Demirkan Binnaz, Unek Ilkay Tuğba, Eriksson Barbro, Akarsu Mesut, Durak Hatice, Sağol Ozgül, Obuz Funda, Binicier Cilem, Füzün Mehmet, Alakavuklar Mehmet
Departments of Internal Medicine, Divisions of Medical Oncology, Dokuz EylUl University, School of Medicine, Izmir.
Turk J Gastroenterol. 2009 Sep;20(3):214-9. doi: 10.4318/tjg.2009.0010.
Pancreatic neuroendocrine tumors constitute about 2% of all gastrointestinal neoplasms. Approximately half of the pancreatic euroendocrine tumors are nonfunctional. Due to lack of specific symptoms, most patients with nonfunctional pancreatic neuroendocrine tumors present with locally advanced or metastatic disease. Second primary malignancies are seen very rarely in these patients. Colon carcinoma ranks third in frequency among primary sites of cancer in both men and women in western countries. Presence of a metachronous colon adenocarcinoma in a patient with nonfunctional pancreatic neuroendocrine tumor has not been reported before. We present a patient who had an asymptomatic mass in the head of the pancreas, detected by ultrasonography in 1996. The patient did not consent to operation. In 2002, after the diagnosis of an unresectable, nonfunctional pancreatic neuroendocrine tumor, interferon alpha- 2b and octreotide were started. A year after biological treatment, he refused further treatment. In 2004, during the evaluation of dissemination of the asymptomatic disease, positron emission tomography revealed a high uptake by the descending colon despite the failure of other imaging methods. After surgery for operable colon carcinoma, the patient received chemotherapy and biological therapy for both tumors. Since 2005, he has been doing well without any further treatment thus far. In conclusion, computerized tomography/magnetic resonance imaging and octreotide scintigraphy may be insufficient to show disseminated disease and asymptomatic second primary malignancies. Therefore, positron emission tomography is a valuable promising option for the evaluation of gastroenteropancreatic neuroendocrine tumors and concomitant or metachronous malignancies. Lifelong follow-up by a multidisciplinary oncology team is needed so that a long-term survival can be achieved with integrated multimodal systemic treatment approaches.
胰腺神经内分泌肿瘤约占所有胃肠道肿瘤的2%。约一半的胰腺神经内分泌肿瘤无功能。由于缺乏特异性症状，大多数无功能胰腺神经内分泌肿瘤患者就诊时已处于局部晚期或发生转移。这些患者中很少见第二原发性恶性肿瘤。在西方国家，结肠癌是男性和女性癌症原发部位中发病率排第三的。此前尚未报道过无功能胰腺神经内分泌肿瘤患者同时发生异时性结肠腺癌。我们报告一例患者，1996年经超声检查发现胰腺头部有一无症状肿块。患者不同意手术。2002年，在诊断为不可切除的无功能胰腺神经内分泌肿瘤后，开始使用α-2b干扰素和奥曲肽治疗。生物治疗一年后，患者拒绝进一步治疗。2004年，在评估无症状疾病的播散情况时，尽管其他影像学检查方法未能发现异常，但正电子发射断层扫描显示降结肠有高摄取。在对可切除的结肠癌进行手术后，患者接受了针对两种肿瘤的化疗和生物治疗。自2005年以来，患者情况良好，至今未再接受任何治疗。总之，计算机断层扫描/磁共振成像和奥曲肽闪烁扫描可能不足以显示播散性疾病和无症状的第二原发性恶性肿瘤。因此，正电子发射断层扫描对于评估胃肠胰腺神经内分泌肿瘤及并发或异时性恶性肿瘤是一种有价值且有前景的选择。需要多学科肿瘤团队进行终身随访，以便通过综合多模式全身治疗方法实现长期生存。
