Abstract
Bone represents a common site of metastases for several solid tumors. However, the ability of neuroendocrine neoplasms (NENs) to localize to bone has always been considered a rare and late event. Thanks to the improvement of therapeutic options, which results in longer survival, and of imaging techniques, particularly after the introduction of positron emission tomography (PET) with gallium peptides, the diagnosis of bone metastases (BMs) in NENs is increasing. The onset of BMs can be associated with severe skeletal complications that impair the patient’s quality of life. Moreover, BMs negatively affect the prognosis of NEN patients, bringing out the lack of curative treatment options for advanced NENs. The current knowledge on BMs in gastro-entero-pancreatic (GEP) and bronchopulmonary (BP) NENs is still scant and is derived from a few retrospective studies and case reports. This review aims to perform a critical analysis of the evidence regarding the role of BMs in GEP- and BP-NENs, focusing on the molecular mechanisms underlining the development of BMs, as well as clinical presentation, diagnosis, and treatment of BMs, in an attempt to provide suggestions that can be used in clinical practice.
Highlights
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors arising from cells with a neuroendocrine phenotype, which originate most frequently from the gastro-entero-pancreatic (GEP)
The ability of NENs to localize in bone has always been considered to be a rare and late event of its natural history and peculiar to some NEN types [6]
Thanks to the improvement of therapeutic options, which prolongs the survival of NEN patients, together with the improvement of imaging techniques, after the introduction of 68 Ga-positron emission tomography (PET)/computed tomography (CT), the diagnosis of bone metastases (BMs) in NENs is increasing, reaching 12% of cases [9,10,11,12,13,14]
Summary
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors arising from cells with a neuroendocrine phenotype, which originate most frequently from the gastro-entero-pancreatic (GEP). The bronchopulmonary (BP) tract [1,2]. NENs traditionally were considered a rare cancer, in the last few decades, there has been a rapid increase in the incidence due to more extensive use of modern imaging techniques [3,4]. The first symptoms of the disease are often related to tumor burden or to specific syndromes caused by hormones and neuroamines secretion in functioning tumors. The incidental diagnosis of NEN is becoming more frequent. NENs could present a different aggressive behavior varying from slow-growing tumors, which represent the majority of cases, to high aggressive carcinomas (NEC) [1,2,5].
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