Neuroendocrine cancer with liver metastases, Ileal neuroendocrine tumor – ultrasonographic and capsule endoscopy appearance: a case report
- Поверь .
Сьюзан пожала плечами.
MATERIALS AND METHODS: Imaging studies of 22 patients 12 men, mean age 60 years with histopathologically confirmed diagnosis, evaluated in the authors's institution during the last five years were retrospectively reviewed by two radiologists, with findings being consensually described focusing on changes observed at computed tomography.
Only one typical carcinoid presented the characteristic appearance of central endobronchial nodule with distal pulmonary atelectasis, while the others were pulmonary nodules or masses. The atypical carcinoids corresponded to peripheral heterogeneous masses. One out of the three LCNCs was a peripheral homogeneous mass, while the others were ill-defined and heterogeneous. The 11 SCLCs corresponded to central, infiltrating and heterogeneous masses with secondary pleuropulmonary neuroendocrine cancer with liver metastases.
Keywords: Computed tomography; Lung neoplasms; Neuroendocrine tumors. Primary neuroendocrine tumors of the lung NTLs originate either from Kulchitzky cells, neuroepithelial bodies or from pluripotent stem cells which are present in the bronchial mucosa, with similar pathological features, and being capable of producing and secreting neuroendocrine cancer with liver metastases hormones and neuroamines 2.
Since neuroendocrine cancer with liver metastases early 's, because of its clinical and histological characteristics, SCLC is classified as a neuroendocrine neoplasia of the lung. In the present study, the authors describe the main imaging findings in a series of histopathologically confirmed cases of NTL, with emphasis on computed tomography CT findings. Also, the authors make a brief description of the main clinical data, including information on the evolution of the cases, correlating them with radiological and anatomopathological data.
Only histopathologically confirmed cases of primary neuroendocrine tumors of the lung were included in the present study.
Services on Demand
A total of 22 patients 12 men, mean age of 60 years, ranging from 32 to 78 neuroendocrine cancer with liver metastases were studied. Considering the retrospective nature of the study, with exams that are part of the clinical neuroendocrine cancer with liver metastases in the assessment of such patients, it exempted a term of free and informed consent in addition to the one obtained previously to the performance of the exams.
Clinical data was obtained after review of the patients' records and imaging studies retrieved from the electronic file system of the authors' institution. Images were reviewed by two radiologists, and the findings were described in consensus. The lesions were evaluated with respect bladder inverted papilloma pathology morphological characteristics, location, dimensions, presence of calcifications, associated changes in the pulmonary parenchyma, lymph node enlargement and presence of distant metastases.
All the imaging studies stored in the electronic file system were reviewed, including plain radiographs and magnetic resonance imaging MRI studies, but the reviewers have particularly focused on the description of CT findings, which is currently the most accurate radiological method and most commonly utilized in the evaluation of lung tumors. In spite of not being related to the main objective of the present study, the neuroendocrine cancer with liver metastases follow-up exams, whenever available, were also reviewed for correlation of imaging findings with the clinical progression according to the type of neoplasia identified at the anatomopathological study.
The description of symptoms was varied, including dyspnea, chronic coughing, chest pain and "repeated pneumonias". Along the medical records review process, data confirming the neuroendocrine cancer with liver metastases of paraneoplastic syndrome due to ectopic production of hormones were not found for any of the patients.
As regards histological type, the lesions of the 22 patients included: five typical carcinoid lesions, three atypical carcinoid lesions, three LCNCs and 11 SCLCs Table 1. Plain radiography could identify the atelectasis neuroendocrine cancer with neuroendocrine cancer with liver metastases metastases the upper right lobe. At CT, the ovoid endobronchial nodule was identified in the origin of the right upper lobe bronchus.
The other cases of typical carcinoid lesion presented as lung nodules or masses, either centrally or peripherally located, with smooth or lobulated margins, homogeneous soft tissue density, and dimensions ranging from 2.
No patient presented lymph node enlargement or metastatic lesions at the initial presentation of the disease. Distal, secondary changes were described in all cases, mainly represented by areas of inflammatory consolidation or atelectasis. All five patients were submitted to surgical resection either segmentectomy or lobectomy and only one patient presented recurrence of the disease in the clinical follow-up, with mediastinal lymph node enlargement identified six years after diagnosis Figure 3.
One patient with a typical carcinoid lesion also underwent MRI, which demonstrated the presence of a well defined nodule in the left lower lobe with intermediate signal intensity on T1-weighted and hyperintense signal on T2-weighed sequences, also with restriction in diffusion weighted imaging and prominent contrast-enhancement more noticeable in delayed phases and with homogeneous appearance Figure 2.
Neuroendocrine tumors NETs are found throughout the intestinal tract, the appendix and terminal ileum being the most common locations, and are classified by site of origin and by degree of differentiation, with well-differentiated lesions representing those tumors formerly referred to as carcinoid tumors. We report the clinical, serological and histological diagnosis of a years-old male patient with congestive heart failure secondary to carcinoid heart disease in the context of liver metastases of an ileum carcinoid tumor. Metastatic carcinoid tumor presenting as right sided heart failure. Int J Endocrinol Metab ;
The three cases of atypical carcinoid tumors were identified both at plain radiography and CT, described as peripheral lung masses with lobulated or irregular contours, with heterogeneous density and contrast-enhancement, dimensions ranging between 3.
One lesion presented nodular calcifications identified at plain radiography, but neuroendocrine cancer with liver metastases characterized at CT.
One patient already presented lymph nodes enlargement and lesions compatible with metastases bone and liver at the initial assessment and evolved to death. Another patient presented suspicious metastic liver lesions at the moment of the diagnosis, progressing with enlargement of the lesions progressive disease and at the time of the present study such patient was undergoing systemic therapy. In one patient the lesion was resected and no recurrence has been identified at most-recent follow-up.
Of the three LCNC patients, one presented a peripheral well-defined mass with homogeneous density, while the other two patients presented heterogeneous, peripheral, ill-defined masses with irregular contours in association with important pleuropulmonary changes Figure 5. The lesions dimensions ranged from 4. The two patients presenting with heterogeneous lesions already presented lymph nodes enlargement neuroendocrine cancer with liver metastases distant metastatic lesions at their initial assessment, and underwent non-surgical therapy, but evolved with progressive disease at follow-up and, later, death.
The other patient presented progressive, metastatic disease and currently is still undergoing local and systemic treatment and has not been submitted to surgical resection of the lung lesion.
Neuroendocrine cancer with liver metastases of the 11 cases of SCLC presented as lesions of similar radiological appearance, characterized as central masses associated with coalescent lymph node enlargement with infiltrating and heterogeneous aspect, invading vascular structures as well as the adjacent tracheobronchial tree Figure 6. Other associated thoracic changes were described in all cases, such as secondary lung lesions, pneumonia, atelectasis, pleural effusion and pleural thickening.
At plain radiography, the characterization of the masses was in general more difficult, particularly in the presence of lung atelectasis and large pleural effusion.
- Papilloma virus vaccinazione gratuita
- Ductal papilloma risk
In general, the lesions that could be measured were larger than 5. Calcifications were not identified in any lesion. In the present study, the authors retrospectively reviewed imaging findings in patients with histopathologically confirmed NTL diagnosed in their institution, with emphasis on CT findings. The authors describe five cases of typical carcinoid tumors and three cases of atypical carcinoid tumors.
Atypical carcinoid tumors are assciated with smoking, most commonly affecting male patients and at older ages 59 years, on averagewhile typical carcinoid tumors lack established association enterobius vermicularis is smoking, affecting younger patients of both genders.
Typical carcinoid tumors represent the most common lung neoplasia in the childhood and most frequently are diagnosed at less advanced clinical stages, rarely with metastases and progressing with longer survival as compared with atypical carcinoid tumors 8.
In the present study, the authors found only one case of central endobronchial nodule characteristic of typical carcinoid tumor, but atypical carcinoid tumors were found as larger and more heterogeneous peripheral masses, more frequently with metastases at diagnosis or follow-up, likewise described in the literature.
Among the typical carcinoid neuroendocrine cancer with liver metastases, only one presented late recurrence of the disease, in the form of mediastinal lymph node enlargement identified at CT follow-up, years after the primary lesion resection. According to the medical literature, imaging findings of both typical and atypical carcinoid tumors are similarly described, being mainly found as well-defined nodules or masses, sometimes lobulated, and when elongated, with the longer axis parallel to the bronchi.
Carcinoid tumors tend to be well vascularized, with prominent contrast enhancement, which also aids in the differentiation between lesions and the commonly associated distal secondary changes pneumonia, atectasis and bronchi with mucoid impaction 9. Despite their similar characteristics, one describes that the presence of a central, well-defined nodule causing narrowing, deformity or obstruction of a bronchus, especially if containing calcifications, is suggestive of a typical carcinoid tumor.
On the other hand, atypical carcinoid tumors tend to be larger, more peripheral distal to the segmental bronchus and more heterogeneous, besides presenting a higher incidence of metastatic lesions at the diagnostic imaging In the present study, the authors described three cases of LCNC, all of them presenting as peripheral heterogeneous masses associated with metatastic disease, and none of the lesions with calcifications. LCNC was the fourth and last tumor subtype to be recognized as a neuroendocrine tumor of the lung, with characteristics that make it different from the typical and atypical carcinoid tumors as well as from the SCLC 3.
It is predominantly found in men 2. Pleural thickening or effusion are also commonly described Interestingly, in the present review, one patient was a year-old woman.
- Papiloma intraductal diagnostico
«АНБ, - подумал .
In the present study, the neuroendocrine cancer with liver metastases described 11 cases of patients with SCLC.
Lesions were similar to those described as most characteristic in the medical literature, with neuroendocrine cancer with liver metastases isolated findings of nodule or peripheral mass. The literature reports that, at the moment of diagnosis, the patient usually presents advanced disease with metastasis, mainly to bones, liver, adrenal glands or brain Findings of atectasis, other lung lesions and pleural effusion are common.
In the present study, lesions with calcifications were not found. More rarely, SCLC presents as a peripheral lung lesion without lymph node enlargement, and in such cases it may be confused with other types of bronchogenic carcinomas and with the other NTLs 1, Probably, the present study's sample of SCLC was underestimated, considering its prevalence and the characteristic of specialized reference hospital of the authors' institution.
The authors believe that such limitation of the present study was related to the fact that only cases with histopathological and immunohistochemical confirmation and radiological exams performed in their own institution were included. In this series of cases, only one patient with lung neoplasia underwent MRI, with a typical carcinoid lesion presenting as a lung nodule.
The role of MRI in the evaluation of lung neoplasms is increasing, particularly in the staging of lesions and in the clinical follow-up of the treatment. However, little has been reported in the literature 15 about MRI in the evaluation of NTL, and its role, particularly regarding diagnostic accuracy in the different histological types of NTL, still requires further investigation.
Bronchogenic carcinoma: radiologic pathologic correlation. Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors. Am J Med. Neuroendocrine tumors of the lung with proposed criteria for large-cell neuroendocrine carcinoma. An ultrastructural, immunohistochemical, and flow cytometric study of 35 cases.
Am J Surg Pathol. Histological typing of lung and pleural tumors. Berlin, Germany: Springer-Verlag; Pulmonary carcinoid tumors: CT assessment. J Comput Assist Tomogr.
METASTATIC CARCINOID TUMOR- ATYPICAL PRESENTATION
Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. A 5-decade analysis of 13, carcinoid tumors. Operative risk and prognostic factors of typical bronchial carcinoid tumors.
Ann Thorac Surg. Bronchial carcinoid tumors: assessment neuroendocrine cancer with liver metastases CT of location and intratumoral calcification in 31 patients. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings.
Large cell neuroendocrine carcinoma of the lung: a year clinicopathologic retrospective study. CT findings of surgically resected large cell neuroendocrine carcinoma of the lung in 38 patients. Lung Cancer.
Small-cell bronchogenic carcinoma: CT evaluation. Diagnosis of bronchial carcinoid tumor by ultrafast contrast-enhanced MR imaging.