LETTERS TO THE EDITOR
Pancreatic neuroendocrine tumors
Tumores neuroendocrinos pancreáticos
Key words: Pancreatic neuroendocrine tumors. Insulinoma. Gastrinoma. Multiple endocrine neoplasia. Non-functioning neuroendocrine tumors. Endoscopic ultrasonography. Fine-needle aspiration.
Palabras clave: Tumores neuroendocrinos pancreáticos. Insulinoma. Gastrinoma. Neoplasia endocrina múltiple. Tumores endocrinos no funcionantes. Ultrasonografía endoscópica. Punción aspirativa con aguja fina.
]]> Dear Editor,
Endocrine or pancreatic neuroendocrine tumors (PNET) were first cited in the 1950s; they may be sporadic or associated with hereditary syndromes, benign or malignant, functioning or non-functioning.
Nowadays, NF-PNETs are the most frequent and their prevalence ranges from 50% to 91%. In our current series (including 70 cases, 33% malignant, 52 operated) the frequency was 72% as compared to 37% in the historical series (1).
Many of them are incidentalomas (40% in our experience versus 20% in the historical series). These demographic data are very similar to the series of 79 cases operated in our country, reported by Cienfuegos et al. (2) (Table I).
Endoscopic ultrasonography (EUS) associated with computed tomography (CT), with or without fine-needle aspiration (FNA), is the best strategy for insulinomas and NF-PNET. Probably in gastrinomas, the best option is the association of EUS with Octreoscan (4) although our results are not aligned with those of other authors (4), since Octreoscan had a diagnostic sensitivity lower than 50%.
In our current series, after NF-PNETs (72%), Zollinger-Ellison syndrome (ZES) was the most prevalent one, with 11 cases (15%), five with MEN-1 (multiple endocrine neoplasia).
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), Octreoscan and intraoperative ultrasonography (IOUS) were primordial for each localizations.
]]> Chheda et al. (5), in a retrospective series of 70 patients, registered 87% of non-functioning tumors, with an overall survival of 90%, in spite of the fact that most patients had metastasis.Cienfuegos et al. (2), in their series of 79 operated PNET (operative mortality about 1.2%), published a frequency of non-functioning tumors of 73%, with 44% of incidentalomas and a rather high 5-year disease free survival, although 30% were metastatic.
We want to congratulate Cienfuegos et al. (2) for their excellent work, even though their survival rate surprises us.
Modesto J. Varas-Lorenzo, Esteban Cugat-Andorra and Jaume Capdevila-Castillón
Unit of Digestive Echoendoscopy. Departments of General and Digestive Surgery
and Instituto Oncológico Teknon (IOT). Centro Médico Teknon Quirón Salud.
Barcelona, Spain
References
]]>1. Varas M, Gornals J, Ponseti JM, et al. Tumores endocrinos o apudomas pancreáticos. Rev Esp Enferm Dig 2011;103:184-90. DOI: 10.4321/S1130-01082011000400003. [ Links ]
2. Cienfuegos JA, Rotellar F, Salguero J, et al. A single institution's 21-year experience with surgically resected pancreatic neuroendocrine tumors: An analysis of survival and prognostic factors. Rev Esp Enferm Dig 2016;108:689-96. DOI: 10.17235/reed.2016.4323/2016. [ Links ]
3. Gornals J, Varas M, Catalá I, et al. Diagnóstico definitivo de los tumores neuroendocrinos (TNE) mediante PAAF ecodirigida por ultrasonografía endoscópica (USE). Rev Esp Enferm Dig 2011; 103:123-8. [ Links ]
4. Alventosa C, Ferrer L, Huguet JM, et al. Síndrome de Zollinger-Ellison. Rev Esp Enferm Dig 2013;105:640-2. DOI: 10.4321/S1130-01082013001000016. [ Links ]
5. Chheda Y, Arora D, Patel R, et al. A retrospective analysis of neuroendocrine tumour of pancreas: A single institute study. Intern J Res Med Sci 2015;3:3041-5. DOI: 10.18203/2320-6012.ijrms20150928. [ Links ]
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