ObjectiveTo summary the treatment of pancreatic neuroendocrine neoplasms (pNENs). MethodsArticles relevant to pNENs at home and abroad were collected and reviewed. ResultsBecause of rare incidence and non-specific clinical syndromes of pNENs, clinician had no enough cognition about it. For pNENs, surgery was still the preferred option, combining other treatments included chemotherapy, somatostatin analogue, α-interferon, molecular targeted therapy, and peptide receptor radionuclide therapy (PRRT). ConclusionSurgery is still considered as the preferred option for controlling the associated biochemical syndromes and curtailing the malignant progression of pNENs.
ObjectiveTo summarize the status and progress of imaging studies of pancreatic neuroendocrine neoplasms (pNENs).MethodThe relevant literatures published recently at domestic and abroad about the imaging of pNENs were collected and reviewed.ResultsDue to poor visibility of pancreatic body and tail, the application of ultrasound (US) was limited. Compared with US, endoscopic ultrasound (EUS) and contrast-enhanced ultrasound (CEUS) could improve the detection rate of pNENs. The ability of plain CT scans to differentiate pathological grades was still controversial, but the value of enhanced scan was higher. CT texture analysis was feasible in the discrimination of nonhypervascular pNENs and pancreatic ductal adenocarcinoma (PDAC). Teta2 was the parameter with the highest diagnostic performance. The enhanced features of MRI were similar to CT. Combined with the apparent diffusion coefficient (ADC) value, the diagnostic and classification capabilities of MRI were improved, and the sensitivity and specificity of different ADC thresholds were also different. 68Ga-tetraazacyclododecane tetraacetic acid (68Ga-DOTA) peptide PET-CT had good preliminary diagnostic value for well-differentiated pNENs, and 18Fluoro-fluorodeoxyglucose (18F-FDG) PET-CT had limited diagnostic value.ConclusionsSomatostatin receptor imaging is of high diagnostic value and can guide clinical treatment and predict prognosis, but it has not been widely used in China. Conventional morphological images have advantages in the diagnosis and classification of pNENs. Therefore, it is important to choose a proper image inspection method.
ObjectiveTo evaluate the effect of surgical management of neuroendocrine liver metastasis. MethodsLiteratures about the surgical management of neuroendocrine liver metastasis were collected and reviewed. ResultsEffect of surgical treatment for neuroendocrine liver metastasis was confirmed, but the molecular mechanism of tumor formation was more complex, and the recurrence rate of surgery was too high, so a large number of new treatment methods had been developed and used clinically, and had achieved good results. These treatments included external beam radiotherapy, internal radiotherapy, liver transplantation, and targeted therapies. ConclusionComprehensive surgical management will be the direction of surgical management of neuroendocrine liver metastasis.
Objective To approach the recent advances in diagnosis and surgical treatment of pancreatic endocrine tumors （PETs）. Methods Articles relevant to diagnosis and treatment of PETs were collected and reviewed. Results PETs are characterized by their ability to over-produce peptides and hormones， which cause specific clinical syndromes. Because of rare incidence and complex clinical syndromes， there are still impediments to early diagnosis of these tumors. Monitoring of serum hormones and imaging method allow early tumor detection. PETs have been investigated for the past several decades. With the great knowledge of these tumors in molecular genetic level， clinical managements have been greatly changed. Conclusions Avoiding misdiagnosis is important for treatment of PETs. Surgical approach is still considered as the preferred option for curtailing the malignant progression of PETs and controlling the associated biochemical syndromes.
ObjectiveTo summarize the diagnosis and treatment process of a patient who underwent laparoscopic local excision of duodenal papillary tumor, and to explore the safety and feasibility of this surgery. MethodThe clinicopathologic characteristics and surgical procedure of the patient with duodenal papillary neuroendocrine tumor admitted to the West China Hospital of Sichuan University in June 2021 were retrospectively analyzed. ResultsThe patient underwent the laparoscopic local excision of duodenal papillary tumor + in situ cholangiojejunostomy and pancreaticojejunostomy. The operation lasted about 3 hours, the blood loss was about 20 mL, and the patient exhausted on the 3rd day after the operation. On the 7th postoperative day, the gastric tube was pulled out and oral feeding was started. On the 8th day, the plasma drainage tube was pulled out and the patient was discharged smoothly. There was no duodenal fistula, bleeding, wound infection, and other complications. After 6 months of follow-up, the general condition of this patient was good, and no tumor recurrence or metastasis was found. ConclusionLaparoscopic local excision is an appropriate option for benign or low-grade malignancies involving the duodenal papillary tumor.
Objective To explore CT features that can be used to identify nonhypervascular pancreatic neuroendocrine neoplasm (pNEN) and pancreatic ductal adenocarcinoma (PDAC). Methods The patients with pathologically confirmed the pNEN and PDAC were retrospectively included from May 2010 to May 2017. The CT features were analyzed. The CT features were extracted by the multivariate logistic regression, and their diagnostic performances were calculated. Results Forty patients with the nonhypervascular pNEN (33 unfunctional, 7 functional) and 80 patients with the PDAC were included in this study. The features of significant differences between the nonhypervascular pNEN and the PDAC included: the location, long diameter, margin, uniform lesions, calcification, and vascular shadows of the lesion (P<0.05). The margin ［OR=14.63, 95% CI (2.82, 75.99)］, calcification ［OR=4.00, 95% CI (1.03, 15.59)］, and location ［OR=3.09, 95% CI(1.19, 7.99)］ of the lesion could independently identify the nonhypervascular pNEN. The multivariate logistic regression model of the differential diagnosis of the nonhypervascular pNEN and PDAC was obtained through the CT features of significant differences. The diagnostic sensitivity was 70.00%, 95% CI (53.5,83.4); specificity was 83.54%, 95% CI (73.5, 90.9); and area under the receiver operating curve was 0.824, 95% CI (0.743, 0.887). Conclusions Multivariate logistic regression model of CT features is helpful for differential diagnosis of nonhypervascular pNEN and PDAC. Features of margin and calcification of lesion are more valuable in differential diagnosis of nonhypervascular pNEN and PDAC.
ObjectiveTo investigate the hotspots from researches on imaging of pancreatic neuroendocrine tumor in recent five years. MethodsThe bibliographies from research literatures on imaging of pancreatic neuroendocrine tumor from 2010 to 2015 in PubMed database were downloaded. The Bicomb 2.0 bibliographies analysis software was used to count high-frequency of Mesh major topics (MJMEs). SPSS 22.0 statistical software was applied for clustering analysis with MJMEs, then to get the topic hotspots. ResultsA total of 357 literatures were screened out during the years of 2010-2015. The MJMEs which frequency > 13 were 28. Taken the 28 MJMEs into clustering analysis, then three research hotspots were clustered. ConclusionResearches on imaging of the pancreatic neuroendocrine tumor in recent five years are mainly in terms of imaging techniques, a comparative study of pathology and endoscopic ultrasonography-fine needle aspiration, imaging and disease treatment.
ObjectiveTo investigate value of MSCT imaging on differentiating low grade pancreatic neuroendo-crine neoplasms (pNENs) from non-low grade pNENs. MethodThe clinical and CT data of 32 patients with pNENs,who were confirmed by pathological diagnosis from January 2014 to August 2015,were collected and analyzed retrospec-tively. ResultsThere were 15 patients with grade 1 in the low grade pNENs group,there were 11 patients with grade 2 and 6 patients with grade 3 in the non-low grade pNENs group.Compared with the low grade pNENs,the non-low grade pNENs had the larger diameter of the tumor (P=0.007),irregular tumor shape (P=0.006),obscure tumor margin (P=0.003),peripancreatic tissue or vascular invasion (P=0.036),lymphadenopathy (P=0.003),distant metastasis (P=0.019),lower absolute enhancement of tumor at the arterial (P=0.003) and the relative enhancement of tumor at the arterial (P=0.013). ConclusionThe analysis of MSCT features might help for differentiating low grade pNENs from non-low grade pNENs,so that more timely selection of appropriate treatment strategies would be made.