Metastases neuroendocrine

Gastric cancer with liver metastases Breast cancer with liver metastases Ovarian cancer with liver metastases Neuroendocrine tumors adrenocortical Eli Completed NCT01262235 Corporation... 

Giraldi, T, Perissin, L., Zorzet, S., Rapozzi, V. and Rodani, M. G. (1994b) Metastasis and neuroendocrine system in stressed mice. Intern. J. Neurosci. 74, 265-278. 

These highly aggressive and rapidly fatal tumors constitute less than 1% of all pancreatic endocrine neoplasms. They are so uncommon that some authors believe a poorly differentiated neuroendocrine carcinoma occurring in the pancreas is most likely a metastasis from an occult primary in the lung. However, there are proven cases of primary in this region." " Many are in fact of ampullary origin, and few are pancreatic. 

Fig. 14.3.Cholangio-MR showing common bile duct stenosis after liver radioembolization. The patient was a 64-year-old man with non-resectable liver metastasis from a neuroendocrine tumor. He became jaundiced 3 months after receiving radioembolization...

In preparation for chemoembolization, all patients fast overnight and are hydrated with intravenous fluids prior to the procedure. Prophylactic antibiotics, corticosteroids (Decadron), and antiemetics (Odanse-tron, Zofran, etc.) are variably given at the outset of the procedure depending on institutional protocols. At MDACC, antibiotics are not administered routinely prior to the procedure but Decadron and Zofran are given. Sedation is typically accomplished by intravenous narcotics (fentanyl and dilaudid), in addition to midazolam HCl (Versed) or other benzodiazepines. For patients with carcinoid or pancreatic neuroendocrine metastasis to the hver, 200 pg of octreotide are given just prior to the procedure and additional doses of octreotide 200 pg, are administered as needed to control the side effects of carcinoid syndrome (carcinoid crisis - hypertension, flushing, etc.). 

Fig. 39.1a-c. A 25-year-old male patient with a history of a neuroendocrine tumor of the pancreas has developed a solitary liver metastasis. The patient was treated according to the local tumor board, a Shows the hypervascularized lesion located in segment 7 of the liver. Control scan (b) immediately after the ablation with the needle still in place showing a successful ablation confirmed in the scan 24 h after treatment (c)... 

Table 2.5.3. Results of chemoembolization in liver metastasis (literature review). (A, Adria Adriamycin, CDDP cisplatin, CoHag bovine collagen, DSM degradable starch microspheres, Epi epirubicin, F, 5-FU 5-fluorouracil, FUDR 5-fluorodeoxy-uridine. Gel gelfoam, M, Mito mitomycin, N/A not available. Neuroend TM neuroendocrine tumors, PVA polyvinyl alcohol, STZ streptozotocin)...

Most patients with neuroendocrine tumor liver metastasis have extensive bilobar involvement. As only one lobe is treated during each embolization session, most patients require a minimum of two treatment sessions in order to treat the entire liver, depending on the hepatic arterial anatomy. An interval of 4 to 6 weeks is recommended between treatment sessions to allow for liver function recovery. 

Immunohistochemical studies relate polysialic acid-NCAM expression to tumor malignancy in neuroblastoma, alveolar rhabdomyosarcoma [189], neuroendocrine lung tumors [190], Wilm s tumor [191], aggressive colon cancers [192], and pancreatic cancer [193]. In studies on the role of polysialic acid in tumor cell behavior, endosialidase has been used as a tool to remove polysialic acid from the surface of cells and tumors. In a metastasis model using human rhabdomyosarcoma TE671 cells, endoNA injected intraperitoneally reduces the expression of polysialic acid and the number of lung and liver metastases formed from intraperi-toneal primary tumors [194]. For comparison, the effect was not seen with intramuscular primary tumors that cannot be reached by the intraperitoneally injected endosialidase. 

Fig. 11.18a,b. Dynamic helical CT of a hypervascular liver metastasis from non-functioning malignant neuroendocrine pancreatic tumor, a The primary tumor (arrow) and the liver metastasis (arrowhead) are similarly enhanced during the arterial phase of liver enhancement. The parenchyma around the metastasis is less dense than the normal left liver lobe due to steal phenomena. This finding is transitory and not depicted in the later phases of the dynamic study (b)... 

Fig. 18.2a-e. Examples of different sonographic presentations of liver metastases. a Isoechoic lesion with hypoechoic halo, lOUS obtained prior to resection of a colonic carcinoma. b Slightly hyperechoic mass with hypoechoic halo and areas of necrosis, primary tumour colon, c Homogeneously hypoechoic lesions are usually well seen, even if small (8 and 12 mm). Primary tumour bronchogenic carcinoma, d Unusual pattern hypoechoic lesion with a hyperechoic halo. Primary testicular carcinoma, on chemotherapy, e Homogeneously hyperechoic metastasis with identical appearances as a typical haemangioma. Primary tumour neuroendocrine carcinoma... 

---