interesting case presentation neuroendocrine lung tumors m. demiri b oncology clinic director saint...
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Interesting Case Presentation
Neuroendocrine Lung Tumors
M. DemiriB Oncology Clinic Director
Saint Savvas Anticancer Hospital
• Male patient, 40 years old• No previous medical history• 6ος/2009: hemoptysis, imaging shows a left
lower pulmonary lobe mass. Patient was subjected to a left lower lobectomy.
• Pathology Report: neuroendocrine neoplasm; atypical carcinoid (AC) [mild cellular pleomorphism, necrosis, 3 mitoses/2 mm2, chromogranin +, NSE +, CD 56 +, CK8/18+]
• 7 /2012: scheduled upper abdomen MRI: at least 22 new lesions with a maximum diameter about 1.5 cm in the left, right and caudate liver lobe, with abnormal signal intensity and contrast agent uptake.
• 10/2012: patient was admitted to the clinic for diagnostic workout and further treatment planning.– NSE, CA19-9, CEA, urine-5-HIAA: normal– Chromogranin: 108 ng/ml (normal values: in serum 10-110, in
plasma 18-150)
Due to their small size the liver lesions could not be biopsied under CT scan and a laparoscopic liver biopsy could not be done
11/2012: Octreoscan: diffuse abnormal uptake of the radioactive substance in the liver, which shows hyperexpression of somatostatin receptors, primarily sst2
• 1/2013: 3rd chemotherapy cycle, good tolerance, CT scan restaging: SD
• 4th cycle: exertional dyspnea. Heart U/S: marginally normal dimensions of the heart chambers and E.F. 60%. Strict fluid equilibrium control was advised as well as cardiology follow up before chemotherapy. CDDP was changed with CarboAUC5 from the 5th cycle.
• 4/2013: completion of 1st line chemotherapyRestaging: PD with increase in the dimensions of
most of the lesions which are noted in all the hepatic lobes, while one left lobe lesion presents a significant enlargement(4 cm from 1.5 cm)
• 9/2013: restaging: hepatic lesions remaining, with increase of the dimensions in certain and a decrease in others. Greater enlargement of the left lobe lesion (6 cm from 4 cm)
• Other therapeutic options are – Everolimus + Somatostatin analog– Lu-Dotatate– LUNA trial (pasireotide)