Defending%20Diagnoses

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Defending Diagnoses

• Carcinoid Tumor (11) Jack Mbabuike
• Colon Adenocarcinoma (3) Joshua Gordon
• Basal Cell Carcinoma (1) Owen Dubowy
• Hepatocellular Carcinoma (1) Amer Assal
• Other Diagnoses
• Pheochromocytoma
• VIPoma
• Gastric Cancer
• Gastrinoma

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Liver Biopsy
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Liver Biopsy Chromogranin
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Colon Biopsy
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Colon Biopsy Chromogranin
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Colon Biopsy Synatophysin
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Final Diagnosis

• Carcinoid syndrome secondary to poorly
  differentiated neuroendocrine carcinoma of the
  colon with liver metastasis

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Neuroendocrine Cancer

• Neuroendocrine cells are widely distributed
  throughout the body
• GI tract and pancreas have the largest component
  of neuroendocrine cells than any other organ
  system
• Nomenclature of GI neuroendocrine tumors is
  confusing WHO standardized in 2005

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Classification of NE Cancers of the Colon
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Classification of Neuroendocrine Cancers of the
Colon

1. Well-Differentiated Tumors Carcinoid
2. Well-Differentiated Endocrine Carcinoma
   Malignant Carcinoid
3. Poorly Differentiated Endocrine Carcinoma our
   patient
4. Mixed Exocrine-Endocrine Carcinoma

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Definition of Carcinoid Syndrome

• Constellation of symptoms produced by the actions
  of neuroendocrine tumor secretory products

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Prevalence of Colon Neuroendocrine Tumors

• Likely underestimated due to need for special
  additional staining
• Large retrospective series of resected colorectal
  tumors found
• - 4 of tumors had partial neuroendocrine
  differentiation
• - 1 complete neuroendocrine differentiation

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Pathophysiology of Colon Neuroendocrine Tumors

• Poorly understood, risk factors are not known
• Some suggestion of hereditary component
• Some overlap with the genetic model of
  tumorigenesis of colonic adenocarcinoma

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Pathogenesis of Mr. Ls Disease
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Clinical Presentation of Colon Neuroendocrine
Cancer

• abdominal pain
• change in bowel habits
• melena/hematochezia
• anemia, weakness, weight loss
• symptoms of carcinoid syndrome rare

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Diagnosis of Neuroendocrine Colon Cancer

• Colonoscopy with biopsy
• Immunohistochemical stains for chromogranin and
  synaptophysin

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Treatment of Neuroendocrine Colon Carcinoma

• Surgery if local disease curative
• Prognosis is poor for metastatic disease
• Chemo is similar to small cell lung cancer
• - Cisplatin and Etoposide
• - Irenotecan
• Treatment of symptoms - Sandostatin

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Follow-up

• Patient had progression of disease after 4 cycles
  of cisplatin and etoposide, bone mets developed
• Irenotectan initiated with continued progression
• Sandostatin initiated for worsening diarrhea and
  flushing
• Patient transferred to Bronx VA for palliative
  radiation therapy
• He passed away last week