORES / AUTHORS:  - Bhoil A; Mittal BR; Gayana S; Kashyap R; Bhattacharya A; Singh N

INSTITUCIÓN / INSTITUTION:  - Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

RESUMEN / SUMMARY:  - Carcinoid tumors are rich in somatostatin receptors and show high uptake of radiotracer on octreotide scintigraphy. 68Ga-DOTATATE could be of great help at initial staging and during follow-up of these patients. We describe a patient with avid 68Ga-DOTATATE and poor F18-FDG uptake.



TÍTULO / TITLE:  - Postpartum hypercalcemia secondary to a neuroendocrine tumor of pancreas; a case  report and review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Iran J Med Sci. 2011 Sep;36(3):217-21.

AUTORES / AUTHORS:  - Ghazi AA; Boustani I; Amouzegar A; Attarian H; Pourafkari M; Gashti HN; Sabetian T; Tirgari F; Ghazi S; Kovacs K

INSTITUCIÓN / INSTITUTION:  - Research Institute for Endocrine Sciences, Taleghani General Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

RESUMEN / SUMMARY:  - Parathyroid hormone-related protein producing pancreatic neuroendocrine tumors have been infrequently reported. Herein, we report a case of an Iranian woman who had such a tumor during pregnancy, and gave birth to a female neonate with esophago-tracheal fistula and imperforated anus. Hypercalcemia was diagnosed at postpartum because of elevated serum calcium levels in the neonate and neurologic deterioration of the mother. Extensive literature review revealed 42 cases with pancreatic neuroendocrine tumors and hypercalcaemia. The clinical and laboratory  findings of such patients are reviewed in this manuscript.



TÍTULO / TITLE:  - Coexistent extra adrenal pheochromocytoma and extrapulmonary tuberculosis: a case report and review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Clin Diagn Res. 2012 Oct;6(8):1430-2. doi: 10.7860/JCDR/2012/4221.2379.

            ●● Enlace al texto completo (gratuito o de pago) 7860/JCDR/2012/4221.2379

AUTORES / AUTHORS:  - K A; Shankar S V; U G

INSTITUCIÓN / INSTITUTION:  - Assistant Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences . B.G.Nagara, Mandya district. Karnataka-571448, India.

RESUMEN / SUMMARY:  - Tuberculosis is a major cause of morbidity and mortality in the developing countries, accounting for two billion infected cases and 1.7 million deaths which were attributed to it in 2006, as per the WHO. Cancer was the leading cause of death, next only to coronary artery disease, with 11.3 million new cases and 7.9  million deaths in 2007. The combination of these two deadly diseases poses significant diagnostic and therapeutic challenges to the clinicians and the pathologists. The relationship of tuberculosis and malignancy can be viewed in two ways: tuberculosis can be a risk factor for cancer or tuberculosis and malignancy can coexist in the same biopsy or in the same patient. An early and an accurate diagnosis is a must for planning the appropriate management. We are describing a very rare case of coexistent extra adrenal pheochromocytoma and extrapulmonary tuberculosis in a single patient, which was diagnosed by fine needle aspiration cytology, with a brief review of the literature.



TÍTULO / TITLE:  - Giant pancreatic insulinoma. The bigger the worse? Report of two cases and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Int J Surg Case Rep. 2012 Dec 11;4(3):265-268. doi: 10.1016/j.ijscr.2012.11.019.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.ijscr.2012.11.019

AUTORES / AUTHORS:  - Ielpo B; Caruso R; Ferri V; Quijano Y; Duran H; Diaz E; Fabra I; Puga R; Oliva C; Olivares S; Vicente E

INSTITUCIÓN / INSTITUTION:  - Madrid Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, España. Electronic address: ielpo.b@gmail.com.

RESUMEN / SUMMARY:  - INTRODUCTION: Giant pancreatic insulinomas are rare endocrine tumors. We describe 2 cases reviewing the current literature. PRESENTATION OF CASE: We report herein  2 female patients affected by giant insulinomas of 14cm and 6cm, respectively. Symptomatic hypoglycemia episodes occurred during 4 months in first case and 3 years in the second one until diagnosis. Both patients were successfully treated  performing a distal pancreatectomy with splenic preservation in the first case and a Whipple’s procedure in the second one. DISCUSSION: Up to now only 7 cases have been reported previously. Insulinomas larger than 3cm accounts for less than 5% of all. This literature review shows that despite the size hypoglycemic symptoms varies from 1 day to 3 years and only 1 out of 9 cases reported presented lymph nodes metastases. No recurrences have been described. CONCLUSION: One of the cases here described (14cm) is the largest presented in the literature. Despite the size, giant insulinoma is related apparently neither to metastases nor to the recurrences.



TÍTULO / TITLE:  - Nonfunctional neuroendocrine tumor of the pancreas: Case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Int J Surg Case Rep. 2013;4(2):225-8. doi: 10.1016/j.ijscr.2012.10.018. Epub 2012 Nov 9.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.ijscr.2012.10.018

AUTORES / AUTHORS:  - Amador Cano A; Garcia F; Espinoza A; Bezies N; Herrera E; De Leija Portilla J

INSTITUCIÓN / INSTITUTION:  - Digestive and Endocrine Surgery Service, Centro Medico Nacional del Noreste UMAE  25 IMSS, Monterrey, Mexico. Electronic address: ackaos_10@hotmail.com.

RESUMEN / SUMMARY:  - INTRODUCTION: Pancreatic neuroendocrine tumors (PNET) have an incidence of one per 100,000 individuals per year. They represent about 1-2% of all pancreatic tumors. PNETs are a heterogeneous group with various clinical presentations and lineage. Non functional PNET (NF-PNET) are incidentally discovered in most cases. This article presents a review of NF-PNET and the case of a patient with this disease, in addition to its diagnosis, clinical presentation, and treatment. PRESENTATION OF CASE: The patient is a 37-year-old asymptomatic man who was sent  from his reference unit because of a pancreatic tumor that was visualized incidentally during a laparotomy performed three months before due to an acute abdomen secondary to blunt abdominal trauma. A CT scan was requested that showed  a retroperitoneal mass 7.5cmx6.6cmx7cm with infiltration of the duodenal wall. Endoscopy was performed, which reported a duodenal ulcer with nonconclusive histological findings. A percutaneous biopsy was obtained out and a diagnosis of  a neuroendocrine tumor was made. Chemotherapy was started because infiltration of the portomesenteric axis was suspected. The patient presented signs of toxicity during his third cycle and therefore was scheduled for exploratory laparotomy. Pancreatoduodenectomy was performed with a histologic diagnosis of a pancreatic neuroendocrine tumor. DISCUSSION: The presentation of a NF-PNET is nonspecific. They continue to be tumors with a low incidence and few studies directed toward early detection and management have been carried out. Currently, CT scans are the studies most used for detection. CONCLUSION: Surgical treatment is preferred in patients without evidence of unresectability with longer survival. The characteristics of NF-PNETs make their detection difficult and new strategies are needed for early detection and management. New studies in early stages with new cytotoxics or analogs are promising.



TÍTULO / TITLE:  - Merkel cell carcinoma with lymph node metastasis in the absence of a primary site: Case report and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Oncol Lett. 2012 Dec;4(6):1329-1334. Epub 2012 Sep 19.

            ●● Enlace al texto completo (gratuito o de pago) 3892/ol.2012.922


INSTITUCIÓN / INSTITUTION:  - Tianjin University of Traditional Chinese Medicine; ; Tianjin Tasly Co. Ltd.;

RESUMEN / SUMMARY:  - Merkel cell carcinoma (MCC) is a rare malignant skin neoplasm with the potential  for local recurrence, spreading to regional lymph nodes (LNs) and distant metastases. Although it has been identified in various anatomical sites, LN metastatic MCC in the absence of a primary site is extremely rare. The present case reports a 54-year-old male who initially underwent histological examination  of a biopsy specimen from the right inguinal LNs. A diagnosis of metastatic small cell carcinoma was made. Nine months later, this diagnosis was changed to MCC with multiple metastases following observation of a tumour mass in the right dorsal thigh. Additionally, in the present study a summary is provided of 23 published cases of MCC with initial LN metastasis in the absence of a primary site, with details of clinical characteristics, natural history and pertinent therapy of this uncommon tumour. The present patient with LN metastatic MCC in the absence of a primary site and the other reported cases demonstrate that although multimodal treatment with surgery, radiotherapy (RT) and chemotherapy provides excellent local control, local recurrence and distant metastases commonly develop in this uncommon tumour. LN metastatic MCC in the absence of a primary site is a highly malignant disease and the role of adjuvant postoperative RT and/or chemotherapy remains to be fully determined.



TÍTULO / TITLE:  - Current state of knowledge on neuroendocrine small bowel tumours: non-systematic  review of the literature based on one case.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - British Medical J (BMJ). Acceso gratuito al texto completo.

            ●● Enlace a la Editora de la Revista http://bmj.com/search.dtl 

            ●● Cita: British Medical J. (BMJ): <> Case Rep. 2013 Jan 17;2013. pii: bcr2012007217. doi: 10.1136/bcr-2012-007217.

            ●● Enlace al texto completo (gratuito o de pago) 1136/bcr-2012-007217

AUTORES / AUTHORS:  - Simion NI; Muntean V; Fabian O

INSTITUCIÓN / INSTITUTION:  - CHUV University Medical Center, Emergency Department, Lausanne, Switzerland.

RESUMEN / SUMMARY:  - More than 60% of neuroendocrine tumours, also called carcinoids, are localised within the gastrointestinal tract. Small bowel neuroendocrine tumours have been diagnosed with increasing frequency over the past 35 years, being the second most frequent tumours of the small intestine. Ileal neuroendocrine tumours diagnosis is late because patients have non-specific symptoms. We have proposed to illustrate as an example the case of a patient, and on its basis, to make a brief review of the literature on small bowel neuroendocrine tumours, resuming several  recent changes in the field, concerning classification criteria of these tumours  and new recommendations and current advances in diagnosis and treatment. This patient came to our emergency department with a complete bowel obstruction, along with a 2-year history of peristaltic abdominal pain, vomits and diarrhoea episodes. During emergency laparotomy, an ileal stricture was observed, that showed to be a neuroendocrine tumour of the small bowel.



TÍTULO / TITLE:  - A review of radiotherapy for merkel cell carcinoma of the head and neck.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - J Skin Cancer. 2012;2012:563829. doi: 10.1155/2012/563829. Epub 2012 Nov 20.

            ●● Enlace al texto completo (gratuito o de pago) 1155/2012/563829

AUTORES / AUTHORS:  - Lee J; Poon I; Balogh J; Tsao M; Barnes E

INSTITUCIÓN / INSTITUTION:  - Odette Cancer Centre, Sunnybrook Health Sciences Centre, Department of Radiation  Oncology, University of Toronto, Toronto, ON, Canada.

RESUMEN / SUMMARY:  - Merkel cell carcinoma of the head and neck (MCCHN) presents a clinical challenge  due to its aggressive natural history, unpredictable lymphatic drainage, and high degree of treatment related morbidity. Histological examination of the regional lymph nodes is very important in determining the optimal treatment and is usually achieved by sentinel lymph node biopsy. Radiotherapy plays a critical role in the treatment of most patients with MCCHN. Surgery with adjuvant radiotherapy to the  primary tumour site is associated with high local control rates. If lymph nodes are clinically or microscopically positive, adjuvant radiotherapy is indicated to decrease the risk of regional recurrence. The majority of locoregional recurrences occur at the edge or just outside of the radiation field, reflecting  both the inherent radiosensitivity of MCC and the importance of relatively large  volumes to include “in-transit” dermal lymphatic pathways. When surgical excision of the primary or nodal disease is not feasible, primary radiotherapy alone should be considered as a potentially curative modality and confers good loco-regional control. Concurrent chemoradiotherapy is well tolerated and may further improve outcomes.



TÍTULO / TITLE:  - Current concepts on gastric carcinoid tumors.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Gastroenterol Res Pract. 2012;2012:287825. doi: 10.1155/2012/287825. Epub 2012 Dec 17.

            ●● Enlace al texto completo (gratuito o de pago) 1155/2012/287825

AUTORES / AUTHORS:  - Nikou GC; Angelopoulos TP

INSTITUCIÓN / INSTITUTION:  - Section of Gastrointestinal Neuroendocrinology, First Department of Propaedeutic  Internal Medicine, Laiko Hospital, University of Athens Medical School, Agiou Thoma 17, Goudi, 11527 Athens, Greece.

RESUMEN / SUMMARY:  - Gastric carcinoid tumors (GCs) are rare lesions representing less than 10% of carcinoid tumors and less than 1% of all stomach neoplasms. There are three distinct types of gastric carcinoids; type I includes the vast majority (70-85%)  of these neoplasms that are closely linked to chronic atrophic gastritis. Type II which accounts for 5-10 %, is associated with Zollinger-Ellison syndrome and often occurs in the context of multiple endocrine neoplasia type 1. Type III, finally, represents 15-25% of gastric carcinoids and is characterized by a far more aggressive course. The optimal clinical approach to GCs remains to be elucidated, depending upon type, size, and number of carcinoids. While there is universal agreement about the surgical treatment of type III GCs, current options for type I and II include simple surveillance, endoscopic polypectomy, surgical excision associated with or without surgical antrectomy, or total gastrectomy. Moreover, the introduction of somatostatin analogues could represent another therapeutic option.



TÍTULO / TITLE:  - Super-selective hepatic arterial infusions as established technique (‘ARETAIEION’ Protocol) of [177Lu]DOTA-TATE in inoperable neuroendocrine liver metastases of gastro-entero-pancreatic (GEP) tumors.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Q J Nucl Med Mol Imaging. 2012 Dec;56(6):551-8.

AUTORES / AUTHORS:  - Limouris GS; Karfis I; Chatzioannou A; Paphiti MI; Lyra M; Gennatas K; Nikou G; Voros D; Pragulidis GP; Polydorou AA; Gouliamos A

INSTITUCIÓN / INSTITUTION:  - Nuclear Medicine Division, Radiology Department I, “Aretaieion” Hospital, Athens  University Medical Faculty, Athens, Greece.

RESUMEN / SUMMARY:  - Aim: Aim of this study was to evaluate the effectiveness of non-carrier added (n. c. a.) [177Lu]DOTA-TATE in inoperable liver metastases, positive for sst2 receptor overexpression (verified by Octreoscan and confirmed by biopsy) due to neuroendocrine gastroenteropancreatic (GEP) tumors. [177Lu]DOTA-TATE has been infused after selective catheterization of the hepatic artery, minimising in parallel the toxicity of non-target tissues. Methods: The dose per session administered to each patient (12 cases in total) was 7400 MBq (200 mCi). Repetitions did not exceed 6-fold with treatment intervals of 5-8 weeks. Response assessment was classified according to the therapeutic benefit. Absorbed doses delivered to metastases, kidneys and red marrow were calculated according to OLINDA 1.1 program and the derived values were correlated to the Response Evaluating Criteria in Solid Tumors (RECIST). CT/MRI scans were performed as baseline before, during and after the end of treatment and monthly ultrasound images for follow-up estimation and measurements. Toxicity (World Health Organization criteria) was measured using blood and urine tests of renal, hepatic and bone marrow function. Results: None of the patients resulted complete response (0.0%); partial response was assessed in 8 (66.7%), disease stabilization in 3 (25%) and progressive disease in 1(8.3%). A 14-month median survival time was estimated for all patients, so far. Eight of 12 (66.7%) showed  a mean target diameter shrinkage ranging from 33% to 45%. The organ average radiation dose estimation was found as follows: a) liver tumor 20.8 mGy/MBq; b) liver 0.14 mGy/MBq; c) kidneys 0.41 mGy/MBq; d) spleen 1.4 mGy/MBq; and f) bone marrow 0.022 mGy/MBq. The average absorbed dose per session to a tumor for a spherical mass of 20 g was estimated to be 20.8 mGy/MBq, depending on the histotype of the tumor. WHO toxicity grade 2 to 3 erythro-, leuko- and thrombo-cytopenia occurred in 9 (75%) cases observed about after the third session. Conclusion: In unresectable metastatic liver lesions positive for somatostatin receptors repeated, trans-hepatic high doses of [177Lu]DOTA-TATE resulted in a more than promising therapeutic outcome with a partial response in  75% of the treated patients. Given the loco-regional modality character of the administration technique, no nephro-toxicity has been so far observed whereas a remarkable myelotoxicity was noticed.



TÍTULO / TITLE:  - The Merkel cell carcinoma challenge: A review from the fine needle aspiration service.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Cancer Cytopathol. 2012 Dec 5. doi: 10.1002/cncy.21237.

            ●● Enlace al texto completo (gratuito o de pago) 1002/cncy.21237

AUTORES / AUTHORS:  - Bechert CJ; Schnadig V; Nawgiri R

INSTITUCIÓN / INSTITUTION:  - Division of Cytopathology, University of Texas Medical Branch, Galveston, Texas.

RESUMEN / SUMMARY:  - Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine carcinoma of the skin that occurs primarily in elderly or immunocompromised patients. For this report, the authors reviewed the diagnostic challenges associated with MCC encountered on their fine-needle aspiration (FNA) service and also conducted an in-depth review of the literature on MCC. A computer search for patients who were diagnosed with MCC by FNA at the authors’ institution from 2006 to 2010 was conducted, and 5 patients were selected for cytologic and immunochemical analyses based on their varied and diagnostically challenging clinical presentations. The  5 selected patients had clinical findings commonly associated with MCC, including advanced age (4 of the 5 patients were ages 75-85 years) and a history of previous malignancies (3 of the 5 patients had a history of previous malignancy), and 1 patient was diagnosed with a concomitant low-grade lymphoma. The patients and their disease illustrated the protean clinical presentation of MCC and the clinical and cytologic challenges associated with this neoplasm. The current findings indicate the need for cytopathologists to be aware of the deceptive presentation of this neoplasm and its cytologic and immunochemical features to correctly diagnose this insidious neoplasm. Cancer (Cancer Cytopathol) 2012. ©  2012 American Cancer Society.