Veena Bheeman, MBBS, MS, Pari M Rajappa, MBBS, MS, Vishwanath M Pai, MBBS, MS, DNB, Dip, MASFr, FRCSGlas, Sandhya Sundaram, MBBS, MD, Sushruthan M, MBBS, MD. Sri Ramachandra Medical College
Introduction: Neuroendrocrine malignancies constitute 0.5% of all cancers. The gastrointestinal tract is the commonest site, followed by the lung. The last decade has seen a steady increase in their incidence. This is a case series of twenty five such tumours and their clinicopathological characteristics
Materials and Methods: Twenty five patients with neuroendocrine tumours of the gastrointestinal tract were studied with reference to their demographic and clinicopathological characteristics. Apart from routine pathological examination, these tumours were also checked for E Cadherin expression as an independent marker of aggressive disease.
Results: The age of our patients ranged from 18 to 67 years. We had 13 female and 12 male patients, contradicting a female preponderance in literature. The vast majority of the tumours we encountered were from the stomach and duodenum, with 5 and 12 patients, respectively. Two tumours were at the gastroduodenal junction, two from the appendix, small intestine and pancreas, each, and one each from the rectum and gall bladder. This is in contrast to literature that shows that neuroendocrine tumours of the GIT most commonly arise from the appendix and small bowel, followed by the rectum, stomach and duodenum. Two of these tumours were functional. The diagnosis was confirmed by immunohistochemistry staining for Chromogranin A and Synaptophysin. Grading was done using WHO criteria that takes into account the mitotic count, Ki 67 Index and necrosis. 21 of our cases were Grade I. Further, Immunohistochemistry for E cadherin showed that absence of expression correlated with more aggressive clinical behavior. 18 out of twenty five patients were operable at presentation and standard resections depending on the organ of origin with adjuvant therapies were given as required. 5 could only be given palliative care. The 2 functional tumours were treated with radiolabelled somatostatin analogues following uptake studies.
Conclusion: As neuroendocrine tumours are relatively rare, information about them is not as abundant as with other malignancies. Absence of E Cadherin expression is associated with more aggressive disease. More studies are required that document the pathological characteristics and clinical behavior in order to offer well rounded treatment protocols that treat not only the primary, but also the generalized effects of the secretions produced by them. Targeted chemotherapy is gaining prominence, but more specific drugs directed at the plethora of receptors these tumours express, could potentially revolutionize treatment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87268
Program Number: P181
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster