unit of gastrenterology unit of endocrinology theagenio hospital, thessaloniki
DESCRIPTION
Metastatic neuroendocrine tumor of the jejunum-ileum. Unit of Gastrenterology Unit of Endocrinology THEAGENIO Hospital, Thessaloniki. History. 5 4 year old male with symptoms of weight loss abdominal pain Past medical history: colitis? for the last 3 years No family history of note. - PowerPoint PPT PresentationTRANSCRIPT
Unit of Gastrenterology
Unit of Endocrinology
THEAGENIO Hospital, Thessaloniki
Metastatic neuroendocrine tumor of the jejunum-ileum
54 year old male with symptoms of weight lossabdominal pain
Past medical history: colitis? for the last 3 yearsNo family history of note
History
Biochemistry-Radiology
Mildly raised LFT’s
Abdominal computed tomography (CT)3 cm mesenteric mass and liver lesion in segment IV
Surgical treatment (1)
The patient was referred for surgical treatment
and underwent (4/2008) laparotomy in which
a 4 cm segment of small bowel was excised along with 2 para-aortic lymph nodes
Histology
Carcinoid tumor of the small bowel, diameter 1.2 cm,invasive of all intestinal wall, with +2/2 lymph nodes
(+) CgA, NSEKi-67< 2% < 2 mitoses/10HPF
G1
The patient was referred to the Gastroenterology Unit
Clinical examination-Initial assessment
Weight: 55 kg, ΒΜΙ: 17 kg/m2
BP 110/70 mm HgClinical examination: nil of noteNo symptoms of carcinoid syndrome
CgA : 230 nmol/l (<4) , 24-h urine 5 HIIA: 1 mg (<8)Heart echo- : normal Οctreoscan: normal distribution
Medical treatment
Somatostatin analogues
Chemotherapy (SZT + 5FU) from 6/2008 (5
cycles)
Reassesment
Abdominal CT (12/2008)Multiple liver metastatic lesions 1-4 cm and a4 cm mass in front of aorta
Platinum based chemotherapy started 1/2009 (6 cycles)
Somatostatin analogues continued
During 2009 the disease remained radiologically stable, although CgA rose to 900 nmol/l
Initiation of mTOR inhibitors (2010)
From January 2010 and for 16 months the patient was treated with Everolimus 10 mg daily
Abdominal CT: Improvement of the large liver lesion by 20%
CgA substantially reduced to 250 nmol/l
The patient opted to stop treatment in May 2011
Οctreoscan (5/2011)
Uptake in some liver mets and abdomen
At the beginning of 2012…
The patient was admitted at the hospital with severe epigastric pain and vomiting
Βarium follow-through
Gastroscopy
Stenosis of the 2nd part of duodenum
Abdominal CT (2/2012)
Abdominal CT (2/2012)
Surgical treatment (2)
Gastro-entero-anastomosis (3/2012)
Liver biopsy
11 months later:
The patient was admitted again with symptoms of ileus
Cachexia, anemia, low albumin, increased PT
Dysfunction of the gastro-entero-anastomosis
Surgical treatment (3)
To the operating room for the 3rd time (3/2013)
A month later the patient succumbed to his disease
In summary
This was a patient with midgut NET who developed
LN, hepatic and mesenteric metastases,
received treatment withSurgery (x 3)Somatostatin analoguesChemotherapyM-TOR inhibitors
and died 5 years after the initial diagnosis
Points for discussion
Extent of initial surgical treatment (extensive vs conservative)
Repeated surgery (palliative)
Use of chemotherapy
Alternative therapeutic approaches