Natural history and clinical outcomes of pancreatic neuroendocrine neoplasms based on the WHO 2017 classification; a single-center experience of 30 years

Fujimori, Nao; Minemura, Masami; Lee, Lingaku; Matsumoto, K.; Takamatsu, Yu; Takaoka, Takehiro; Teramatsu, Katsuhito; Suehiro, Yuta; Murakami, Masatoshi; Igarashi, Hisato; Oono, Takamasa; Ohtsuka, Takao; Nakamura, Masafumi; Koga, Yutaka; Oda, Yoshinao; Ito, Tetsuhide; Ogawa, Yoshihiro

doi:10.1016/j.pan.2020.04.003

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…Ampullary NET was associated with a better prognosis than NEC, as previously reported in PanNEN [3] (Table 1). Table 2 shows the clinicopathological details of all patients with ampullary NEN.…”

Section: Clinicopathological Findings Of Ampullary Nenssupporting

confidence: 81%

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Ampullary Neuroendocrine Neoplasm: Clinicopathological Characteristics and Novel Endoscopic Entity

Matsumoto

Fujimori

Hata

et al. 2022

Dig Dis

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Background: Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of studies examining ampullary NEN makes it difficult to clarify their unique characteristics. This study aimed to elucidate the clinical characteristics of ampullary NEN. Methods: We enrolled 162 patients with PB-NEN diagnosed at Kyushu University Hospital between 2011 and 2020. Clinical features, pathological diagnoses, treatments, and prognoses were retrospectively analyzed. We also compared ampullary NEN with pancreatic NEN (PanNEN). Results: We analyzed 10 ampullary NEN cases and 149 PanNEN cases. The ampullary NEN cases consisted of four cases of NET G1 (neuroendocrine tumor Grade 1), one NET G2 (Grade 2), and five NECs (neuroendocrine carcinoma). The incidences of NEC and cholangitis were significantly higher in ampullary NEN than in PanNEN. All ampullary NETs had a submucosal tumor-like appearance, as identified by endoscopic ultrasound-guided fine needle aspiration. We treated small NET G1 (<10 mm) with endoscopic papillectomy and large NET G1 with pancreaticoduodenectomy. There were no cases of recurrence after resection. All ampullary NECs presented with the characteristic endoscopic finding of a ‘‘crater sign” similar to deep-mining ulcers seen in gastric malignant lymphoma. Four cases underwent surgical resection, and one case was unresectable. Two patients who underwent multidisciplinary treatment were maintained without recurrence for over 2 years. Conclusions: Endoscopic findings showed identifiable distinctions between ampullary NETs and NECs.

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Section: Clinicopathological Findings Of Ampullary Nenssupporting

confidence: 81%

“…Among the pancreato-biliary (PB) regions, which include the pancreas, biliary tract, and ampulla of Vater, the majority of NENs are derived from the pancreas. Pancreatic NEN (PanNEN) has been reported to a certain extent, and its clinical features, including the natural history of disease progression, have been established [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Ampullary Neuroendocrine Neoplasm: Clinicopathological Characteristics and Novel Endoscopic Entity

Matsumoto

Fujimori

Hata

et al. 2022

Dig Dis

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“…It is in ac cor dance with the re sults of Mihalache et al [35] who proved the value of SRS in lo cat ing the tu mor, but he em pha sized that tu mor grading based on the mi totic count and Ki-67 in dex must be es tab lished for ev ery case. Ac cord ing to Fujimori et al [36], Ki-67 in dex of >10 % is one of the sig nif i cant unfa vor able pre dic tors for sur vival of these pa tients.…”

Section: Discussionmentioning

confidence: 70%

The role of somatostatin receptor scintigraphy in the diagnosis and follow-up of the pancreatic neuroendocrine neoplasms

et al. 2020

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The aim of investigation was to assess the role of somatostatin receptor scintigraphy in diagnosis and follow-up of pancreatic neuroendocrine neoplasms. Somatostatin receptor scintigraphy was performed with 740 MBq 99mTc-EDDA/HYNIC TOC for diagnosis of primary tumors and follow-up after the therapy. There were 63 true positive, 24 true negative, 4 false positive, and 6 false negative findings. Sensitivity was 91.3 %, specificity 85.7 %, positive predictive value 94.0 %, negative predictive value 80.0 %, accuracy 89.7 %. The SPECT contributed diagnosis in 28 true positive findings. In 32 patients (33 %) somatostatin receptor scintigraphy significantly changed the management of the patients (10 had surgery, in 17 somatostatin analogues, and in 5 peptide receptor radionuclide therapy was introduced). Mean Ki-67 index in true positive patients was 13.8 ?5.0 % while in true negative 7.1 ? 3.4% which is significantly lower at p < 0.05. There was significantly (p < 0.01) higher number of increased chromogranin A values in true positive than in true negative patients (p = 0.000857). Our results confirmed the value of SRS in the diagnosis and follow-up of the patients with pancreatic neuroendocrine neoplasms PanNEN if primary tumors, recurrences or metastases are suspected, as well as for appropriate choice of the therapy.

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“…Pancreatic neoplasia, especially ductal adenocarcinoma, comprises the third leading cause of cancer death in North America with the highest mortality rate among all major cancers 13–15 . Surgery is the only potentially curative treatment for pancreatic cancer, while systemic and targeted therapies play neoadjuvant, adjuvant or palliative roles 16,17 .…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, the quantity of tissue in pancreas biopsies is often limited. In addition, AIP may present as a mass‐forming lesion 8–21 . Therefore, if mass‐targeted biopsy shows non‐neoplastic tissue with inflammatory features, it may raise the differential of AIP.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of histological features resembling autoimmune pancreatitis in neoplastic pancreas resections

2020

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Prevalence of histological features resembling autoimmune pancreatitis in neoplastic pancreas resections Aims: Types 1 and 2 autoimmune pancreatitis (AIP) can mimic pancreatic neoplasia. Due to the small quantity of tissue in mass-targeted pancreas biopsies, inflammatory features may raise the differential of AIP. However, the frequency of AIP-like histology in neoplastic pancreas is not well characterised. Therefore, the specificity of inflammatory lesions on biopsy with respect to the diagnosis of AIP is uncertain. Methods and results: Neoplastic pancreas resections performed at our institution between 2008 and 2019 were retrospectively reviewed. Features of AIP types 1 and 2 were assessed in the non-neoplastic areas. If features of immunoglobulin (Ig)G4-associated AIP were seen, IgG4 immunohistochemistry was performed. We identified 163 neoplastic pancreas resections. Of these, 34 had one or more types of inflammatory lesions in non-neoplastic pancreatic tissue. Dense lymphoplasmacytic inflammation mimicking type 1 AIP was found in six cases with mild to moderately increased IgG4-positive plasma cells. Neutrophilic infiltrates in small intralobular ducts were found in 20 cases. Mild extralobular ductitis or duct microabscess was found in 10 specimens. Marked neutrophilic duct destruction that resembled granulocytic epithelial lesions was found in 12 cases. Some cases showed multiple features. Conclusion: Approximately 20% of neoplastic pancreas resections showed focal areas that could raise the differential of AIP. More cases showed neutrophilic predominant inflammation as seen in type 2 autoimmune pancreatitis, compared to dense lymphoplasmacytic infiltrates seen in type 1 AIP. Pathologists must be cautious when making a diagnosis of AIP on biopsy tissue based on histological findings alone.

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Natural history and clinical outcomes of pancreatic neuroendocrine neoplasms based on the WHO 2017 classification; a single-center experience of 30 years

Cited by 13 publications

References 17 publications

Ampullary Neuroendocrine Neoplasm: Clinicopathological Characteristics and Novel Endoscopic Entity

Ampullary Neuroendocrine Neoplasm: Clinicopathological Characteristics and Novel Endoscopic Entity

The role of somatostatin receptor scintigraphy in the diagnosis and follow-up of the pancreatic neuroendocrine neoplasms

Prevalence of histological features resembling autoimmune pancreatitis in neoplastic pancreas resections

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