Department of Dermatology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
Department of Endocrinology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
J Eur Acad Dermatol Venereol. 2018 Nov;32(11):1887-1892. doi: 10.1111/jdv.14830. Epub 2018 Feb 14.
The presence of cutaneous nodules in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs) receiving depot somatostatin analogs (SSAs) is a diagnostic challenge as differential diagnosis between injection site reactions and metastases is essential.
To characterize the clinical, radiological, cytological and histopathological features of subcutaneous nodules in patients with GEP-NETs treated with SSAs.
Retrospective, cross-sectional study of patients with GEP-NETs treated with SSAs in whom subcutaneous nodules were detected on routine abdominal computed tomography (CT) scans. High resolution and colour Doppler ultrasonography was performed. Those patients with inconclusive radiological studies went through fine-needle aspiration cytology (FNAC) and/or biopsy.
Twelve patients (five males, seven females) were included (six midgut carcinoid NETs, six pancreatic NETs). Three patients received intramuscular depot octreotide, seven subcutaneous lanreotide, and two both treatments. CT scan findings were nonspecific. Sonography revealed a hyperechoic pattern in recent injections, and a hypoechoic pattern with a characteristic hyperechoic peripheral rim in long-term injections (more than 3 months after injection). On colour Doppler sonography, nodules showed no signs of intralesional vascularity. Fine-needle aspiration cytology (FNAC) was performed in five patients, revealing a characteristic acellular proteinaceous material. Biopsy in four patients showed different reactional infiltrates around the acellular material.
High resolution and colour Doppler ultrasonography may be very useful for the differential diagnosis of subcutaneous nodules in patients with GEP-NETs treated with SSAs. FNAC and a biopsy are useful tests for confirmation of the diagnosis in patients with inconclusive findings. We propose a management algorithm.
接受长效生长抑素类似物（SSA）治疗的胃肠胰神经内分泌肿瘤（GEP-NET）患者出现皮肤结节是一个诊断难题，因为必须区分注射部位反应和转移灶。
描述接受 SSA 治疗的 GEP-NET 患者皮下结节的临床、放射学、细胞学和组织病理学特征。
回顾性分析接受 SSA 治疗的 GEP-NET 患者的病例，这些患者在常规腹部计算机断层扫描（CT）中发现皮下结节。进行高分辨率和彩色多普勒超声检查。对影像学检查结果不确定的患者进行细针抽吸细胞学检查（FNAC）和/或活检。
共纳入 12 名患者（5 名男性，7 名女性）（6 名中肠类癌 NET，6 名胰腺 NET）。3 名患者接受肌肉内奥曲肽 depot 治疗，7 名患者接受皮下兰瑞肽治疗，2 名患者同时接受两种治疗。CT 扫描结果无特异性。超声显示近期注射的高回声模式，长期注射（注射后 3 个月以上）的低回声模式，伴有特征性的高回声外周边缘。彩色多普勒超声显示结节内无血管内信号。5 名患者进行了细针抽吸细胞学检查（FNAC），显示特征性的无细胞蛋白样物质。4 名患者的活检显示无细胞物质周围有不同的反应性浸润。
高分辨率和彩色多普勒超声对 SSA 治疗的 GEP-NET 患者皮下结节的鉴别诊断非常有用。FNAC 和活检是对检查结果不确定的患者进行确诊的有用检查。我们提出了一种管理算法。
