Pancreatic and Ileal Neuroendocrine Tumors: Metastatic Disease or a Novel MEN Syndrome?

IF 4.5 1区 医学 Q1 PATHOLOGY
American Journal of Surgical Pathology Pub Date : 2024-11-01 Epub Date: 2024-07-22 DOI:10.1097/PAS.0000000000002290
Sylvia L Asa, Amr Mohamed
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引用次数: 0

Abstract

Multiple endocrine neoplasms are a feature of multiple endocrine neoplasia (MEN) syndromes types 1, 2, 4, and 5. However, the ileum is not usually involved in these disorders. We report a series of patients with neuroendocrine tumors (NETs) involving both the pancreas and the ileum. We searched the laboratory information system and personal consultation records of the authors from 2019 to 2023 for patients who had neuroendocrine tumors (NETs) involving both the pancreas and ileum. In a series of 846 patients, we identified 4 patients with pancreatic and ileal NETs, 2 female and 2 male, ages 52 to 75. Two female patients had primary EC cell tumors of the ileum with metastasis to the pancreas that showed expression of CDX2 and serotonin similar to the ileal primary tumors. Two males had primary lesions in the 2 sites with different immunoprofiles; the ileal tumors expressed CDX2 and serotonin and were negative for ARX, whereas the pancreatic tumors expressed ARX, glucagon, and pancreatic polypeptide and were negative for CDX2 and serotonin. In both male patients, the nontumorous pancreas showed preneoplastic changes in the endocrine elements, suggesting germline predisposition to endocrine neoplasia. Testing for known genetic alterations underlying MEN syndromes has not identified a genetic alteration that can be implicated in the development of NETs in both pancreas and ileum. Our series indicates the rare occurrence of NETs in both the pancreas and ileum and emphasizes the importance of using the correct biomarkers to distinguish metastasis from primary neoplasms at the different sites. The rare occurrence of primary ileal and pancreatic NETs may represent a novel MEN syndrome with as yet unknown germline predisposition.

胰腺和回肠神经内分泌肿瘤:转移性疾病还是新型 MEN 综合征?
多发性内分泌肿瘤是多发性内分泌肿瘤综合征(MEN)1、2、4 和 5 型的特征之一。然而,这些疾病通常不会累及回肠。我们报告了一系列同时累及胰腺和回肠的神经内分泌肿瘤(NET)患者。我们检索了作者在2019年至2023年期间的实验室信息系统和个人就诊记录,以寻找同时累及胰腺和回肠的神经内分泌肿瘤(NET)患者。在一系列846名患者中,我们发现了4名胰腺和回肠NET患者,2女2男,年龄在52岁至75岁之间。两名女性患者的回肠原发性EC细胞肿瘤转移至胰腺,其CDX2和5-羟色胺的表达与回肠原发性肿瘤相似。两名男性患者的原发病灶位于两个部位,但免疫特征不同;回肠肿瘤表达CDX2和5-羟色胺,ARX阴性;而胰腺肿瘤表达ARX、胰高血糖素和胰多肽,CDX2和5-羟色胺阴性。在这两名男性患者中,非肿瘤性胰腺的内分泌元件出现了肿瘤前病变,这表明他们具有内分泌肿瘤的种系易感性。在对 MEN 综合征的已知基因改变进行检测后,尚未发现一种基因改变可导致胰腺和回肠均发生 NET。我们的系列研究表明,胰腺和回肠均罕见NET,并强调了使用正确的生物标志物区分不同部位的转移瘤和原发性肿瘤的重要性。原发性回肠和胰腺NET的罕见发生可能代表了一种新的MEN综合征,其种系倾向尚不清楚。
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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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