Freezing Fort Knox: Mesenteric Carcinoid Cryoablation

Soule, Erik; Bagherpour, Arya; Matteo, Jerry

doi:10.1159/000479794

Cited by 7 publications

(8 citation statements)

References 8 publications

(8 reference statements)

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“…Thermal ablation is widely achieved by radiofrequency ablation. Other energy sources such as laser 163 and cryoablation 164 have been reported to be used in the treatment of NET liver metastasis. The locally ablative techniques require laparoscopy or imaging guidance (US, CT or MRI, 163 PET/CT 165 ) of the needle/probe to the target lesion to deliver energy.…”

Section: Managementmentioning

confidence: 99%

Management of Gastrointestinal Neuroendocrine Tumors

Wang

Zheng-Pywell

Chen

et al. 2019

Clin Med Insights Endocrinol Diabetes

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Neuroendocrine neoplasms (NENs) are derived from neuroendocrine cell system and can have benign or malignant characteristics. They are rare tumors, but have been increasing in incidence over the past 40 years. Patients with NENs may develop symptoms due to primary tumor invasion, metastasis, or from secretion of hormonally active tumor substances. Multiple imaging modalities are used for diagnosis and staging, including specialty scans such as 111In pentetreotide (Octreoscan) and 68Gallium-DOTATATE, along with endoscopy, endoscopic ultrasound, and biochemical marker testing. Treatment involves both surgical approach, for both primary and metastatic lesions, as well as medical management for symptom management and disease progression. This article will review the current clinical knowledge regarding the diagnosis, treatment, and prognosis of these fascinating neoplasms and the associated hormonal syndromes.

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Section: Managementmentioning

confidence: 99%

Management of Gastrointestinal Neuroendocrine Tumors

Wang

Zheng-Pywell

Chen

et al. 2019

Clin Med Insights Endocrinol Diabetes

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“…NETs demonstrate a strong propensity for metastasis with 82% of NETs showing liver metastasis at autopsy [8]. This case demonstrates a rare case of IVC syndrome seen in a patient with metastatic small bowel NET.…”

Section: Discussionmentioning

confidence: 81%

Inferior Vena Cava Syndrome as a Manifestation of Metastatic Carcinoid Tumor

Stankard

Soule

Matteo

2021

Gastrointest Tumors

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Small bowel-origin carcinoid tumor is indolent but may metastasize relentlessly to various sites, including the liver. Over the past 9 years, we have treated a 69-year-old woman who has undergone 5 percutaneous liver ablations, 5 hepatic intra-arterial chemoembolizations, an ovarian cryoablation, and a trans-ventral hernia mesenteric cryoablation. These interventions are all related to her inoperable carcinoid malignancy. After the patient presented with swelling of the abdomen and both lower extremities, computed tomography (CT) angiography was performed, revealing a circumferential hepatic metastatic mass encasing the intrahepatic inferior vena cava (IVC) and extensive third spacing of fluids specific to the IVC distribution below the diaphragm. A venogram of the intrahepatic IVC revealed extrinsic compression causing 95% narrowing of the vessel. A balloon was advanced to the level of the lesion and inflated, increasing the caliber of the vessel. Subsequently, 2 covered aortic stent graft cuffs were deployed in an overlapping fashion within the lumen of the IVC, traversing the area of narrowing. Next, an open-cell aortic dissection stent was placed across both overlapping aortic stents from the renal veins to the hepatic veins. Following this, three 17-gauge cryoablation probes were inserted into the segment 1 intrahepatic lesions encasing the newly stented IVC via an anterior percutaneous approach. Two 10-min freeze cycles were performed with intraoperative CT imaging, demonstrating circumferential coverage of the lesions. Posttreatment venogram revealed patent stent grafts within the intrahepatic IVC, and restoration of vessel patency. No immediate postoperative complications were noted. The patient’s abdominal and lower extremity swelling resolved completely within 1 week after procedure. Two-month follow-up CT demonstrated markedly decreased size of the metastatic lesions and no adverse effects. Six- and 9-month PET-CT scans demonstrated maintained patency of the IVC stent. This palliative procedure allowed the patient to maintain good performance status and alleviated her symptoms of IVC syndrome. The radial force generated by the multiple aortic stents will ostensibly maintain the patency of the intrahepatic IVC. Cryoablation of the encasing metastatic lesion was performed with markedly decreased size of the tumor on the 2-month follow-up.

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“…Percutaneous cryoablation's analgesic effect due to freezing tissue and nerves makes for a less painful post-operative experience [ 5 ]. Cryoablation has demonstrated an ability to stimulate a potent inflammatory response in the treated tissue by releasing proinflammatory cytokines and immune cells.…”

Section: Discussionmentioning

confidence: 99%

“…They metastasize through lymphatic channels and traditionally spread to the liver. Within the liver, the symptoms of carcinoid syndrome are exhibited by the excretion of serotonin [ 5 ]. These symptoms include diarrhea, flushing, and abdominal pain [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Expanding the Frontiers of Treatment: Cryoablation of an Ovarian Mass

Montanarella¹,

Soule²,

Concepcion³

et al. 2021

Cureus

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The ovaries are a common site of metastasis from a variety of solid organ malignancies. These tumors most commonly originate from the gastrointestinal tract. Neuroendocrine tumors of the small bowel are unrelenting in their tendency to exhibit this type of distant spread, which poses a challenge for curative treatment. Whether metastatic disease to the ovary or primary ovarian malignancy, this is a major cause of morbidity and mortality for women of various ages. Currently, a mainstay of palliative treatment for advanced-stage disease resides in surgical debulking and chemotherapy. At times, these patients may not be surgical candidates due to various reasons which may include a large disease burden. Computed tomography-guided percutaneous cryoablation is a minimally invasive technique that has shown promise in treating solid organ metastatic lesions by exposing them to lethal temperatures. We describe a novel technique of palliative cryoablation of a primary small bowel carcinoid tumor that metastasized to the ovary. Hydrodissection was utilized to create a window for safe percutaneous treatment. At the end of freeze cycles, intraoperative CT was performed, demonstrating greater than 90% incorporation of the ovarian tumor within the margins of the lethal ice zone. Our team decided that this was a maximum percentage of freeze due to neighboring vessels and bowel. The patient tolerated this treatment well, and there were no reported post-operative complications. The procedure was clinically successful at shrinking the tumor as demonstrated on a nine-month follow-up CT. Percutaneous cryoablation is already a widely utilized method for treating tumors in various locations including the kidneys and liver. The application of cryoablation can be expanded as an effective and safe palliative technique for treating ovarian tumors. This may be especially useful in patients that are not surgical candidates.

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Freezing Fort Knox: Mesenteric Carcinoid Cryoablation

Cited by 7 publications

References 8 publications

Management of Gastrointestinal Neuroendocrine Tumors

Management of Gastrointestinal Neuroendocrine Tumors

Inferior Vena Cava Syndrome as a Manifestation of Metastatic Carcinoid Tumor

Expanding the Frontiers of Treatment: Cryoablation of an Ovarian Mass

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