scholarly journals Liver metastases of MEN1 related duodenopancreatic neuro-endocrine tumors; strategies and outcomes

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e61 ◽  
Author(s):  
S. Nell ◽  
E.B. Conemans ◽  
J.M. de Laat ◽  
C.R. Pieterman ◽  
I.H.M. Borel Rinkes ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Endocrine Tumors

Ablative therapies for liver metastases of digestive endocrine tumours.

2003 ◽  
pp. 463-468 ◽  
Author(s):  
D O'Toole ◽  
F Maire ◽  
P Ruszniewski
Keyword(s):  
Liver Metastases ◽  
Somatostatin Analogs ◽  
Hepatic Metastases ◽  
Vascular Occlusion ◽  
Treatment Method ◽  
Vascular Tumors ◽  
Endocrine Tumors ◽  
Hepatic Ischemia ◽  
Ablative Therapies

Hepatic metastases are frequently encountered in patients with digestive endocrine tumors and their presence plays an important role in quality of life and overall prognosis. Surgery is the treatment method of choice for hepatic metastases but this is frequently impossible due to the extent of disease. Systemic chemotherapy is offered to patients with diffuse and/or progressive liver metastases but results are disappointing especially in patients with metastases of midgut origin. In the latter patients with carcinoid syndrome, somatostatin analogs are frequently initially effective but their efficacy wanes due to disease progression and development of tachyphylaxis. Other therapeutic options in the treatment of hepatic metastases are locoregional strategies where vascular occlusion induces ischemia in these highly vascular tumors using either surgical or radiological techniques. Available methods include surgical ligation of the hepatic artery, transient hepatic ischemia or sequential hepatic arterialization. Trans-catheter arterial chemoembolization has proven effective in terms of long palliation and objective tumor responses. Other treatments aimed at regional destruction either alone or in combination with surgery include radiofrequency ablation and cryotherapy. The latter are usually important adjuncts to surgery and are usually reserved for limited disease.

Prospective study of chemoembolization (CE) of liver metastases from endocrine tumors. A report of 15 cases

1994 ◽  
Vol 4 (1) ◽  
Author(s):  
Paul Legmann ◽  
Philippe Ruszniewski ◽  
Samir Hochlaf ◽  
Michel Mignon
Keyword(s):  
Prospective Study ◽  
Liver Metastases ◽  
Endocrine Tumors

scholarly journals Prospective Study of the Natural History of Gastrinoma in Patients with MEN1: Definition of an Aggressive and a Nonaggressive Form

2001 ◽  
Vol 86 (11) ◽  
pp. 5282-5293 ◽  
Author(s):  
Fathia Gibril ◽  
David J. Venzon ◽  
Jeremiah V. Ojeaburu ◽  
Showkat Bashir ◽  
Robert T. Jensen
Keyword(s):  
Natural History ◽  
Tumor Growth ◽  
Prospective Study ◽  
Liver Metastases ◽  
Hepatic Metastases ◽  
Endocrine Tumors ◽  
Zollinger Ellison Syndrome ◽  
Pancreatic Endocrine Tumors ◽  
History Of ◽  
Aggressive Tumor

The natural history of pancreatic endocrine tumors (PETs) in patients with MEN1 is largely unknown. Recent studies in patients with sporadic PETs show that in a subset, tumor growth is aggressive. To determine whether PETs in patients with MEN1 show similar growth behavior, we report results from a long-term prospective study of 57 patients with MEN1 and Zollinger-Ellison syndrome. All patients had tumor imaging studies yearly, and the mean follow-up was 8 yr. Only patients with PETs 2.5 cm or larger underwent abdominal surgical exploration. Hepatic metastases occurred in 23%, and in 14% tumors demonstrated aggressive growth. Three tumor-related deaths occurred, each due to liver metastases, and in each, aggressive tumor growth was present. Overall, 4% of the study group, 23% with liver metastases and 38% with aggressive disease, died. Aggressive growth was associated with higher gastrins and larger tumors. Patients with liver metastases with aggressive growth differed from those with liver metastases without aggressive growth in age at MEN1 onset or diagnosis and primary tumor size. Survival was decreased (P = 0.0012) in patients with aggressive tumor growth compared with those with liver metastases without aggressive growth or with no liver metastases without aggressive growth. Based on these results a number of factors were identified that may be clinically useful in determining in which patients aggressive tumor growth may occur. These results demonstrate in a significant subset of patients with MEN1 and Zollinger-Ellison syndrome, aggressive tumor growth occurs and can lead to decreased survival. The identification of prognostic factors that identify this group will be important clinically in allowing more aggressive treatment options to be instituted earlier.

Bone metastases in patients with gastrinomas: a prospective study of bone scanning, somatostatin receptor scanning, and magnetic resonance image in their detection, frequency, location, and effect of their detection on management.

1998 ◽  
Vol 16 (3) ◽  
pp. 1040-1053 ◽  
Author(s):  
F Gibril ◽  
J L Doppman ◽  
J C Reynolds ◽  
C C Chen ◽  
V E Sutliff ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Liver Metastases ◽  
Bone Metastases ◽  
Bone Scan ◽  
Somatostatin Receptor ◽  
Axial Skeleton ◽  
Bone Lesions ◽  
Endocrine Tumors ◽  
Bone Scanning ◽  
Imaging Results

PURPOSE To determine whether bone scan, magnetic resonance imaging (MRI), or somatostatin receptor scintigraphy (SRS) is best for identifying bone metastases in patients with gastrinomas, as well as their frequency and location, whether their detection affects management, and what patient subgroups should be examined. MATERIALS AND METHODS One hundred fifteen patients with gastrinoma were prospectively studied. Patients were examined yearly and those with liver metastases were reexamined every 3 months. Based on clinical history, histology, growth pattern, and development of new bone lesions, possible bone metastases were classified as to whether they were or were not bone metastases. Imaging results were correlated at different times in the disease course and with disease extent. RESULTS Bone scan was positive in 52 patients, MRI in seven, and SRS in six. Eight patients (7%) were determined to have bone metastases and MRI was correctly positive in seven, SRS in six, and bone scan in five. SRS or MRI was positive in all patients with bone metastases. Bone scan had significantly lower specificity and sensitivity, and a higher rate (P < .02) of false-negative results than MRI or SRS. Bone metastases occurred in 31% of patients with liver metastases and 0% with only lymph node metastases. The initial bone metastases were in the spine or sacrum (75%) followed in descending order by the pelvis or sacroiliac joints (38%), scapula or shoulder, and ribs. In all cases, detection of bone metastases changed the management. CONCLUSION SRS and MRI, because of high sensitivity and specificity, are recommended over bone scanning to screen for bone metastases in patients with gastrinomas. However, because bone metastases can occur initially outside the axial skeleton, SRS is the recommended initial localization method of choice. Bone metastases occur in 7% of all patients and 31% of patients with liver metastases, only occur in patients with liver metastases, are usually in the axial skeleton initially, and their detection changes management in all cases. Patients with pancreatic endocrine tumors with liver metastases should undergo SRS every 6 months to 1 year to detect bone metastases.

Detection of Liver Metastases From Endocrine Tumors: A Prospective Comparison of Somatostatin Receptor Scintigraphy, Computed Tomography, and Magnetic Resonance Imaging

2005 ◽  
Vol 23 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Clarisse Dromain ◽  
Thierry de Baere ◽  
Jean Lumbroso ◽  
Hubert Caillet ◽  
Agnès Laplanche ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Liver Metastases ◽  
Somatostatin Receptor ◽  
Somatostatin Receptor Scintigraphy ◽  
Emission Computed Tomography ◽  
Endocrine Tumors ◽  
Resonance Imaging ◽  
Receptor Scintigraphy

Purpose To compare the respective sensitivity of somatostatin receptor scintigraphy (SRS), computed tomography (CT), and magnetic resonance imaging (MRI) in the detection of liver metastases from well-differentiated gastroenteropancreatic endocrine tumor (WDGEP ET) patients. To define predictive factors for “high-sensitivity SRS.” Patients and Methods Sixty-four patients with WDGEP ET underwent SRS with abdominal single-photon emission computed tomography (SPECT), spiral CT, and 1.5-T MRI within a 15-day interval, the order of which was randomized. Two readers analyzed images of each modality, blindly and independently. Results Hepatic metastases were present in 40 of the 64 patients and confirmed by pathology after liver biopsy or surgery in 32 and eight patients, respectively. SRS, CT, and MRI detected a total of 204, 325, and 394 metastases, respectively. The number of detected metastases was significantly higher with MRI than with CT (P = .02) and SRS (P < 10−4) and higher with CT than with SRS (P < 10−4). SRS was negative in seven patients with a positive CT and/or MRI. More lesions were detected in 10 patients by SPECT compared with static views. The median metastasis size was significantly correlated (P = .04) with the sensitivity of SRS. Conclusion MRI seems to have an edge over CT and SRS for the detection of liver metastases from endocrine tumors. We recommend the systematic performance of liver MRI at WDGEP ET initial staging and before major therapeutic events. The low performance of SRS was mainly explained by the impact of the metastasis size on the detection capacity of SRS.

Expression of metastasis-associated gene products and liver metastases in pancreatic endocrine tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 11089-11089
Author(s):  
J. Helm ◽  
J. Strosberg ◽  
E. Henderson-Jackson ◽  
N. Hafez ◽  
A. Hakam ◽  
...  
Keyword(s):  
Protein Expression ◽  
Liver Metastases ◽  
Sensitivity And Specificity ◽  
Predictive Accuracy ◽  
Hepatic Metastases ◽  
Endocrine Tumors ◽  
Metastatic Tumors ◽  
Allred Score ◽  
Parallel Testing ◽  
Pancreatic Endocrine Tumors

11089 Background: Outcomes in well-differentiated pancreatic endocrine tumors can be difficult to predict using pathologic criteria. We recently identified a novel set of 3 metastasis-associated genes by microarray: Palladin, p21, RUNX1T1. Our aim was to evaluate the potential for these markers, individually or in combination, to predict liver metastases as an indicator of adverse outcome. Methods: Palladin, p21, and RUNX1T1 immunostains were done on a tissue microarray of 39 resected primary pancreatic endocrine neoplasms, 14 of which had hepatic metastases. The Allred score was determined as the sum of stain intensity (scored 0–3) and % cells stained (scored 0–5). Receiver operating characteristic (ROC) analysis was used to choose the cutpoint in Allred score (high vs low protein expression) to optimize sensitivity and specificity for predicting liver metastases. Results: Nearly all tumors with liver metastases showed high Palladin and p21 levels (Allred score > 3 and > 4, respectively), while protein expression was lower in the majority of non-metastatic tumors. In contrast, RUNX1T1 expression was low (Allred score < 4) in most tumors with liver metastases, but higher in all except one of the non-metastatic tumors. Individual test sensitivities for predicting liver metastases were 100% for high Palladin, 93% for high p21 and 85% for low RUNX1T1, while corresponding specificities were 63%, 75%, and 96%. Tumors were correctly classified as being metastatic or not (predictive accuracy) by Palladin, p21, or RUNX1T1 expression in 76%, 76%, and 92% of cases, respectively. If abnormal expression of even one of 3 proteins is considered a positive test (parallel testing), then sensitivity of all 3 together for predicting liver metastases was 100%, specificity 48%, and predictive accuracy 68%. Conclusions: 1) High Palladin, high p21, or low RUNX1T1 expression have good sensitivity and specificity for predicting liver metastases in pancreatic endocrine tumors. 2) Parallel testing with all 3 markers achieved 100% sensitivity but at a cost of reduced specificity. 3) Differential expression of these biomarkers may predict aggressive tumor behavior that warrants more aggressive management. No significant financial relationships to disclose.

Surgical management of liver metastases from gastrointestinal endocrine tumors

2010 ◽  
Vol 34 (4-5) ◽  
pp. 274-282 ◽  
Author(s):  
E. Boleslawski ◽  
S. Dharancy ◽  
S. Truant ◽  
F.-R. Pruvot
Keyword(s):  
Liver Metastases ◽  
Surgical Management ◽  
Endocrine Tumors

Metastasis-Associated Gene Products and Liver Metastases in Pancreatic Endocrine Tumors

Pancreas ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 276
Author(s):  
Aejaz Nasir ◽  
James Helm ◽  
Jonathan R. Strosberg ◽  
Leslie M. Turner ◽  
Evita B. Henderson-Jackson ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Endocrine Tumors ◽  
Gene Products ◽  
Pancreatic Endocrine Tumors ◽  
Metastasis Associated Gene

scholarly journals Hepatic Arterial Embolization versus Chemoembolization in the Treatment of Liver Metastases from Well-Differentiated Midgut Endocrine Tumors: A Prospective Randomized Study

2012 ◽  
Vol 96 (4) ◽  
pp. 294-300 ◽  
Author(s):  
Frédérique Maire ◽  
Catherine Lombard-Bohas ◽  
Dermot O’Toole ◽  
Marie-Pierre Vullierme ◽  
Vinciane Rebours ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Randomized Study ◽  
Arterial Embolization ◽  
Prospective Randomized Study ◽  
Endocrine Tumors ◽  
Well Differentiated ◽  
Hepatic Arterial Embolization

Uptake of mangafodipir trisodium in liver metastases from endocrine tumors

1998 ◽  
Vol 8 (3) ◽  
pp. 682-686 ◽  
Author(s):  
Chen Wang ◽  
Håkan Ahlström ◽  
Barbro Eriksson ◽  
Maria Lönnemark ◽  
Steven McGill ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Endocrine Tumors ◽  
Mangafodipir Trisodium
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