Gastrointestinal and pancreatic endocrine tumours

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Summary

The radiological diagnosis and interventional management of neuroendocrine tumours of the gastrointestinal tract and pancreas are challenging, demanding the complete gamut of available resources.

Carcinoid tumours are most commonly found in the appendix and small bowel. Barium studies usually disclose a small solitary mucosal or submucosal mass in the distal ileum at times associated with smooth muscle hypertrophy and thickening of the mucosal folds. Intussusception and bowel obstruction may be the presenting finding. Mesenteric involvement may evoke a desmoplastic reaction with rigidity, fixation, angulation and tethering of small bowel loops. Angiography may demonstrate a hypervascular primary neoplasm but more frequentyly reveals vascular encasement and distortion from the mesenteric desmoplastic reaction.

Pancreatic islet cell tumour is best defined radiologically by angiography and computed tomography as a well circumscribed hypervascular mass which enhances with contrast material. Portal venous sampling is of considerable assistance in localizing insulinoma.

Metastases from neuroendocrine tumours to lymph nodes and to the liver are usually hypervascular. In the evaluation of the liver by CT scanning prior to contrast as well as dynamic scanning during the bolus intravenous injection of contrast material are necessary. At times the precontrast scan is mesenteric artery followed by selective hepatic arteriography is the most accurate combination for the detection of hepatic metastases.

Interventional radiological management by sequential hepatic arterial embolization is the treatment of choice for multiple hepatic metastases from neuroendocrine tumours. Thus far, the maximum number of embolic episodes in a single patient has been 13. The carcinoid syndrome has been controlled in 87% while 79% of islet cell tumour hepatic metastases have responded.

Contraindications to HAE includes a combination of all of the following: (i) replacement of more than 50% of the liver by tumour, (ii) serum lactic dehydrogenase above 425 mU/ml, (iii) serum glutamic oxaloacetic transaminase above 100mU/ml, and (iv) bilirubin above 2 mg/dl. In the face of occlusion of the portal vein by intravascular neoplasm, HAE is contraindicated only if portal flow through collateral vein is away from the liver.

References (110)

  • JagerRM et al.

    Carcinoid apudomas

    Current Problems in Cancer

    (1977)
  • McGillDB et al.

    Hormonal diarrhea due to pancreatic tumor

    Gastroenterology

    (1980)
  • MartinEN et al.

    Pathology of endocrine tumors of the GI tract

    Clinics in Gastroenterology

    (1974)
  • Murray-LyonIM et al.

    Treatment of secondary hepatic tumors by ligation of hepatic artery and infusion of cytoxic drugs

    Lancet

    (1970)
  • O'BergK et al.

    Peptide hormone markers in screening for endocrine tumors in multiple endocrine tumors in multiple endocrine adenomatosis, type I

    American Journal of Medicine

    (1982)
  • AjaniJA et al.

    Islet cell tumors metastatic to the liver: effective palliation by sequential hepatic artery embolization

    Annals of Internal Medicine

    (1988)
  • AmbergJR et al.

    Roentgenographic observations in the Zollinger-Ellison syndome

    Journal of the American Medical Association

    (1964)
  • BallardHS et al.

    Familial multiple endocrine adenoma-peptic ulcer complex

    Medicine

    (1964)
  • BancksNH et al.

    The roentgenologic spectrum of small intestinal carcinoid tumors

    American Journal of Roentgenology

    (1975)
  • BernardinoME et al.

    Delayed hepatic CT scanning: increased confidence and improved detection of hepatic metastasis

    Radiology

    (1986)
  • BiermanHR et al.

    Studies on the blood supply of tumors in man: vascular patterns of the liver by hepatic angiography in vivo

    Journal of the National Cancer Institute

    (1951)
  • BluthI

    Gastrointestinal carcinoid tumours: roentgen features

    Radiology

    (1960)
  • BoijsenE et al.

    Radiologic diagnosis of ileal carcinoid tumors

    Acta Radiologica (Diagnosis)

    (1974)
  • BreedisC et al.

    The blood supply for neoplasms in the liver

    American Journal of Pathology

    (1954)
  • BrennanMF et al.

    Cancer of the endocrine system

  • CarrascoCH

    Localization of neuroendocrine tumors of the pancreas

  • CarrascoCH et al.

    Apudomas metastatic to the liver: treatment by hepatic artery embolization

    Radiology

    (1983)
  • CarrascoCH et al.

    The carcinoid syndrom: palliation by hepatic artery embolization

    American Journal of Roentgenology

    (1986)
  • ChoKJ et al.

    Glucagon producing islet cell tumor of the pancreas

    American Journal of Roentgenology

    (1977)
  • ChoKJ et al.

    Localization of the source of hyperinsulism: percutaneous transhepatic portal and pancreatic vein catheterization with hormone assay

    American Journal of Roentgenology

    (1982)
  • ChuangVP et al.

    Hepatic artery embolization in the treatment of hepatic neoplasms

    Radiology

    (1981)
  • ChuangVP et al.

    Superselective catheterization technique in hepatic angiography

    American Journal of Roentgenology

    (1983)
  • CollenMJ et al.

    Assessment of the ability of angiography to localize gastrinoma in patients with Zollinger-Ellison syndrome (ZES)

    Gastroenterology

    (1984)
  • CruetzfeldtW et al.

    Carcinoids and carcinoid syndrome

    American Journal of Medicine

    (1987)
  • DavisZ et al.

    Malignant corcinoid syndrome

    Surgery, Gynecology and Obstetrics

    (1973)
  • DiBisceglieAM et al.

    Pancreatic endocrdine tumor presenting with obstructive jaundice

    American Journal of Gastroenterology

    (1984)
  • DoddGD

    Carcinoid tumors of the gastrointestinal tract

  • DoddsWJ et al.

    Severe peptic esophagitis in a patient with Zollinger-Ellison syndrome

    Americal Journal of Roentgenology

    (1971)
  • DoppmanJL

    Multiple endocrine syndromes: A nightmare for the endocrine radiologist

  • DunnickNR et al.

    Localizing insulinomas with combined radiographic methods

    American Journal of Roentgenology

    (1980)
  • EelkemaEA et al.

    CT features of non-functioning islet cell carcinoma

    American Journal of Roentgenology

    (1984)
  • EpsteinHY et al.

    Angiographic localization of insulinomas: High reported success rate and two additional cases

    Annals of Surgery

    (1969)
  • FerrucciJT et al.

    Advances in hepatobiliary radiology

    Radiology

    (1988)
  • FoleyWD

    Hepatic MR imaging at 1.5T

    Radiology

    (1988)
  • FreenyPC

    Hepatic CT: state of the art

    Radiology

    (1988)
  • FriesenSR

    Tumors of the endocrine pancreas

    New England Journal of Medicine

    (1982)
  • FriesenSR et al.

    Pancreatic polypeptide update: its roles in detection of the trait for multiple endocrine adenopathy syndrome, type I, and pancreatic polypeptide-secreting tumors

    Surgery

    (1983)
  • GerlockAJ et al.

    Pancreatic somatostatinoma: histologic, clinical and angiographic features

    American Journal of Roentgenology

    (1979)
  • GodwinDJ

    Carcinoid tumors: an analysis of 2,837

    Cancer

    (1975)
  • GoldbergBB et al.

    Real time aspiration-biopsy transducer

    Journal of Clinical Ultrasound

    (1980)
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