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Tumores neuroendócrinos gástricos e duodenal simultaneos
Saiote,Joana; Ramos,Gon?alo; Santos,Liliana; Dias,António Mateus; Bentes,Teresa; Barreiras,Jo?o;
Jornal Português de Gastrenterologia , 2012,
Abstract: gastrointestinal neuroendocrine tumors are relatively rare neoplasms and usually occur singly. the probability of simultaneous occurrence of gastric and duodenal carcinoid tumors is low. the authors report a case of a 73-year old male patient, diagnosed pernicious anemia 13 years ago, who underwent upper endoscopy for surveillance. the examination revealed atrophic gastritis and a polypoid lesion in the duodenal bulb, which was completely excised. pathological examination revealed gastric microcarcinoids in the context of atrophic gastritis and a neuroendocrine tumor in the duodenal bulb. the authors discuss the simultaneous occurrence of gastric carcinoid tumors and duodenal, in the context of pernicious anemia, addressing the etiopathogenic mechanism, treatment strategy and prognosis of these diseases
Neuroendocrine tumors: fascination and infrequency Tumores neuroendocrinos: fascinación e infrecuencia  [cached]
M. J. Varas Lorenzo
Revista Espa?ola de Enfermedades Digestivas , 2009,
Abstract: In this article, I review and update of gastro-entero-pancreatic neuroendocrine tumors, which so much fascination have risen among healthcare providers on grounds of their infrequency, hormonal syndromes, and high survival rate, is performed based on references from the past fifteen years. Se efectúa una revisión y puesta al día, basándose en citas bibliográficas de los últimos quince a os, de los tumores neuroendocrinos gastroenteropancreáticos, que tanta fascinación han provocado en el estamento médico por su infrecuencia, síndromes hormonales y supervivencia elevada.
Tumores neuroendocrinos gastroenteropancreáticos Gastroenteropancreatic neuroendocrine tumors (GEP-NETS)
Cristian Camilo Vargas Martínez,Rodrigo Casta?o Llano
Revista Colombiana de Gastroenterologia , 2010,
Abstract: Los tumores neuroendocrinos gastroenteropancreáticos son neoplasias raras distribuidas a lo largo del tubo digestivo y poseen características peculiares, como la captación de sales de plata, la expresión de marcadores de célula neuroendocrina y los gránulos secretorios de contenido hormonal. Según su tama o, localización anatómica y la presencia de metástasis, estos tumores debutan con distintas características clínicas y pronóstico. El diagnóstico temprano, que requiere de un alto grado de sospecha y una confirmación con estudios especializados, resulta invaluable para tratar estas lesiones a tiempo y aumentar la sobrevida de los pacientes. El tratamiento quirúrgico es la herramienta de primera mano, y otras terapias médicas ayudan a mejorar los síntomas y la calidad de vida de aquellos pacientes con lesiones irresecables. En esta revisión, se tratan los aspectos más relevantes en cuanto a la clasificación, morfología, localización, diagnóstico y tratamiento de estas neoplasias gastrointestinales, y al final, se expone la única experiencia colombiana sobre la epidemiología y el manejo de los tumores neuroendocrinos Gastroenteropancreatic neuroendocrine tumors (GEP-NETS) are rare neoplasms which can occur anywhere in the gastrointestinal tract. Their particular characteristics include uptake of silver salts, neuroendocrine cell marker expression and hormonal secretory granules. Depending on their size, anatomical location and upon whether or not metastasis has occurred, these tumors can show different clinical patterns and have different prognoses. Early diagnosis is essential for treating these lesions and improving the patients' prognoses, but it requires a high degree of suspicion and confirmation by special testing. Surgical treatment is the first choice, but other medical therapy can be helpful for patients who have unresectable disease. This review presents the most relevant aspects of classification, morphology, methods of locating tumors, diagnosis and treatment of GEP-NETS. It presents only the Colombian experience in the epidemiology and management of these tumors
Tumores neuroendocrinos del páncreas Pancreatic neuroendocrine tumors  [cached]
Luis Burgos S J,María Eugenia Burgos de C.
Revista médica de Chile , 2004,
Abstract: All pancreatic neuroendocrine tumors derive from Langerhans islet cells and have a low incidence. Half of them are functioning tumors that produce diverse hormones and occasionally cause serious clinical endocrine syndromes. They may be malignant, but they have a better survival, if compared to pancreatic ductal adenocarcinoma. Insulinoma, gastrinoma, glucagonoma, VIPoma (VIP=vasoactive intestinal peptide), somatostatinoma and ACTHoma are functioning tumors and they may also be part of Multiple Endocrine Neoplasia type I (MEN 1) syndrome and of von Hippel-Lindau disease. Diagnosis of non-functioning tumors is usually late, when they reach a big size and have even developed nodal and hepatic metastases. Nowadays, there are effective medical treatments for the medical problems secondary to excessive hormone production. For example, the hypergastrinemia typical of the Zollinger-Ellison syndrome in gastrinoma, can be adequately managed. Surgical resection is the most advisable therapy for pancreatic endocrine tumors, especially when they are small, when long time survival is better. Pre and intra operative imagenology is a great aid to locate these tumors. There are several surgical alternatives, according to the tumor size and location within the pancreas. Furthermore, palliative therapy can be used in disseminated disease. Treatment success is the result of a multidisciplinary medical team work of endocrinologists, surgeons, gastroenterologists, pathologists and geneticists (Rev Méd Chile 2004; 132: 627-34).
Manejo endoscópico de los tumores neuroendocrinos gástricos Endoscopic management of gastric neuroendocrine tumors  [cached]
Martín Gómez Zuleta,William Otero Regino,José Pion Otero
Revista Colombiana de Gastroenterologia , 2011,
Abstract: Introducción: No existe en el mundo una guía sobre qué hacer con los pacientes a quienes les encontramos un TNE gástrico; si bien se aconseja realizar mucosectomía a las lesiones menores de 1 cm en las que no existan metástasis, otros grupos aconsejan el manejo quirúrgico, pero no está claro cómo deben seguirse los pacientes ya tratados. El objetivo del presente trabajo es describir nuestra experiencia en el manejo endoscópico de estos pacientes. Pacientes y métodos: Estudio descriptivo, de forma retrospectiva, realizado durante un periodo de 4 a os en dos instituciones. Las diferentes variables fueron consignadas en un instrumento de recolección de datos, específicamente dise ado para la presente investigación, que incluía lo siguiente: características sociodemográficas, presentación clínica (síntomas asociados), hallazgos endoscópicos, exámenes solicitados, tratamiento instaurado (cirugía, endoscópico); se describió la técnica endoscópica utilizada para la resección, el número y tama o de las lesiones así como la evolución clínica y el desenlace del paciente. Resultados: En total se incluyeron para el estudio 29 pacientes con TNE los cuales tuvieron en total 43 lesiones; 28 tumores fueron TNE tipo I y un caso fue tipo III. La edad promedio al momento del diagnóstico fue 55 ± 10 a os, 64% mujeres. Los pacientes tenían los tumores en los siguientes sitios: cuerpo gástrico 23, fondo gástrico 4 y en el antro 2; 14 (17,2%) tenían anemia perniciosa. El tratamiento endoscópico se realizó en todos los 28 pacientes con TNE tipo I. Los métodos endoscópicos fueron mucosectomía con asa 17 (60,7%), mucosectomía con cap 4 (14,2%), y mucosectomía con banda en 7 (25%). El seguimiento desde el diagnóstico hasta la fecha de la realización del estudio fue en promedio de 32,5 meses (6-47 meses). Un paciente falleció y el diagnóstico fue TNE III. Es decir que la sobrevida actual de los pacientes con TNE gástrico tipo I es del 100%. Conclusión: El TNE tipo I tiene un excelente pronóstico con sobrevida de 100% en el seguimiento realizado. El tratamiento endoscópico es seguro y efectivo en estos pacientes con las técnicas de mucosectomía descritas en la literatura. Introduction: Nowhere in the world is there a clear guide for what we must do for patients with gastric neuroendocrine tumors (gastric NETs). Although mucosectomy is often advised for lesions of less than 1cm in which there are no metastases, some groups advocate surgical management. In addition, it is not clear how treated patients should be followed up. The aim of this study is to describe our experience in the e
Tumores neuroendocrinos gástricos: presentación clínica, endoscópica y alternativas de tratamiento Clinical and endoscopic presentation of gastric neuroendocrine-tumors  [cached]
Raúl Lazarte C,Jaime Poniachik T,Gladys Smok S,Jorge Contreras B
Revista médica de Chile , 2002,
Abstract: Background: Gastric neuroendocrine tumors correspond to less than 1% of all gastric tumors. These tumors can be of three types. Seventy five percent are type I and are associated to chronic atrophic gastritis type A (CAG- A). Half of them are associated with pernicious anemia. Type II tumors are associated with Zollinger Ellison syndrome and type I multiple endocrine neoplasia. Type III are sporadic tumors. Aim: To report the clinical, endoscopical features and response to the treatment of gastric neuroendocrine tumors. Patients and methods: A retrospective study of eleven patients (seven male, aged 38 to 72 years old) with a pathological diagnosis of gastric neuroendocrine tumor. Their clinical presentation, associated diseases, treatment and follow up were reviewed. Results: Epigastric pain was present in eight patients, weight loss in three, epigastric pain and weight loss in one and post prandial abdominal pain in two. At endoscopy, multiple polyps in the fundus were observed in six, verrucose gastritis in one, polyps in the antrum in one, two subcardial polyps in 1, a fundus ulcer in one and a Bormann III type lesion in one. Chronic atrophic gastritis was diagnosed in seven patients and pernicious anemia in five. Serum gastrin levels were determined in 4 patients and were high in all. Four subjects were treated with endoscopic polipectomy only. A partial or total gastrectomy was done in seven patients. No complications or mortality occurred during the follow up. Conclusions: Abdominal pain is a common presentation of patients with gastric neuroendocrine neoplasia. Polyps predominantly in the fundus are the most common endoscopic finding. Surgical treatment or endoscopical polypectomy, depending of the extension of the disease, yield satisfactory results (Rev Méd Chile 2002; 130: 985-92).
Tumores neuroendocrinos: una revisión sobre los aspectos clínicos, diagnóstico y tratamiento. Neuroendocrine tumors: a review of the clinical aspects, diagnosis and treatment.
Lisbet Rodríguez Fernández,Arturo Hernández Yero,Yordanka Pi?a Rivera,Marelys Yanes Quesada
Revista Cubana de Endocrinología , 2008,
Abstract: El estudio de los tumores neuroendocrinos ha sido objeto de interés por la ciencia médica. Se han desarrollado diversos métodos para su diagnóstico, tratamiento y pronóstico, cada uno con sus ventajas e inconvenientes. Los resultados publicados son experiencias de otros países, que sería de mucha utilidad aplicar en el nuestro, para aproximarse a la prevalencia real de estos tumores en nuestro medio y tener un tratamiento adecuado de los pacientes afectados con esta enfermedad. El objetivo de este trabajo es brindar una panorámica de las tendencias actuales acerca de los aspectos clínicos, diagnóstico y tratamiento de los tumores neuroendocrinos, que sirva como herramienta de trabajo para la práctica médica y para la actividad docente de los médicos relacionados con el tema. The study of neuroendocrine tumors has been object of interests by medical science. Different methods have been developed for their diagnosis, treatment and prognosis, each of them with its advantages and inconveniences. The published results are based on the experience of other countries, and it would be very useful to apply them in our country to get closer to the real incidence of these tumors in our environment and to have an adequate treatment of the patients affected with this disease. The objective of this paper is to offer a view of the current trends as regards the clinical aspects, the diagnosis and treatment of the neuroendocrine tumors that serves as a working tool for medical practice and for the teaching activity of the physicians related to this topic.
Clinical Aspects of Gastric and Duodenal Neuroendocrine Neoplasms  [cached]
Sung Chul Park,Hoon Jai Chun
Journal of Gastroenterology and Hepatology Research , 2012, DOI: 10.6051/ j.issn.2224-3992.2012.01.53
Abstract: With the development of endoscopy, the incidence of gastric andduodenal neuroendocrine neoplasms (NENs) has increased in recentdecades. In the 2010 World Health Organization (WHO) classification,well-differentiated NENs were classified into NET G1 or G2,which is equivalent to the carcinoid tumor. Poorly differentiatedNENs were named neuroendocrine carcinoma (NEC). Gastric NENsare classified into four types in accordance with their characteristics.Type 1 generally appears as multiple polypoid tumors at the fundusand corpus and takes a benign course. Type 2 has morphologicallysimilar characteristics to type 1 and is associated with Zollinger-Ellisonsyndrome. Endoscopic treatment should be considered for casesin which the tumor is less than 2 cm and confined to mucosa and submucosa.In type 1 and type 2 accompanying hypergastrinemia, if thetumor was less than or equal to 1 cm, observation without endoscopicresection may be considered. Type 3 occurs sporadically and requiresaggressive surgical treatment, including gastric resection and lymphnode dissection due to poor prognosis. Poorly differentiated neuroendocrinecarcinomas were classified as type 4. Although type 4 tumorsare usually inoperable, surgery is sometimes performed with the aimof reducing tumor volume. Somatostatin analog, interferon alpha,and cytotoxic chemotherapy can be used with metastatic NENs. DuodenalNENs are rare compared to stomach NENs. The prognosis ofduodenal NENs depends on their size. Endoscopic resection can beperformed in small duodenal NENs. Surgery, including Whipple’sprocedure, should be considered in large tumors.
Tumores neuroendócrinos do cólon e reto: experiência do Instituto Nacional do Cancer no Brasil Colon and rectum neuroendocrine tumors: experience of the National Cancer Institute in Brazil  [cached]
Daniel Cesar,Renato Morato Zanatto,Marcus Vinícius Motta Valad?o da Silva,Rinaldo Gol?alves
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2013,
Abstract: RACIONAL: Os tumores neuroendócrinos (TNEs) s o raros e compreendem apenas 0,49% de todas as neoplasias malignas. A maioria acomete o trato gastrointestinal. OBJETIVO: Analisar os fatores demográficos, características clinicopatológicas, tratamento empregado, fatores prognósticos e resultados oncológicos relacionados aos TNEs colorretais. MéTODOS: No período compreendido entre 1996 e 2010 foram tratados 174 pacientes. Destes, 34 localizavam-se no cólon e reto. Foram analisados fatores demográficos, estadiamento, os procedimentos terapêuticos aplicados e seus resultados. No seguimento todos os pacientes foram acompanhados acima de três anos com exames de imagem, dosagem de 5-HIIA urinário, cromogranina-A sérica e fosfatase ácida prostática. RESULTADOS: A média de idade no diagnóstico foi de 54,5 anos (22-76), com predominancia do sexo feminino (64,7%). Dos 12 com TNEs de cólon, um (8,3%) foi classificado como estádio IA; um (8,3%) em IB; três (25%) em IIIB e sete (58,4%) em IV. Dos 22 pacientes com TNEs de reto, seis (27,3%) foram classificados como estádio IA; quatro (18,2%) em IB; três (13,6%) em IIIA; um (4,5%) em IIIB e oito (36,4%) em IV. Dos TNEs de reto, nove (41%) foram tratados com ressec o endoscópica, seis (27,2%) com procedimento cirúrgico e seis (27,2%) somente com quimioterapia. Onze pacientes com TNEs de cólon (91,6%), foram tratados cirurgicamente, sendo sete paliativamente, um (8,4%) com ressec o endoscópica e nenhum foi submetido à quimioterapia no primeiro momento. Após seguimento médio de 55 meses, 19 (55%) pacientes estavam vivos. Analisando a sobrevida global obteve-se média de 29 meses no estádio IA, 62 meses no IB, 12 meses no IIIA, 31 meses no IIIB e 39 meses no IV. CONCLUS O: O tratamento dos TNEs de cólon e reto é complexo, pois depende de variáveis que s o individuais a cada paciente. Com adequado manuseio, o prognóstico pode ser favorável e a sobrevida longa, mas ela está relacionada ao grau de diferencia o tumoral, tamanho, localiza o do tumor, estadiamento no momento do diagnóstico, eficácia da terapêutica adotada e à aderência do paciente ao seguimento após o tratamento. BACKGROUND: Neuroendocrine tumors (NETs) are rare, comprising nearly 0.49% of all malignancies. The majority occurs in the gastrointestinal tract. AIM: To analyze the demographic factors, clinicopathologic features, treatment employed, prognostic factors and the oncologic results related to colorectal NETs. METHODS: Between the period from 1996 to 2010 174 patients were treated. From these, 34 were localized in the colon and rectum. Demographic factors,
Preoperative detection of gastrointestinal neuroendocrine tumors using endoscopic ultrasonography Detección preoperatoria de los tumores neuroendocrinos digestivos mediante ultrasonografía endoscópica  [cached]
M. J. Varas Lorenzo,J. M. Miquel Collell,M. D. Maluenda Colomer,J. Boix Valverde
Revista Espa?ola de Enfermedades Digestivas , 2006,
Abstract: Objective: almost 30% of gastroenteropancreatic neuroendocrine tumors (GEPET) escape preoperative identification using standard imaging techniques. The goal of this retrospective study is to present our cumulative experience in the assessment of GEPET by preoperative endoscopic ultrasonography (EUS), and to compare it with a literature review. Patients and methods: thirty-seven patients with suspected specific hormonal syndromes were sequentially examined with US, CT, MRI, angiography, OctreoScan, and radial and sectorial EUS. Sixteen were males (43%) and 21 were females (57%), with a mean age of 61 years (interval: 40-84 a). Of all 37 patients, 27 had 19 endocrine tumors in the pancreas and 14 tumors in their gastrointestinal tract. No tumors were demonstrated in 10 patients, hence they were used as a control group. Of all 37 patients, 24 were operated on or had histological samples collected, with the presence of 26 GEPET (10 carcinoids) being confirmed in 22 patients. Results: EUS sensitivity and diagnostic accuracy were 81% and 78%. Specificity was 80%. All these values were similar to the mean values obtained from the literature review. Three pancreatic rumors smaller than or equal to 1 cm (insulinomas) were detected, which had escaped diagnosis with previous US, CT, and MRI studies. An echoendoscopic examination of the pancreas could not be completed in two cases (5%), a pancreas carcinoid and an already gastrectomized double pancreatic gastrinoma. Conclusion: EUS is a good preoperative technique for GEPET detection, and may likely be superior to other imaging techniques in the assessment of small tumors. The usefulness of EUS as a primary exploration after US or HCT has been posited for tumor diagnosis and localization before surgery.
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