Gastroenteropancreatic neuroendocrine tumors in patients with HIV infection: a trans-Atlantic series.

BACKGROUND

Non-AIDS-defining cancers are an important problem in HIV-infected patients. The occurrence of neuroendocrine (NE) tumors in sites other than the lung and skin has not been well characterized in the setting of concurrent HIV infection.

METHODS

HIV-positive patients with biopsy-confirmed NE tumors localized to the gastrointestinal tract were identified based on the personal archives of the authors. A retrospective chart review was performed, and data regarding demographics, HIV status, presenting symptoms and signs, diagnostic work-up, therapeutic interventions, and outcome were extracted.

RESULTS

We identified 4 adult patients, mean age 42 years (range: 37-47) infected with HIV, who developed NE tumors originating in their gastrointestinal tact. They had only moderate immunosuppression with a median CD4 count of 497 cells/mm (range: 182-1100) and chronic HIV infection (2-15 years duration). Symptoms at presentation were nonspecific, including abdominal pain, diarrhea, weight loss, and rectal bleeding. A specialized diagnostic work-up was required, including serum chromogranin and urinary 5-hydroxyindoleacetic acid levels, colonoscopy, radioactive isotope scans, and the demonstration of NE differentiation in procured pathologic material. The spectrum of tumors ranged from benign (typical carcinoid) to highly aggressive neoplasms (NE carcinoma). Treatment with octreotide, surgical resection, or systemic chemotherapy provided effective symptomatic relief and was associated with a favorable outcome, despite metastases in 2 patients.

CONCLUSIONS

These cases serve to broaden the spectrum of neoplasms that may be encountered in the current HIV era, and illustrate the difficulty in establishing the diagnosis of NE tumors in the context of HIV infection.