Mesenteric changes in an ultrasound examination can facilitate the diagnosis of neuroendocrine tumors of the small intestine

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Journal of Ultrasonography

Polish Ultrasound Society (Polskie Towarzystwo Ultrasonograficzne)

Subject: Medicine

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ISSN: 2084-8404
eISSN: 2451-070X

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VOLUME 15 , ISSUE 62 (September 2015) > List of articles

Mesenteric changes in an ultrasound examination can facilitate the diagnosis of neuroendocrine tumors of the small intestine

Andrzej Smereczyński * / Teresa Starzyńska / Katarzyna Kołaczyk

Keywords : neuroendocrine tumors,  small intestine,  mesenteric lesions,  abdominal ultrasound,  diagnosis

Citation Information : Journal of Ultrasonography. Volume 15, Issue 62, Pages 274-282, DOI: https://doi.org/10.15557/JoU.2015.0024

License : (CC BY-NC-ND 3.0)

Received Date : 01-December-2014 / Accepted: 04-June-2015 / Published Online: 13-September-2016

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ABSTRACT

Neuroendocrine tumors make up an interesting pathology of a variable clinical picture, prognosis, localization, endocrine activity and degree of malignancy. Aim: The aim of this paper is to assess whether ultrasonography can be helpful in diagnosing neuroendocrine tumors in the small intestine by analyzing changes in the mesentery. Material and methods:From 1996 to 2013, we encountered 17 patients (9 women and 8 men at the mean age of 57) with a neuroendocrine tumor in the small intestine. The diagnosis was confi rmed in all patients by pathomorphological examinations. All retrospectively analyzed patients (n =17) had an abdominal US examination conducted in accordance with the previously mentioned protocol. Results: Primary neuroendocrine tumors were visualized ultrasonography in 13 of 17 patients (76.5%). In the remaining 4 patients, tumors in the small bowel were diagnosed in CT enteroclysis (n = 3) and conventional enteroclysis (n = 1). Somatostatin receptor scintigraphy and CT enteroclysis supplemented the ultrasound result by providing information about the stage of the disease in 7 cases. In most of the 17 patients with a euroendocrine tumor diagnosed by ultrasound (n = 11, 64.7%), changes in the mesentery were prevailing pathological signs that raised suspicion and, consequently, helped localize the primary lesion. The hypoechoic mesenteric lymph nodes were the greatest (9–18 mm), well-circumscribed, and the largest of them showed signs of vascularization. The size of hypoechoic lesions in the mesentery ranged from 25 to 53 mm. These lesions showed moderate blood fl ow. All of them were single, usually poorly circumscribed; two lesions showed slight calcifi cations. Conclusions: In an abdominal US examination, 2/3 of patients with neuroendocrine tumors in the small bowel manifest 
secondary lesions in the mesentery which are easier to visualize than the primary focus. 30% of them are manifested as hypoechoic masses. The detection of such lesions should prompt the search for the primary focus in the small intestine.

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REFERENCES

1. Kos-Kudła B: Guzy neuroendokrynne przewodu pokarmowego. Via Medica, Gdańsk 2010.
2. Modlin IM, Lye KD, Kidd M: A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003; 97: 934–959.
3. Maggard MA, O’Connell JB, Ko CY: Updated population-based review of carcinoid tumors. Ann Surg 2004; 240: 117–122.
4. Modlin IM, Champoneria MC, Chan AK, Kidd M: A three-decade analysis 3,911 small intestinal neuroendocrine tumors: the rapid pace of no progress. Am J Gastroenterol 2007; 102: 1464–1473.
5. Yao JC, Hassan M, Phan A, Dagohoy C,Learg C, Mares JE et al.: One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008; 26: 3063–3072.
6. Hari DM, Goff SL, Reich HJ, Leung AM, Sim MS, Lee JH et al.: Small bowel carcinoid: location isn’t everything. World J Gastrointest Surg 2013; 5: 239–244.
7. Mocellin S, Nitti D: Gastrointestinal carcinoid: epidemiological and survival evidence from large population-based study (n=25531). Ann Oncol 2013; 24: 3040–3044.
8. Reznek RH: CT/MRI of neuroendocrine tumours. Cancer Imaging 2006; 6: S163–S177.
9. Bolanowski M, Bednarczuk T, Bobek-Billewicz B, Handkiewicz-Junak D, Jeziorski A, Nowakowska-Duława E et al.: Neuroendocrine neoplasms of the small intestine and the appendix – management guideline (recommended by the Polish Network of Neuroendocrine Tumours). Endokrynol Pol 2013; 64: 480–493.
10. Smereczyński A, Gałdyńska M, Lubiński J, Bojko S, Król M, Ostasz O:Obrazy USG rakowiaków przewodu pokarmowego w materiale własnym. Ultrasonografi a 2005; 22: 92–96.
11. Horton KM, Kamel I, Hofmann L, Fisher EK: Carcinoid tumors of the small bowel: a multitechnique imaging approach. Am J Roentgenol 2004; 182: 559–567.
12. Ćwikła JB, Nasierowska-Guttmejer A, Jeziorski KG, Cichocki A, Durlik M, Andziak P et al.: Diagnostic algorithm of neuroendocrine tumors of the digestive system (GEP-NET) and bronchi. Pol J Radiol 2005; 70: 85–92.
13. Kim KW, Krajewski KM, Nishino M, Jagannathan JP,ShiragareAB, Tirumani SH et al.: Update on the management of gastroenteropancreatic neuroendocrine tumors with emphasis on the role of imaging. Am J Roentgenol 2013; 201: 811–824.
14. Ganeshan D, Bhosale P, Yang T, Kundra V: Imaging features of carcinoid tumors of the gastrointestinal tract. Am J Roentgenol 2013; 201: 773–786.
15. Morin ME, Panella J, Baker DA, Engle J: Ultrasound detection of a carcinoid tumor. Gastrointest Radiol 1979; 4: 359–360.
16. Swobodnik W, Wechsler JG, Ditschuneit H: [Sonographic diagnosis of malignant small intestine carcinoid tumor. A case report]. Ultraschall Med 1983; 4: 47–48.
17. Rioux M, Duchesne N, Langis P: Carcinoid tumor of the appendix: ultrasound fi ndings in two cases. J Clin Ultrasound 1994; 22: 129–133.
18. Rioux M, Langis P, Naud F: Sonographic appearance of primary small bowel carcinoid tumor. Abdom Imaging 1995; 20: 37–43.
19. Deeg KH, Reising A, Seitz G: Sonographic diagnosis of a carcinoid tumour of the appendix in a 14-year-old boy. Ultraschall Med 2003; 24: 120–122.
20. Kala Z, Válek V, Kysela P, Svoboda T: A shift in diagnostics of the small intestine tumors. Eur J Radiol 2007; 62: 160–165.
21. Dörffel Y, Wermke W: Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography. Ultraschall Med 2008; 29: 506–514.
22. Rickes S, Uhle C, Neye H, Ensberg D, Rauh P: Diagnose eines Ileumcarcinoids mittel kontrastverstärken Ultraschalls. Med Klin 2009; 104: 564–566.
23. Pantongrag-Brown L, Buetow PC, Carr NJ, Lichtenstein JE, Buck JL:Calcifi cation and fi brosis in mesenteric carcinoid tumor: CT fi ndings and pathologic correlation. Am J Roentgenol 1995; 164: 387–391.
24. Hellman P, Hessman O, Akerström G, Stålberg P, Hennings J, BjörckM et al.: Stenting of the superior mesenteric vein in mitgut carcinoid disease with large mesenteric masses. World J Surg 2010; 34: 1373–1379.
25. Kamaoui I, De-Luca V, Ficarelli S, Mennesson N, Lombard-Bohas C, Pilleul F: Value of CT enteroclysis in suspected small-bowel carcinoid tumors. Am J Roentgenol 2010; 194: 629–633.
26. Yanaru-Fujisawa R, Matsumoto T, Esaki M, Ohji Y, Gishima M, Hirahashi M et al.: A case of multiple carcinoid tumors of the small intestine. Endoscopy 2009; 41 Suppl. 2: E299–E300.

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