Neuroendocrine Tumours If you don t suspect it you can t detect it! Dr JWS Devar HPB Surgeon University of Witwatersrand E-AHPBA CHBAH & WDGMC

Save this PDF as:
Size: px
Start display at page:

Download "Neuroendocrine Tumours If you don t suspect it you can t detect it! Dr JWS Devar HPB Surgeon University of Witwatersrand E-AHPBA CHBAH & WDGMC"

Transcription

1 Neuroendocrine Tumours If you don t suspect it you can t detect it! Dr JWS Devar HPB Surgeon University of Witwatersrand E-AHPBA CHBAH & WDGMC

2 Case Study 43 yr old female with a history of a left mastectomy in 2014 and adjuvant chemo and DXT for Breast Ca. No medical co morbidities March 2018 complaining of abd pain, particularly post prandially Clinical Examination non contributary FBC/U&E/LFT/INR/CEA/Ca 19.9/AFP normal

3 CT scan

4 CT scan & DDx?

5 FNA Grade 1 Neuroendocrine Tumour Dotatoc PET CT scan confirmed neuroendocrine tumour in the HOP and metastases in the Right liver. Options?

6 Pancreaticoduodenectomy

7 Cells of Origin Stem cell Gastrointestinal neuroendocrine lineages arise from a common stem cell precursor in the base of the intestinal crypts or in the neck of the gastric glands Differentiate into diverse types of neuroendocrine cells under the influence of transcription factors Math1 and neurogenin 3 (NGN3) Non-secretory cell lineage Secretory lineages Math1+ NGN3+ Enterocytes Goblet cells Paneth cells Endocrine cell lineages Beta2 Pax4 Pax6 Endocrine cell types Gastrin Secretin CCK SST GIP 5-HT SP GLP-1, PYY/NT Image courtesy of IM Modlin.

8 PITUITARY THYROID, PARATHYROID LUNG, THYMUS ADRENAL MEDULLA & PARAGANGLIA GI tract, PANCREAS SKIN

9

10 GEP-NET Registry 1005 patients July 2009 Dec 2012 PNETs 42% 60% non-functional NETS

11 Background Heterogenous group of tumors of the diffuse neuroendocrine system Histology intracellular markers of endocrine cells (serotonin, cathecholamines, neuron specific enolase, synaptophysin, chromogranins A/B ) Majority Sporadic and 40-50% have metastatic disease at presentation 60-90% are Non Functional Minority Genetic Syndromes(MEN 1,MEN 2,NF, von Hippel Lindau and Tuberous sclerosis)

12 NET Are the Second Most Prevalent Type of Gastrointestinal Malignancy 1,200, 000 1,100, 000 2x more prevalent than pancreatic cancer 100, Colorectal 1 GEP-NET 2 Stomach 1 Pancreas 1 Esophagus 1 Hepatobiliary 1 Prevalence in SEER Database 1. National Cancer Institute. SEER Cancer Statistics Review, Modlin IM, Lye KD, Kidd M. Cancer. 2003;97(4):

13 Incidence of NETs per 100,000 Incidence of all malignant neoplasms per 100,000 The Overall Incidence of NET Is Increasing Compared With All Malignant Neoplasms 6.00 Incidence of all malignant neoplasms Incidence of neuroendocrine tumours Year The incidence and prevalence of NET has increased approximately 500% over the past 30 years which may be partially due to improved diagnosis 0 Source: US SEER database. Adapted with permission from Yao JC, et al. J Clin Oncol. 2008:26:

14 Oncogenesis

15 Diagnosis/staging Majority are found incidentally during routine imaging Functional symptoms related to the cell of origin(diarrhoea, flushing, sweating, palpitations, swinging blood pressures) Biochemistry: Screening tests: U-5HIAA, U-VMA,cortisol General markers: chromogranins Specific markers: hormones, pro-hormones, gastrin, etc

16 Neuroendocrine Cells Are Peptide Hormone-Producing Cells that Share a Neural-Endocrine Phenotype Synaptophysin Small synaptic vesicles Chromogranin A Membrane protein of neurosecretory granules Peptide hormone In neurosecretory granule Secreted into the serum biomarkers Klöppel G. et al. International Collaboration on Neuroendocrine Tumours. Vienna, Austria NET

17 Chromogranin/Secretogranins Water-soluble acidic glycoproteins in NETs CgA: 439 peptide molecule most used CgB: secretogranin I selective use CgC: secretogranin II - rarely used Cgs are NOT secreted by non-nets

18 Usefulness of Cgs Plasma CgA is increased in most NETs pcga levels are proportionate to tumor size Plasma Cg more reliable than urine metabolites CgB can be used as a complement and clinical trials

19 Non-tumor increases of CgA Renal & Liver Failure Chronic gastritis PPIs Stimulation of the sympathetic nervous system IBD

20 How to diagnose NET s Anatomical Imaging CT scan MRI bone, spine, now liver Functional Imaging Octreoscan sstr2 MIBG Gallium PET (Dotatate/Dotanoc/Dotatoc) G1 and G2 Ki 67 <10% GLP1 for Insulinomas FDG PET G2/G3 lesions Ki67>10%

21 How to diagnose a NET EUS FNA make the diagnosis Cell block can help with grading Core Biopsy best for establishing the Grade

22 Ki67 Counting Options to quantify Ki67 1. Percentage of actively dividing tumour cells in a 2000 cell count 1. Using a computerized digital image analysis system to measure the positive percentage The result should be reported as a single percentage

23 WHO 2010

24 WHO 2017 Grading Change

25 WHO 2017

26 Cumulative Survival Grading of GEP-NENs According to ENETS/WHO/AJCC G1 G G1 vs. G2 G1 vs. G3 G2 vs. G3 P=0.040 P P G Time (months) * 10 High power field (HPF) = 2 mm 2 at least 40 fields (40x magnification) evaluated in areas of highest mitotic density Percent of 2000 tumour cells in areas of highest nuclear labelling with MIB1 antibody. Pape UF et al. Cancer. 2008;113:

27 Indications for Surgery Resectable Primary NETS - surgery best option Resectable metastatic disease Resection of the primary lesion in non-resectable metastatic disease? Unresectable Symptomatic Primary Debulking Hepatic Metastatic disease with good prognostic indices Liver Transplant

28 Laparoscopic Distal pancreatectomy

29 Who should receive Debulking Surgery? Patients with obstructive symptoms Mesenteric vascular compromise Life threatening hormone related symptoms Ideally aim for 90% debulking Other debulking options RFA Microwave ablation Arterial & chemoembolisation Cryotherapy Radioembolisation - SIRT

30

31 Advanced locoregional Functional tumours Symptom control Symptom control SSA sandostatin/lanreotide Locoregional therapies/debulking surgery Pasireotide no benefit COOPERATE 2 trial IFN-alpha Telotristat serotonin synthesis inhibitor

32 Management of metastatic Midgut NENs First line Therapy

33 Advanced locoregional Disease Non Functional tumour Antiproliferation effect. Watch wait - low Ki67 and low tumour burden Sandostatin/Lanreotide Midgut G1/G2 NET s Promid/Clarinet Studies PNET s Ki67 index < 10% High liver tumour burden >25%

34 Disease Progression in PNETs Everolimus/Sunitinib

35 Radiant-4 Lung and midgut NENs Everolimus PFS 11mnths Placebo 3.9 mnths Confirmed findings in Radiant-2 Now part of ENETs guidelines for midgut & Lung SUNLAND trial still pending Sunitinib.

36 Disease Progression in Mid Gut NET s

37

38

39 Role of Systemic chemotherapy G2 disease with rapid progression < 6mnths or Ki67 >10% 5FU/Streptozocin Temozolomide/Capecitabine G3b Ki67% >20 & poor differentation Cisplatinum and Etoposide

40 Median survival (months) Improving Access to Specialised Care Potentially Improves Patient Outcomes 160 Median survival of patients Multidisciplinary centres have improved survival Median survival of patients is 3 times in high volume centres Data are consistent between centres of excellence Median survival of patients Centre-specific 1-3 data Population based data SEER database 1 SEER database 1 SEER database 1 (all NET patients) (all NET patients) (all NET patients) Midgut metastatic carcinoid only Moffitt Cancer Centre 2 Midgut metastatic carcinoid only Uppsala Centre 3 Midgut metastatic carcinoid only Berlin / Paris 4 1. Yao JC, et al. J Clin Oncol 2008;26: Strosberg J. Poster presented at ASCO GI 2008; 3. Öberg K. Oral presentations at ENETS, CCNETS, and NANETS, Jann et al Cancer, 2011;117:

41

42 Take Home Second most important GIT malignancy Incidence is on the rise Surgery upfront if resectable Metastatic disease can be well controlled Overall survival is better if treated in a high volume centre New trials for targeted therapy Radiant 4 - positive Netter 1- positive Importance of a NET MDT

Gastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors

Gastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors Gastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors Jaume Capdevila, MD, PhD Vall d'hebron University Hospital Vall d'hebron Institute of Oncology (VHIO)

More information

TRACTAMENT ONCOLÒGIC DELS TUMORS NEUROENDOCRINS METASTÀSICS

TRACTAMENT ONCOLÒGIC DELS TUMORS NEUROENDOCRINS METASTÀSICS TRACTAMENT ONCOLÒGIC DELS TUMORS NEUROENDOCRINS METASTÀSICS Jaume Capdevila Unitat de Tumors GI i Endocrins Hospital Universitari Vall d Hebron Barcelona Experts, acollidors i solidaris OUTLINE BACKGROUND

More information

NeuroEndocrine Tumors Diagnostic and therapeutic challenges: introduction

NeuroEndocrine Tumors Diagnostic and therapeutic challenges: introduction NeuroEndocrine Tumors Diagnostic and therapeutic challenges: introduction Prof Eric Van Cutsem, MD, PhD Gastroenterology/Digestive Oncology Leuven, Belgium Eric.VanCutsem@uzleuven.be Diagnostic & therapeutic

More information

NET und NEC. Endoscopic and oncologic therapy

NET und NEC. Endoscopic and oncologic therapy NET und NEC Endoscopic and oncologic therapy Classification well-differentiated NET - G1 and G2 - carcinoid poorly-differentiated NEC - G3 - like SCLC well differentiated NET G3 -> elevated proliferation

More information

PNET 3/7/2015. GI and Pancreatic NETs. The Postgraduate Course in Breast and Endocrine Surgery. Decision Tree. GI and Pancreatic NETs.

PNET 3/7/2015. GI and Pancreatic NETs. The Postgraduate Course in Breast and Endocrine Surgery. Decision Tree. GI and Pancreatic NETs. GI and Pancreatic NETs The Postgraduate Course in Breast and Endocrine Surgery Disclosures Ipsen NET Advisory Board Marines Memorial Club and Hotel San Francisco, CA Eric K Nakakura San Francisco, CA March

More information

GI CARCINOID Dr Mussawar Iqbal Consultant Oncologist Hull and East Yorkshire Hospitals NHS Trust

GI CARCINOID Dr Mussawar Iqbal Consultant Oncologist Hull and East Yorkshire Hospitals NHS Trust GI CARCINOID Dr Mussawar Iqbal Consultant Oncologist Hull and East Yorkshire Hospitals NHS Trust Introduction Carcinoid was old term, introduced in 1906 by German pathologist Cancinoma like More recent

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL NEUROENDOCRINE GASTRO-ENTERO-PANCREATIC TUMOURS GI Site Group Neuroendocrine gastro-entero-pancreatic tumours Authors: Dr.

More information

Treatment algorithm Neuroendocrine tumours. Gregory Kaltsas Endocrine Unit, Department of Pathophysiology, University of Athens, Greece

Treatment algorithm Neuroendocrine tumours. Gregory Kaltsas Endocrine Unit, Department of Pathophysiology, University of Athens, Greece Treatment algorithm Neuroendocrine tumours Gregory Kaltsas Endocrine Unit, Department of Pathophysiology, University of Athens, Greece Outline Presenting a meaningful algorithm Means used to develop algorithm

More information

An Overview of NETS. Richard R.P. Warner M.D

An Overview of NETS. Richard R.P. Warner M.D An Overview of NETS Richard R.P. Warner M.D Diagnosis and Treatment Approaches Carcinoid (and other NETs) not as benign as originally described 13-50% of all carcinoids have distant metastases when first

More information

NICaN Pancreatic Neuroendocrine Tumour SACT protocols. 1.0 Dr M Eatock Final version issued

NICaN Pancreatic Neuroendocrine Tumour SACT protocols. 1.0 Dr M Eatock Final version issued Reference No: Title: Author(s) Systemic Anti-Cancer Therapy (SACT) Guidelines for Pancreatic Neuro-endocrine Tumours Dr Martin Eatock, Consultant Medical Oncologist & on behalf of the GI Oncologists Group,

More information

SCOPE TODAYS SESSION. Case 1: Case 2. Basic Theory Stuff: Heavy Stuff. Basic Questions. Basic Questions

SCOPE TODAYS SESSION. Case 1: Case 2. Basic Theory Stuff: Heavy Stuff. Basic Questions. Basic Questions MONDAY TEACHING SCOPE TODAYS SESSION Case 1: Basic Questions Case 2 Basic Questions Basic Theory Stuff: AJCC TNM + Stage Group for Carcinoid of the Appendix Management of Carcinoid of the Appendix (NCCN)

More information

NET εντέρου Τι νεότερο/ Νέες μελέτες. Μαντώ Νικολαΐδη παθολόγος-ογκολόγος ΜΗΤΕΡΑ

NET εντέρου Τι νεότερο/ Νέες μελέτες. Μαντώ Νικολαΐδη παθολόγος-ογκολόγος ΜΗΤΕΡΑ NET εντέρου Τι νεότερο/ Νέες μελέτες Μαντώ Νικολαΐδη παθολόγος-ογκολόγος ΜΗΤΕΡΑ NET: A Diverse Group of Malignancies 1-3 Wide spectrum of malignancies arising in neuroendocrine cells throughout the body

More information

MEDICAL MANAGEMENT OF METASTATIC GEP-NET

MEDICAL MANAGEMENT OF METASTATIC GEP-NET MEDICAL MANAGEMENT OF METASTATIC GEP-NET Jeremy Kortmansky, MD Associate Professor of Clinical Medicine Yale Cancer Center DISCLOSURES: NONE Introduction Gastrointestinal and pancreatic neuroendocrine

More information

Diagnosing and monitoring NET

Diagnosing and monitoring NET Diagnosing and monitoring NET Inaccurate or delayed diagnosis of neuroendocrine tumors (NET) is common, because many NET are small and asymptomatic. 1 When symptoms are present, they are usually nonspecific

More information

Neuroendocrine Tumors: Just the Basics. George Fisher, MD PhD

Neuroendocrine Tumors: Just the Basics. George Fisher, MD PhD Neuroendocrine Tumors: Just the Basics George Fisher, MD PhD Topics that we will not discuss Some types of lung cancer: Small cell neuroendocrine lung cancer Large cell neuroendocrine lung cancer Some

More information

Oberndofer 1907 Illeal Serotonin Secreting Tumor Carcinoid (Karzinoide)

Oberndofer 1907 Illeal Serotonin Secreting Tumor Carcinoid (Karzinoide) GEP-NET Adel K. El-Naggar, M.D., Ph.D. The University of Texas MD Anderson Cancer Center, Houston, Texas Oberndofer 1907 Illeal Serotonin Secreting Tumor Carcinoid (Karzinoide) 1 Histogenesis 16 different

More information

Management of Neuroendocrine Tumors

Management of Neuroendocrine Tumors Management of Neuroendocrine Tumors Professor Barbro Eriksson Department of Endocrine Oncology ENETS Centre of Excellence Uppsala University Hospital Diagnostic Challenges in NET Heterogeneous group of

More information

WHAT TO EXPECT IN 2015? - Renuka Iyer, MD Associate Professor of Medicine, University at Buffalo Associate Professor of Oncology, Roswell Park Cancer

WHAT TO EXPECT IN 2015? - Renuka Iyer, MD Associate Professor of Medicine, University at Buffalo Associate Professor of Oncology, Roswell Park Cancer WHAT TO EXPECT IN 2015? - Renuka Iyer, MD Associate Professor of Medicine, University at Buffalo Associate Professor of Oncology, Roswell Park Cancer Institute Overview Diagnosis: Gallium scan Biomarkers

More information

Review of Gastrointestinal Carcinoid Tumors: Latest Therapies

Review of Gastrointestinal Carcinoid Tumors: Latest Therapies Review of Gastrointestinal Carcinoid Tumors: Latest Therapies Arvind Dasari, MD, MS Department of Gastrointestinal Medical Oncology The University of Texas MD Anderson Cancer Center Houston, TX, USA Neuroendocrine

More information

Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14

Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14 Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14 Contents 14. Neuroendocrine Tumours 161 14.1. Diagnostic algorithm

More information

EXOCRINE: 93% Acinar Cells Duct Cells. ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others

EXOCRINE: 93% Acinar Cells Duct Cells. ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others EXOCRINE: 93% Acinar Cells Duct Cells Digestive Enzymes Trypsin: Digests Proteins Lipases: Digests Fats Amylase: Digest Carbohydrates ENDOCRINE: 5% Alpha Cells Beta Cells Delta Cells Others Hormones Glucagon

More information

GEP NEN. Personalised approach. Curative and Palliative Surgery. ESMO Preceptorship Programme Neuroendocrine Neoplasms Lugano April 2018

GEP NEN. Personalised approach. Curative and Palliative Surgery. ESMO Preceptorship Programme Neuroendocrine Neoplasms Lugano April 2018 GEP NEN Personalised approach Curative and Palliative Surgery ESMO Preceptorship Programme Neuroendocrine Neoplasms Lugano 13 14 April 2018 Professor Andrea Frilling Department of Surgery and Cancer Imperial

More information

Fast, automated, precise

Fast, automated, precise Thermo Scientific B R A H M S / NSE Immunodiagnostic Assays Fast, automated, precise Neuroendocrine tumor markers on KRYPTOR Systems First and only fully automated CgA assay worldwide Shortest time to

More information

Hepatobiliary and Pancreatic Malignancies

Hepatobiliary and Pancreatic Malignancies Hepatobiliary and Pancreatic Malignancies Gareth Eeson MD MSc FRCSC Surgical Oncologist and General Surgeon Kelowna General Hospital Interior Health Consultant, Surgical Oncology BC Cancer Agency Centre

More information

Color Codes Pathology and Genetics Medicine and Clinical Pathology Surgery Imaging

Color Codes Pathology and Genetics Medicine and Clinical Pathology Surgery Imaging Saturday, November 5, 2005 8:30-10:30 a. m. Poorly Differentiated Endocrine Carcinomas Chairman: E. Van Cutsem, Leuven, Belgium 9:00-9:30 a. m. Working Group Sessions Pathology and Genetics Group leaders:

More information

NEUROENDOCRINE CARCINOID TUMORS PANCREATIC NEUROENDOCRINE TUMORS

NEUROENDOCRINE CARCINOID TUMORS PANCREATIC NEUROENDOCRINE TUMORS University of Miami Jackson Memorial Hospital Role of the Surgeon in the Approach to Neuroendocrine tumors Dido Franceschi, MD Professor of Surgery University of Miami Karzinoide Siegfried Oberndorfer,

More information

A New Proposal for Metabolic Classification of NENs Stefano Severi IRST Meldola Italy

A New Proposal for Metabolic Classification of NENs Stefano Severi IRST Meldola Italy RADIONUCLIDE THERAPY AND ALLIED SCIENCE President: Giovanni Paganelli Chairman: Maria Salvato Baltimore USA Domenico Barone Meldola Italy A New Proposal for Metabolic Classification of NENs Stefano Severi

More information

Neuroendocrine Tumors

Neuroendocrine Tumors Neuroendocrine Tumors Neuroendocrine tumors arise from cells that release a hormone in response to a signal from the nervous system. Neuro refers to the nervous system. Endocrine refers to the hormones.

More information

Tumor markers. Chromogranin A. Analyte Information

Tumor markers. Chromogranin A. Analyte Information Tumor markers Chromogranin A Analyte Information -1-2018-04-22 Chromogranin A Introduction Chromogranin A (CgA) is a 439-amino acid protein with a molecular weight of 48 to 60 kda, depending on glycosylation

More information

Toward More Aggressive Management of Neuroendocrine Tumors: Current and Future Perspectives

Toward More Aggressive Management of Neuroendocrine Tumors: Current and Future Perspectives Toward More Aggressive Management of Neuroendocrine Tumors: Current and Future Perspectives Moderator: Ashley Grossman, MD, FRCP Professor of Neuroendocrinology William Harvey Research Institute Barts

More information

FRANKLY SPEAKING ABOUT CANCER: NEUROENDOCRINE & CARCINOID TUMORS (NETS)

FRANKLY SPEAKING ABOUT CANCER: NEUROENDOCRINE & CARCINOID TUMORS (NETS) FRANKLY SPEAKING ABOUT CANCER: NEUROENDOCRINE & CARCINOID TUMORS (NETS) Gilda s Club Quad Cities November 5 th, 2018 Joseph Dillon, MD Neuroendocrine Tumor Clinic University of Iowa Hospitals & Clinics

More information

Hot of the press. Γρηγόριος Καλτσάς MD FRCP Καθηγητής Παθολογίας Ενδοκρινολογίας ΕΚΠΑ

Hot of the press. Γρηγόριος Καλτσάς MD FRCP Καθηγητής Παθολογίας Ενδοκρινολογίας ΕΚΠΑ Hot of the press Γρηγόριος Καλτσάς MD FRCP Καθηγητής Παθολογίας Ενδοκρινολογίας ΕΚΠΑ Outline Diagnostic developments Histopathology Molecular Therapeutic developments Results on PRRT Telotristat in carcinoid

More information

2015: Year in Review Results of Recent Trials

2015: Year in Review Results of Recent Trials 2015: Year in Review Results of Recent Trials Pamela L. Kunz, MD Assistant Professor of Medicine / GI Oncology Director, Stanford NET Program Stanford University School of Medicine Disclosures Research

More information

Surgical Therapy of GEP-NET: An Overview

Surgical Therapy of GEP-NET: An Overview Surgical Therapy of GEP-NET: An Overview Pierce K.H Chow MBBS, MMed, FRCSE, FAMS, PhD Professor, Duke-NUS Graduate School of Medicine Senior Consultant Surgeon, Singapore General Hospital Visiting Senior

More information

Management of Pancreatic Islet Cell Tumors

Management of Pancreatic Islet Cell Tumors Management of Pancreatic Islet Cell Tumors Ravi Dhanisetty, MD November 5, 2009 Morbidity and Mortality Conference Case Presentation 42 yr female with chronic abdominal pain. PMHx: Uterine fibroids Medications:

More information

Case Presentation. Marianne Ellen Pavel. Charité University Medicine Berlin. ESMO Preceptorship on GI Neuroendocrine Tumors

Case Presentation. Marianne Ellen Pavel. Charité University Medicine Berlin. ESMO Preceptorship on GI Neuroendocrine Tumors Case Presentation Marianne Ellen Pavel Charité University Medicine Berlin ESMO Preceptorship on GI Neuroendocrine Tumors Session 3; Singapore November 2, 2012 06.11.2012 Medical History 46-year-old man

More information

OPTIMISING OUTCOMES IN GASTROINTESTINAL NEUROENDOCRINE TUMOURS

OPTIMISING OUTCOMES IN GASTROINTESTINAL NEUROENDOCRINE TUMOURS OPTIMISING OUTCOMES IN GASTROINTESTINAL NEUROENDOCRINE TUMOURS Dr Mairéad McNamara Senior lecturer, University of Manchester & Honorary Consultant in Medical Oncology, The Christie NHS Foundation Trust

More information

Carcinoid Tumors: The Beginning and End. Surgical Oncology Update 2011 Chris Baliski MD, FRCS BC Cancer Agency, CSI October 21, 2011

Carcinoid Tumors: The Beginning and End. Surgical Oncology Update 2011 Chris Baliski MD, FRCS BC Cancer Agency, CSI October 21, 2011 Carcinoid Tumors: The Beginning and End Surgical Oncology Update 2011 Chris Baliski MD, FRCS BC Cancer Agency, CSI October 21, 2011 1 st described by Oberndofer(1907) Karzinoide = cancer like Arise from

More information

Teresa Alonso Gordoa Servicio Oncología Médica Hospital Universitario Ramón y Cajal

Teresa Alonso Gordoa Servicio Oncología Médica Hospital Universitario Ramón y Cajal Teresa Alonso Gordoa Servicio Oncología Médica Hospital Universitario Ramón y Cajal Incidence per 100,000 EPIDEMIOLOGY Incidence rates of neuroendocrine tumors by primary tumor site 1.4 1.2 1.0 0.8 0.6

More information

Strategies in the Management of Neuroendocrine Tumors. Dr. Jean Maroun Dr. Elena Tsvetkova

Strategies in the Management of Neuroendocrine Tumors. Dr. Jean Maroun Dr. Elena Tsvetkova Strategies in the Management of Neuroendocrine Tumors Dr. Jean Maroun Dr. Elena Tsvetkova 1 A ZORSE 2 Neuroendocrine Tumour Classification Neuroendocrine Tumours Carcinoid Tumours Pancreatic Neuroendocrine

More information

Jaume Capdevila, MD GI and Endocrine Tumor Unit Vall d Hebron University Hospital Developmental Therapeutics Unit Vall d Hebron Institute of Oncology

Jaume Capdevila, MD GI and Endocrine Tumor Unit Vall d Hebron University Hospital Developmental Therapeutics Unit Vall d Hebron Institute of Oncology Jaume Capdevila, MD GI and Endocrine Tumor Unit Vall d Hebron University Hospital Developmental Therapeutics Unit Vall d Hebron Institute of Oncology OUTLINE Molecular Rationale for the use of SSAs in

More information

Rare GI Malignancies

Rare GI Malignancies Rare GI Malignancies Jordan Karlitz, MD Associate Professor of Medicine, Division of Gastroenterology Director, Hereditary GI Cancer and Genetics Program Tulane University School of Medicine Outline Gastrointestinal

More information

Surgery for NET Challenges and specific aspects

Surgery for NET Challenges and specific aspects Surgery for NET Challenges and specific aspects Raymond Aerts, MD Department of Abdominal Surgery and Liver Transplantation University Clinics Leuven ESMO Preceptorship on GI neuroendocrine tumours (NETs)

More information

Neuroendocrine Tumors

Neuroendocrine Tumors Neuroendocrine Tumors FCDS Annual Conference Boca Raton Marriott at Boca Center July 28, 2016 Steven Peace, BS, CTR Anatomy and Physiology of the (Neuro)Endocrine System WHO Classification, Tumor Grade

More information

Cutting Edge Treatment of Neuroendocrine Tumors

Cutting Edge Treatment of Neuroendocrine Tumors Cutting Edge Treatment of Neuroendocrine Tumors Daneng Li, MD Assistant Clinical Professor Department of Medical Oncology & Therapeutics Research City of Hope Click to edit Master Presentation Date DISCLOSURE

More information

Cutting Edge Treatment of Neuroendocrine Tumors

Cutting Edge Treatment of Neuroendocrine Tumors Cutting Edge Treatment of Neuroendocrine Tumors Daneng Li, MD Assistant Clinical Professor Department of Medical Oncology & Therapeutics Research City of Hope Click to edit Master Presentation Date DISCLOSURE

More information

Pancreatic Neuroendocrine Tumours

Pancreatic Neuroendocrine Tumours UCLH Cancer Collaborative Pancreas Update Meeting 12 th July 2017 Pancreatic Neuroendocrine Tumours Dr. Christos Toumpanakis MD PhD FRCP Consultant in Gastroenterology/Neuroendocrine Tumours Hon. Senior

More information

SURGERY OF NETS. Iakovos N Nomikos MD FACS. Director and Chairman, Department of Surgery METAXA Memorial Cancer Hospital Piraeus Greece

SURGERY OF NETS. Iakovos N Nomikos MD FACS. Director and Chairman, Department of Surgery METAXA Memorial Cancer Hospital Piraeus Greece SURGERY OF NETS Iakovos N Nomikos MD FACS Director and Chairman, Department of Surgery METAXA Memorial Cancer Hospital Piraeus Greece Epidemiology 5-fold increase in occurrence of NETS over past 30 years

More information

Recent developments of oncology in neuroendocrine tumors (NETs)

Recent developments of oncology in neuroendocrine tumors (NETs) Recent developments of oncology in neuroendocrine tumors (NETs) Marc Peeters MD, PhD Coordinator Multidisciplinary Oncological Center Antwerpen (MOCA) Head of the Oncology Department UZA, Professor in

More information

Pancreatic neuroendocrine cancer with liver metastases and multiple peritoneal metastases: report of one case

Pancreatic neuroendocrine cancer with liver metastases and multiple peritoneal metastases: report of one case Case Report Pancreatic neuroendocrine cancer with liver metastases and multiple peritoneal metastases: report of one case Yang Wang, Dongbing Zhao Department of Abdominal Surgery, Cancer Institute & Hospital,

More information

Index. Surg Oncol Clin N Am 15 (2006) Note: Page numbers of article titles are in boldface type.

Index. Surg Oncol Clin N Am 15 (2006) Note: Page numbers of article titles are in boldface type. Surg Oncol Clin N Am 15 (2006) 681 685 Index Note: Page numbers of article titles are in boldface type. A Ablative therapy, for liver metastases in patients with neuroendocrine tumors, 517 with radioiodine

More information

Selection of Appropriate Treatment

Selection of Appropriate Treatment Expert Review in Metastatic Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs): Selection of Appropriate Treatment Reference Slide Deck Neuroendocrine Tumors (NETs): A Diverse Group of Malignancies

More information

Update on Surgical Management of NETs

Update on Surgical Management of NETs Update on Surgical Management of Neuroendocrine Tumors James R. Howe, M.D. Director, Surgical Oncology and Endocrine Surgery University of Iowa College of Medicine Distribution of NETs 2000-2004 27% ---

More information

Neuroendocrine Tumours (NETs) - Treatment Pathway Toolkit. See inside for further information on rarer types of NETs

Neuroendocrine Tumours (NETs) - Treatment Pathway Toolkit. See inside for further information on rarer types of NETs Neuroendocrine Tumours (NETs) - Treatment Pathway Toolkit 1 3 5 7 9 Gastrointestinal NETs Functioning Pancreatic NETs - Insulinoma Functioning Pancreatic NETs - Glucagonoma Non-functioning Pancreatic NETs

More information

Disclosure of Relevant Financial Relationships

Disclosure of Relevant Financial Relationships Disclosure of Relevant Financial Relationships USCAP requires that all faculty in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS

More information

Scottish Neuroendocrine Tumour Group

Scottish Neuroendocrine Tumour Group SCONET Scottish Neuroendocrine Tumour Group Consensus Guidelines for the Management of Patients with Neuroendocrine Tumours Date of Publication: February 2015 Updated: July 2015 (v1.1) Contributing Authors

More information

Evaluation and Management of Neuroendocrine Tumors

Evaluation and Management of Neuroendocrine Tumors Evaluation and Management of Neuroendocrine Tumors Jennifer Chan, MD, MPH Clinical Director, Program in Neuroendocrine and Carcinoid Tumors Dana-Farber/Brigham and Women's Cancer Center October 14, 2017

More information

Octreotide LAR in neuroendocrine tumours a summary of the experience

Octreotide LAR in neuroendocrine tumours a summary of the experience Endocrinology in oncology Review article Octreotide LAR in neuroendocrine tumours a summary of the experience Agnieszka Kolasińska-Ćwikła, MD, PhD Department of Chemotherapy, Oncology Clinic, Maria Sklodowska-Curie

More information

Ronald C. Walker, MD, Prof of Radiology Vanderbilt University Medical Center Nashville, TN. Ga-DOTATATE PET/CT imaging Initial Vanderbilt experience

Ronald C. Walker, MD, Prof of Radiology Vanderbilt University Medical Center Nashville, TN. Ga-DOTATATE PET/CT imaging Initial Vanderbilt experience Ronald C. Walker, MD, Prof of Radiology Vanderbilt University Medical Center Nashville, TN 68 Ga-DOTATATE PET/CT imaging Initial Vanderbilt experience Disclosures: No financial disclosures or conflicts

More information

Development of New Treatment Modalities Oncolytic Viruses and Nanotechnique

Development of New Treatment Modalities Oncolytic Viruses and Nanotechnique Development of New Treatment Modalities Oncolytic Viruses and Nanotechnique By Professor Kjell Öberg, M.D., Ph.D. Dept. of Endocrine Oncology, University Hospital, Uppsala, Sweden Nashville Oct. 2011 Hallmarks

More information

NET / GIST / MEN. 2014/2015 FCDS Educational Webcast Series. October 16, Steven Peace, CTR

NET / GIST / MEN. 2014/2015 FCDS Educational Webcast Series. October 16, Steven Peace, CTR NET / GIST / MEN 2014/2015 FCDS Educational Webcast Series October 16, 2014 Steven Peace, CTR Anatomy and Physiology of the (Neuro)Endocrine System WHO Classification, Tumor Grade, Hereditary Syndromes

More information

Pancreatic polypeptide secreting tumors an institutional experience and review of the literature

Pancreatic polypeptide secreting tumors an institutional experience and review of the literature ORIGINAL ARTICLE Pancreatic polypeptide secreting tumors an institutional experience and review of the literature Angela Tatiana Alistar 1, Michelle Kang Kim 2, Richard Warner 2, Erin Moshier 3, Randall

More information

Diagnosis abnormal morphology and /or abnormal biochemistry

Diagnosis abnormal morphology and /or abnormal biochemistry Diagnosis abnormal morphology and /or abnormal biochemistry MEN 1 GEP Tumours Pancreatico-Nodal (-Duodenal) Affects 35-80% of MEN1 patients Functioning or non functioning Hyperplasia microadenoma macrotumours

More information

Jose Ramos. Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma

Jose Ramos. Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma Role of Surgery in isolated hepatic metastasis from breast carcinoma, melanoma or sarcoma Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Evolution of liver resection Better understanding

More information

NET ΠΝΕΥΜΟΝΑ: τι νεότερο / νέες μελέτες

NET ΠΝΕΥΜΟΝΑ: τι νεότερο / νέες μελέτες NETMASTERCLASS 2017: an interactive workshop NET ΠΝΕΥΜΟΝΑ: τι νεότερο / νέες μελέτες Νικόλαος Τσουκαλάς MD, MSc, PhD Ογκολόγος - Παθολόγος, MSc Βιοπληροφορική Επιμελητής Α, Ογκολογικό Τμήμα Νοσηλευτικό

More information

Sandostatin LAR. Sandostatin LAR (octreotide acetate) Description

Sandostatin LAR. Sandostatin LAR (octreotide acetate) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.09 Subject: Sandostatin LAR Page: 1 of 5 Last Review Date: March 16, 2018 Sandostatin LAR Description

More information

SIRT in the Management of Metastatic Neuroendocrine Tumors

SIRT in the Management of Metastatic Neuroendocrine Tumors SIRT in the Management of Metastatic Neuroendocrine Tumors Navesh K. Sharma, DO, PhD Assistant Professor, Departments of Radiation Oncology, Diagnostic Radiology and Nuclear Medicine Medical Director,

More information

Objectives. Terminology 03/11/2013. Pitfalls in the diagnosis of Gastroenteropancreatic Neuroendocrine Tumors. Pathology Update 2013

Objectives. Terminology 03/11/2013. Pitfalls in the diagnosis of Gastroenteropancreatic Neuroendocrine Tumors. Pathology Update 2013 Pitfalls in the diagnosis of Gastroenteropancreatic Neuroendocrine Tumors Pathology Update 2013 Ozgur Mete, MD Consultant in Endocrine Pathology, Department of Pathology, University Health Network Assistant

More information

PANCREATIC NEUROENDOCRINE TUMOURS A

PANCREATIC NEUROENDOCRINE TUMOURS A PANCREATIC NEUROENDOCRINE TUMOURS A RARE PANCREATIC TUMOUR David L Chan 1,2, Nick Pavlakis 1, Paul Roach 2, Dale Bailey 2, Jennifer Arena 3, Eva Segelov 4 1. Department of Medical Oncology, Royal North

More information

Systemic Therapy for Gastroenteropancreatic (GEP) Neuroendocrine Tumors and Lung Carcinoid

Systemic Therapy for Gastroenteropancreatic (GEP) Neuroendocrine Tumors and Lung Carcinoid Systemic Therapy for Gastroenteropancreatic (GEP) Neuroendocrine Tumors and Lung Carcinoid The Medical Oncology Perspective Nevena Damjanov, MD Associate professor Abramson Cancer Center of the University

More information

ADRENAL MEDULLARY DISORDERS: PHAEOCHROMOCYTOMAS AND MORE

ADRENAL MEDULLARY DISORDERS: PHAEOCHROMOCYTOMAS AND MORE ADRENAL MEDULLARY DISORDERS: PHAEOCHROMOCYTOMAS AND MORE DR ANJU SAHDEV READER AND CONSULTANT RADIOLOGIST QUEEN MARY UNIVERSITY AND ST BARTHOLOMEW S HOSPITAL BARTS HEALTH, LONDON, UK DISCLOSURE OF CONFLICT

More information

NEUROENDOCRINE TUMOURS Updated December 2015 by Dr. Doreen Ezeife (PGY-5 Medical Oncology Resident, University of Calgary)

NEUROENDOCRINE TUMOURS Updated December 2015 by Dr. Doreen Ezeife (PGY-5 Medical Oncology Resident, University of Calgary) NEUROENDOCRINE TUMOURS Updated December 2015 by Dr. Doreen Ezeife (PGY-5 Medical Oncology Resident, University of Calgary) Reviewed by Dr. Cynthia Card (Staff Medical Oncologist, University of Calgary)

More information

Collaborative Practice in the Management of Patients With Gastrointestinal and Pancreatic Neuroendocrine Tumors

Collaborative Practice in the Management of Patients With Gastrointestinal and Pancreatic Neuroendocrine Tumors Collaborative Practice in the Management of Patients With Gastrointestinal and Pancreatic Neuroendocrine Tumors Collaborative Practice in the Management of Patients With Gastrointestinal and Pancreatic

More information

Nuevas alternativas en el manejo de TNE avanzados

Nuevas alternativas en el manejo de TNE avanzados Nuevas alternativas en el manejo de TNE avanzados Jaume Capdevila Hospital Universitari Vall d Hebron Barcelona Coordinación científica: Dr. Fernando Rivera Hospital Universitario Marqués de Valdecilla,

More information

GEP NET: algoritmo terapeutico. Dottor Nicola Fazio

GEP NET: algoritmo terapeutico. Dottor Nicola Fazio GEP NET: algoritmo terapeutico Dottor Nicola Fazio Basi per il trattamento Caratteristiche del paziente Caratteristiche del tumore P.S., sindrome, comorbidità Differenziazione, Ki-67 Imaging morfologico

More information

An Unexpected Cause of Hypoglycemia

An Unexpected Cause of Hypoglycemia An Unexpected Cause of Hypoglycemia Stacey A. Milan, MD FACS Surgical Oncology Nothing to disclose Disclosures Objectives Identify indications for workup of hypoglycemia Define work up for hypoglycemic

More information

Pathology testing and Neuroendocrine tumours (NETs)

Pathology testing and Neuroendocrine tumours (NETs) Pathology testing and Neuroendocrine tumours (NETs) NETs are probably far more common than we think. Most grow so slowly and produce such widely varied and non-specific symptoms, or no symptoms at all,

More information

EUS FNA NEUROENDOCRINE TUMORS. A. Ginès Endocopy Unit Hospital Cínic. Barcelona (Spain)

EUS FNA NEUROENDOCRINE TUMORS. A. Ginès Endocopy Unit Hospital Cínic. Barcelona (Spain) EUS FNA NEUROENDOCRINE TUMORS A. Ginès Endocopy Unit Hospital Cínic. Barcelona (Spain) GI NEUROENDOCRINE TUMORS GENERAL CONCEPTS Rare neoplasms arising from the neuroendocrine cells of the GI tract Include:

More information

The PET-NET Study 2016 CNETS Grant Award

The PET-NET Study 2016 CNETS Grant Award The PET-NET Study 2016 CNETS Grant Award CANM Meeting April 21, 2017 Hagen Kennecke, MD, MHA, FRCPC Medical Oncology, BC Cancer Agency Associate Professor, University of British Columbia Raja Ampat, Indonesia

More information

THE HIGHS AND LOWS OF ADRENAL GLAND PATHOLOGY

THE HIGHS AND LOWS OF ADRENAL GLAND PATHOLOGY THE HIGHS AND LOWS OF ADRENAL GLAND PATHOLOGY Symptoms of Adrenal Gland Disorders 2 Depends on whether it is making too much or too little hormone And on what you Google! Symptoms include obesity, skin

More information

Guide for patients, carers and doctors about Neuroendocrine (NET) Cancer

Guide for patients, carers and doctors about Neuroendocrine (NET) Cancer Guide for patients, carers and doctors about Neuroendocrine (NET) Cancer Guide for patients, carers and doctors about Neuroendocrine (NET) Cancer First Edition: 2015 The Unicorn Foundation PO BOX 384 Blairgowrie

More information

CT PET SCANNING for GIT Malignancies A clinician s perspective

CT PET SCANNING for GIT Malignancies A clinician s perspective CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset

More information

Peptide Receptor Radionuclide Therapy (PRRT) of NET

Peptide Receptor Radionuclide Therapy (PRRT) of NET Peptide Receptor Radionuclide Therapy (PRRT) of NET Dr. Tuba Kendi Associate Prof of Radiology, Mayo Clinic, Rochester, MN 2014 MFMER slide-1 Relevant Financial Relationship(s) None Off Label Usage None

More information

Addison's disease Neuroendocrine tumors Paraneoplastic syndromes

Addison's disease Neuroendocrine tumors Paraneoplastic syndromes Addison's disease Neuroendocrine tumors Paraneoplastic syndromes Miklós Tóth Professor of Medicine and Endocrinology 9 th April, 2018 Semmelweis University 2nd Department of Medicine Addison's disease

More information

Neuroendocrine Tumor of Unknown Primary Accompanied with Stomach Adenocarcinoma

Neuroendocrine Tumor of Unknown Primary Accompanied with Stomach Adenocarcinoma J Gastric Cancer 2011;11(4):234-238 http://dx.doi.org/10.5230/jgc.2011.11.4.234 Case Report Neuroendocrine Tumor of Unknown Primary Accompanied with Stomach Adenocarcinoma Ho-Yeun Kim, Sung-Il Choi 1,

More information

Commonly Encountered Neuro-Endocrine Tumors of the Gut

Commonly Encountered Neuro-Endocrine Tumors of the Gut Commonly Encountered Neuro-Endocrine Tumors of the Gut Moderators: Giuseppe Aliperti, MD Steven Edmundowicz, MD Panelists Douglas O. Faigel, MD Professor of Medicine Department of Gastroenterology Oregon

More information

OVERVIEW OF THE DIAGNOSIS AND TREATMENT OF GI NETS

OVERVIEW OF THE DIAGNOSIS AND TREATMENT OF GI NETS OVERVIEW OF THE DIAGNOSIS AND TREATMENT OF GI NETS Dr Christos G. Toumpanakis MD PhD FRCP FEBGH Consultant in Gastroenterology/Neuroendocrine Tumours Hon. Senior Lecturer University College of London Neuroendocrine

More information

Pheochromocytoma AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGY ILLINOIS CHAPTER OCTOBER 13, 2018

Pheochromocytoma AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGY ILLINOIS CHAPTER OCTOBER 13, 2018 Pheochromocytoma AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGY ILLINOIS CHAPTER OCTOBER 13, 2018 Steven A. De Jong, M.D., FACS, FACE Professor and Vice Chair of Surgery Chief, Division of General Surgery

More information

WHO e TNM: Importanza della classificazione nell approccio terapeutico

WHO e TNM: Importanza della classificazione nell approccio terapeutico WHO e TNM: Importanza della classificazione nell approccio terapeutico Marco Volante Mauro Papotti Dipartimento di Scienze Cliniche e Biologiche Ospedale San Luigi Orbassano, Torino Rare tumors Heterogeneous

More information

Gastrinoma: Medical Management. Haley Gallup

Gastrinoma: Medical Management. Haley Gallup Gastrinoma: Medical Management Haley Gallup Also known as When to put your knife down Gastrinoma Definition and History Diagnosis Historic Management Sporadic vs MEN-1 Defining surgical candidates Nonsurgical

More information

New Developments in the Care and Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors Dr. Tim Asmis The Ottawa Hospital Cancer

New Developments in the Care and Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors Dr. Tim Asmis The Ottawa Hospital Cancer New Developments in the Care and Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors Dr. Tim Asmis The Ottawa Hospital Cancer Centre MD, FRCPC CAGPO September 2018 Disclosures Consultant

More information

Learning. A part of your guide to Neuroendocrine Tumours (NETs)

Learning. A part of your guide to Neuroendocrine Tumours (NETs) Learning A part of your guide to Neuroendocrine Tumours (NETs) Your support guide This book will help you better understand NETs. It is however a reference only; you should always go to your doctor or

More information

Principles of diagnosis, work-up and therapy The Gastroenterologist s role

Principles of diagnosis, work-up and therapy The Gastroenterologist s role Principles of diagnosis, work-up and therapy The Gastroenterologist s role Dr. Christos G. Toumpanakis MD PhD FRCP Consultant in Gastroenterology/Neuroendocrine Tumours Hon. Senior Lecturer University

More information

RADIOFREQUENCY ABLATION

RADIOFREQUENCY ABLATION RADIOFREQUENCY ABLATION ELIZABETH DAVID M D FRCPC VASCULAR A ND INTERVENTIONAL RADIOLOGIST SUNNYBROOK HEALTH SCIENCES CENTRE GIST GASTROINTESTINAL STROMAL TUMORS Stromal or mesenchymal neoplasms affecting

More information

Afternoon Session Cases

Afternoon Session Cases Afternoon Session Cases Case 1 19 year old woman Presented with abdominal pain to community hospital Mild incr WBC a14, 000, Hg normal, lipase 100 (normal to 75) US 5.2 x 3.7 x 4 cm mass in porta hepatis

More information

What the oncologist needs to know from the pathologist?

What the oncologist needs to know from the pathologist? Grade 3 GEP Neuroendocrine Neoplasms: from pathology to the clinic and back What the oncologist needs to know from the pathologist? Marianne Pavel Friedrich Alexander Universität Erlangen-Nürnberg 30th

More information

ITALIAN SURGICAL SOCIETY ENDOCRINE SURGERY SCHOOL LIVER METASTASIS FROM NEUROENDOCRINE TUMORS

ITALIAN SURGICAL SOCIETY ENDOCRINE SURGERY SCHOOL LIVER METASTASIS FROM NEUROENDOCRINE TUMORS ITALIAN SURGICAL SOCIETY ENDOCRINE SURGERY SCHOOL LIVER METASTASIS FROM NEUROENDOCRINE TUMORS Gennaro Favia Liver metastasis from NETs Incidence 75% in NETs Knox CD, J Gastroint Surg 2006 .but 28-45% cases

More information

Community Case. Saeed Awan R5

Community Case. Saeed Awan R5 Community Case Saeed Awan R5 18 year old presents to ER with history of pain right lower quadrant for three days. Nauseated, denies vomiting and bowel movements normal and no urinary complaint. Admitted

More information

Imaging of Neuroendocrine Metastases

Imaging of Neuroendocrine Metastases Imaging of Neuroendocrine Metastases Aoife Kilcoyne, Shaunagh McDermott, Colin McCarthy,Manuel Patino, Dushyant Sahani, Michael Blake Abdominal Imaging Division Massachusetts General Hospital Disclosure

More information

Grade 2 Ileum NET with liver and bone metastasis

Grade 2 Ileum NET with liver and bone metastasis Grade 2 Ileum NET with liver and bone metastasis BERNARDO MARQUES ENDOCRINOLOGY DEPARTMENT PORTUGUESE INSTITUTE OF ONCOLOGY - COIMBRA April 2018, Lugano, Switzerland JPB, male, 67 years old April 2015

More information