Gastric neuroendocrine tumor: A practical literature review

Roberto, Gabriel Antônio; Rodrigues, Carolina Magalhães Britto; Peixoto, Renata D’Alpino; Younes, Riad Naim

doi:10.4251/wjgo.v12.i8.850

Cited by 32 publications

(39 citation statements)

References 41 publications

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“…[ 16 , 39 ] According to the recent WHO classification system, tumor is a NEC, with aggressive behaviour, vascular invasion, and metastases. [ 40 ]…”

Section: Discussionmentioning

confidence: 99%

Gastric neuroendocrine neoplasms and precursor lesions

et al. 2022

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Rationale: Gastric neuroendocrine neoplasms (g-NENs) represent a distinctive group of gastric tumors, stratified into different prognostic categories according to different histological characteristics, put forth in the 2018 World Health Organization classification system. The clinical presentations, as well as pathological features, represent important data in establishing the type of the tumor, in estimating the tumor behavior, and in selecting the best therapeutic strategy. In our case series we presented different clinical scenarios that may be encountered in practice regarding gastric NENs. We performed a literature review and discussed diagnostic strategy, current classification system, precursor lesions, and therapeutic options in g-NENs. Patient concerns: The first patient was a 41-year-old female with weight loss, persistent dyspeptic complaints and a history of pernicious anemia. In the second clinical case a 61-year-old man was admitted with heartburn, abdominal pain, diarrhea and mild iron deficiency anemia. The third patient was a 56-year-old male with a history of neoplasia, admitted for weight loss, dyspeptic complaints, and liver metastases. Diagnosis: All the 3 patients underwent upper endoscopy with targeted biopsies. Histopathological and laboratory evaluation, together with imagistic evaluation (abdominal ultrasound, endoscopic ultrasound, and magnetic resonance imaging) allowed the distinction between 3 different types of gastric tumors: type 1 enterochromaffin-like-cell G1 NET, type 2 enterochromaffin-like-cell G2 NET, and type 3 G2 NET with liver metastases. Interventions: Endoscopic polypectomy of the largest lesion was performed in patient with type 1 g-NET and autoimmune chronic atrophic gastritis, followed by regular endoscopic surveillance with biopsies. In type 2 g-NET associated with pancreatic gastrinoma, pancreaticoduodenectomy with total gastrectomy were performed. In type 3 g-NET, detected in metastatic stage, oncologic therapy was performed. Outcomes: The patients follow-up was selected according to tumor behavior, from regular endoscopic surveillance to oncology follow-up. The prognosis was good in case 1, whilst poorer outcomes were associated with more aggressive tumors in case 2 and case 3. Lessons: g-NENs are rare tumors with distinct clinical and histological features. Our case series emphasized the role of close collaboration between clinician and pathologist, as well as the importance of a detailed pathology report.

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“…[ 16 , 39 ] According to the recent WHO classification system, tumor is a NEC, with aggressive behaviour, vascular invasion, and metastases. [ 40 ]…”

Section: Discussionmentioning

confidence: 99%

Gastric neuroendocrine neoplasms and precursor lesions

et al. 2022

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“…Parietal cell antibodies are present in 80%. This type is less aggressive, and the prognosis is excellent[ 14 ].…”

Section: Clinical Profiles Of Gep-nens Based On the Location Of Tumormentioning

confidence: 99%

“…Hypergastrinaemia results in hyperplasia and hypertrophy of ECL cells resulting in multiple, small (approximately 1 cm) NENs that are less aggressive with good prognosis. The gastric pH will be low and abdominal pain and diarrhoea will be present[ 14 ]. Patients with type 2 gastric NENs should be investigated for pituitary and parathyroid disease in view of the frequent association with MEN1.…”

Section: Clinical Profiles Of Gep-nens Based On the Location Of Tumormentioning

confidence: 99%

Gastroenteropancreatic neuroendocrine neoplasms: A clinical snapshot

Fernandez¹,

Agarwal²,

Pottakkat³

et al. 2021

WJGS

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Our understanding about the epidemiological aspects, pathogenesis, molecular diagnosis, and targeted therapies of neuroendocrine neoplasms (NENs) have drastically advanced in the past decade. Gastroenteropancreatic (GEP) NENs originate from the enteroendocrine cells of the embryonic gut which share common endocrine and neural differentiation factors. Most NENs are well-differentiated, and slow growing. Specific neuroendocrine biomarkers that are used in the diagnosis of functional NENs include insulin, glucagon, vasoactive intestinal polypeptide, gastrin, somatostatin, adrenocorticotropin, growth hormone releasing hormone, parathyroid hormone-related peptide, serotonin, histamine, and 5-hydroxy indole acetic acid (5-HIAA). Biomarkers such as pancreatic polypeptide, human chorionic gonadotrophin subunits, neurotensin, ghrelin, and calcitonin are used in the diagnosis of non-functional NENs. 5-HIAA levels correlate with tumour burden, prognosis and development of carcinoid heart disease and mesenteric fibrosis, however several diseases, medications and edible products can falsely elevate the 5-HIAA levels. Organ-specific transcription factors are useful in the differential diagnosis of metastasis from an unknown primary of well-differentiated NENs. Emerging novel biomarkers include circulating tumour cells, circulating tumour DNA, circulating micro-RNAs, and neuroendocrine neoplasms test (NETest) (simultaneous measurement of 51 neuroendocrine-specific marker genes in the peripheral blood). NETest has high sensitivity (85%-98%) and specificity (93%-97%) for the detection of gastrointestinal NENs, and is useful for monitoring treatment response, recurrence, and prognosis. In terms of management, surgery, radiofrequency ablation, symptom control with medications, chemotherapy and molecular targeted therapies are all considered as options. Surgery is the mainstay of treatment, but depends on factors including age of the individual, location, stage, grade, functional status, and the heredity of the tumour (sporadic vs inherited). Medical management is helpful to alleviate the symptoms, manage inoperable lesions, suppress postoperative tumour growth, and manage recurrences. Several molecular-targeted therapies are considered second line to somatostatin analogues. This review is a clinical update on the pathophysiological aspects, diagnostic algorithm, and management of GEP NENs.

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“…Gastric neuroendocrine neoplasia (gNEN) is a heterogeneous group representing the most frequent gastroenteropancreatic NEN. Although gNENs account for less than 2% of gastric neoplasms, their incidence has been rising over the past 30 years due to the increasing use of upper endoscopy [ 1 ]. Concerning their different behaviours and prognoses, gNENs are clinically divided into three major types [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Tumour progression is promoted by hypergastrinemia as a consequence of acid suppression and loss of parietal cells of the gastric body mucosa [ 5 , 6 ]. Type I gNENs are diagnosed during endoscopies of the upper gastrointestinal tract usually carried out for anaemia or nonspecific symptoms (e.g., dyspepsia), corresponding to 0.6-2% of gastric polyp cases [ 1 ]. They are usually small and multifocal polyps appearing pale and yellowish with transparent blood vessels under white light endoscopy, while when using electronic chromoendoscopy, they present as regular mucosal and vascular patterns with central erosion and sometimes with a clear demarcation line [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Endoscopic Techniques in the Management of Type I Gastric Neuroendocrine Neoplasia: A Systematic Review

Panzuto

Esposito

Rinzivillo

et al. 2021

Gastroenterology Research and Practice

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Background. Endoscopic resection is considered the treatment of choice for type I gastric neuroendocrine neoplasia (gNEN) given its indolent behaviour; however, the favoured endoscopic technique to remove these tumours is not well established. Aims. This systematic review is aimed at investigating the best endoscopic management for type I gNEN. Methods. PubMed Central/Medline and Scopus were systematically searched for records up to August 31, 2020. Results. After screening the 675 retrieved records, 6 studies were selected for the final analysis. The main endoscopic resection techniques described were endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Overall, 112 gNENs were removed by EMR and 77 by ESD. Both techniques showed similar results for complete and en bloc resection (97.4% and 98.7%; 92.3% and 96.3% with ESD and EMR, respectively). ESD was associated with a higher rate of complications than EMR (11.7% vs. 5.4%), but this difference was not statistically significant ( p = 0.17 ). The rates of recurrence during follow-up were 18.2% and 11.5% for EMR and ESD, respectively. Conclusions. To date, there are no sufficient data showing superiority of a given endoscopic technique over others. Both ESD and EMR seem to be effective in the management of type I gNEN, with a relatively low rate of recurrence.

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Gastric neuroendocrine tumor: A practical literature review

Cited by 32 publications

References 41 publications

Gastric neuroendocrine neoplasms and precursor lesions

Gastric neuroendocrine neoplasms and precursor lesions

Gastroenteropancreatic neuroendocrine neoplasms: A clinical snapshot

Comparison of Endoscopic Techniques in the Management of Type I Gastric Neuroendocrine Neoplasia: A Systematic Review

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