The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors

Aaron T Scott; Daniel Pelletier; Jessica E Maxwell; Scott K Sherman; Kendall J Keck; Guiying Li; Joseph S Dillon; Thomas M O'Dorisio; Andrew M Bellizzi; James R Howe

doi:10.1245/s10434-019-07370-3

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The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors

Journal article

Peer reviewed

The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors

Aaron T Scott, Daniel Pelletier, Jessica E Maxwell, Scott K Sherman, Kendall J Keck, Guiying Li, Joseph S Dillon, Thomas M O'Dorisio, Andrew M Bellizzi and James R Howe

Annals of surgical oncology, Vol.26(8), pp.2525-2532

08/2019

DOI: 10.1245/s10434-019-07370-3

PMCID: PMC6612307

PMID: 31011904

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Abstract

The small bowel and pancreas are the most common primary sites of neuroendocrine tumors (NETs) giving rise to metastatic disease. Some patients with small bowel NETs (SBNETs) present with synchronous or metachronous pancreatic NETs (PNETs), and it is unclear whether these are separate primaries or metastases from one site to the other. A surgical NET database including patients undergoing operations for SBNETs or PNETs was reviewed. Patients with synchronous or metachronous tumors in both the small bowel and pancreas were identified, and available tissues from primary tumors and metastases were examined using a 4-gene quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) panel developed for evaluating NETs of unknown primary. Of 338 patients undergoing exploration, 11 had NETs in both the small bowel and pancreas. Tissues from 11 small bowel tumors, 9 pancreatic tumors, and 10 metastases were analyzed. qPCR and IHC data revealed that three patients had separate SBNET and PNET primaries, and five patients had SBNETs that metastasized to the pancreas. Pancreatic tissue was unavailable in two patients, and qPCR and IHC gave discrepant results in one patient. NETs in both the small bowel and pancreas were found in 3% of our patients. In nearly two-thirds of evaluable patients, the pancreatic tumor was a metastasis from the SBNET primary, while in the remaining one-third of patients it represented a separate primary. Determining the origin of these tumors can help guide the choice of systemic therapy and surgical management.

Neuroendocrine Tumors - pathology

Intestinal Neoplasms - surgery

Pancreatic Neoplasms - metabolism

Prognosis

Prospective Studies

Follow-Up Studies

Intestine, Small - pathology

Neuroendocrine Tumors - metabolism

Humans

Intestinal Neoplasms - metabolism

Pancreatic Neoplasms - surgery

Liver Neoplasms - surgery

Lymphatic Metastasis

Neoplasms, Second Primary - surgery

Intestinal Neoplasms - pathology

Neoplasms, Second Primary - metabolism

Pancreatic Neoplasms - secondary

Intestine, Small - surgery

Liver Neoplasms - metabolism

Biomarkers, Tumor - metabolism

Neuroendocrine Tumors - surgery

Intestine, Small - metabolism

Liver Neoplasms - secondary

Neoplasms, Second Primary - pathology

Details

Title: Subtitle: The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors
Creators: Aaron T Scott - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Daniel Pelletier - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Jessica E Maxwell - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Scott K Sherman - Department of Surgery, University of Chicago, Chicago, IL, USA
Kendall J Keck - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Guiying Li - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Joseph S Dillon - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Thomas M O'Dorisio - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Andrew M Bellizzi - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
James R Howe - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA. james-howe@uiowa.edu
Resource Type: Journal article
Publication Details: Annals of surgical oncology, Vol.26(8), pp.2525-2532
DOI: 10.1245/s10434-019-07370-3
PMID: 31011904
PMCID: PMC6612307
NLM abbreviation: Ann Surg Oncol
ISSN: 1068-9265
eISSN: 1534-4681
Publisher: United States
Grant note: UL1 TR002537 / NCATS NIH HHS CA148062-0 / NIH HHS T32 CA148062 / NCI NIH HHS CA174521-01 / NCI NIH HHS P30 CA086862 / NCI NIH HHS UL1TR002537 / NIH HHS P50 CA174521 / NCI NIH HHS
Language: English
Date published: 08/2019
Academic Unit: Pathology; Surgery; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
Record Identifier: 9984051772602771

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