Rectal Carcinoid Tumors Research Articles

S389 Active Ulcerative Colitis and Rectal Carcinoid Tumors: A Rare Occurrence

S389 Active Ulcerative Colitis and Rectal Carcinoid Tumors: A Rare Occurrence

18F-FDG, 68Ga-PSMA, and 64Cu-DOTATATE PET/CT—One Patient, Three Cancers

Abstract A 67-year-old man with a history of multiple myeloma, prostate cancer, and rectal carcinoid tumor underwent 18F-FDG PET/CT for surveillance, which revealed a non–FDG-avid lesion in the liver. To rule out metastasis from prostate cancer and carcinoid tumor, 68Ga-PSMA and 64Cu-DOTATATE PET/CT scans were ordered for respective malignancies. The 64Cu-DOTATATE scan showed radiotracer uptake in the hepatic lesion compatible with metastasis of the carcinoid tumor. Additionally, both 68Ga-PSMA and 64Cu-DOTATATE PET/CT scans revealed nodal metastasis within the pelvis. This case highlights the importance of appropriate radiotracer selection in conjunction with patient history in the evaluation of patients with multiple malignancies.

Double-snare resection technique: a new approach for treating rectal carcinoid tumors.

Double-snare resection technique: a new approach for treating rectal carcinoid tumors.

Incidentally Found Rectal Carcinoid Tumor in a 46-Year-Old Female: The Potential for Complications and the Importance of Screening Guidelines

BACKGROUND: Carcinoid tumors are rare neuroendocrine tumors that can be found in the gastrointestinal tract as well as other areas throughout the body. The neurosecretory nature of these tumors can have implications for other chronic diseases that patients may have, including diabetes and hypertension. Certain treatments that may be implemented for patients that have carcinoid tumors, such as somatostatin analogs and Everolimus, can also alter blood glucose control. This highlights the importance of diagnosing and treating carcinoid tumors as early as possible to avoid complications associated with metastasis and more intense treatment. With more advanced disease, clinicians should consider the possible effects of carcinoid tumors and their treatments on other chronic conditions as they manage the patient. For gastrointestinal carcinoid tumors, colonoscopy screening guidelines are incredibly important to counsel patients on, as resection can yield a complete cure for carcinoid tumors when they are found at an early stage. THE CASE: We describe the case of an incidentally diagnosed rectal carcinoid tumor in a 46-year-old female patient with a history of type 2 diabetes mellitus and hypertension. This tumor was discovered on colonoscopy, which had been delayed due to complications following a surgical procedure that the patient had recently undergone. CONCLUSION: Carcinoid tumors are quite rare, however, the incidence of neuroendocrine tumors, including gastrointestinal carcinoid tumors, is growing. Thus, it is important to consider the implications of such tumors on pre-existing chronic conditions, such as diabetes and hypertension. Also, more research efforts should be directed towards standardizing the treatment protocol for such tumors, specifically rectal carcinoid tumors, and counseling patients on the importance of screening guidelines. When rectal carcinoid tumors are caught early, complete surgical resection can be curative, which is ideal. However, with more advanced disease, symptoms of the tumor itself as well as necessary treatments can impact other chronic conditions, possibly requiring modifications to a patient’s prior medication regimen. Fortunately, the carcinoid tumor in the described patient was not advanced enough to cause significant alteration in her other chronic conditions, however, this case is still a great example of how carcinoid tumors can arise asymptomatically, which is why it is important for the astute clinician to counsel on screening recommendations. This emphasizes the importance of using a team-based approach to ensure that the carcinoid tumor is diagnosed and adequately treated without significantly affecting other conditions so that patients can achieve optimal outcomes for each condition being managed. It also highlights the crucial importance of screening guidelines so that conditions can be caught early to mitigate downstream consequences.

S2237 An Atypical Case of Squamous Cell Carcinoma of the Rectum Masquerading as a Rectal Carcinoid Tumor

S2237 An Atypical Case of Squamous Cell Carcinoma of the Rectum Masquerading as a Rectal Carcinoid Tumor

Robotic transanal minimally invasive surgery: a single institutional experience

Robotic transanal minimally invasive surgery (R-TAMIS) is a novel and evolving technique with limited reported outcomes in the literature. Compared to the laparoscopic approach, R-TAMIS provides enhanced optics, increased degrees of motion, superior ergonomics, and easier maneuverability in the confines of the rectum. We report a single institution experience at a large quaternary referral academic medical center with R-TAMIS using the da Vinci Xi® platform. This is a retrospective review of electronic medical records at the Mayo Clinic from September 2017 to April 2020. It includes all available clinical documentations for patients undergoing R-TAMIS at our institution. Patient demographics, intraoperative data (procedure time, tumor size and distance), complications, and pathology reports were reviewed. A total of 28 patients underwent R-TAMIS. Median follow-up was 23.65months. Sixteen patients underwent R-TAMIS for endoscopically unresectable rectal polyps, eight for rectal adenocarcinoma, two for rectal gastrointestinal stromal tumor, and two for rectal carcinoid tumor. The mean size of the lesions was 4.1cm (range 0.2-13.8cm). The mean location of lesions was 7.8cm (range 0-16cm) from the anal verge. The mean operative time was 132.5 ± 46.8min. There was one 30-day complication, and no deaths. Twenty-three (82%) patients were discharged the day of surgery. R-TAMIS is a safe, feasible, and effective technique for the surgical treatment of a variety of rectal pathology. A hybrid technique can be used for the resecting tumors extending into the anal canal.

Ligation-assisted endoscopic mucosal resection has high complete resection rate in rectal carcinoid tumor

AimWe aimed to compare the outcomes of different therapeutic modalities in rectal carcinoid tumors.MethodWe retrospectively collected 145 patients with rectal carcinoid tumors which were pathologically diagnosed from 2005/01/01 to 2016/12/31. We compared tumor size, complete resection rate and recurrent rate between different therapeutic modalities. Then, prospectively compared the treatment outcomes of 28 patients treated with ligation assisted endoscopic mucosal resection (LEMR) and 25 patients treated with endoscopic mucosal resection with cap (EMRC).ResultThe mean size of tumors was 6.5 mm (1–25 mm), and the mean follow-up duration was 26 months (6–118 months). The therapeutic modalities included ligation-assisted endoscopic mucosal resection (LEMR) (25 tumors, 17%), endoscopic mucosal resection (EMR) (31 tumors, 21%), snare polypectomy (30 tumors, 21%), biopsy forceps removal (46 tumors, 32%) and surgical resection (13 tumors, 11%), including 6 tumors treated with transanal endoscopic microsurgery (TEM) method. In view of pathologically complete resection rate, LEMR was highest (100%), followed by surgical resection (85%). However, EMR only had 42% pathologically complete resection rate. Besides, LEMR and surgical resection had no local recurrence and significantly higher clinically complete resection rate, compared to other treatments. For the further prospective study, complete resection was noted in 28 (100%) patients in LEMR group and 13 (52%) patients in EMRC group.ConclusionIn the treatment of rectal carcinoid tumors, LEMR is safe and effective compared with traditional endoscopic treatments.

Endoscopic submucosal dissection versus endoscopic mucosal resection for rectal carcinoid tumor. A meta-analysis and meta-regression with single-arm analysis.

As there has been so far no consensus on the best endoscopic resection technique, a meta-analysis was conducted to compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for treating rectal carcinoid tumors. MEDLINE and EMBASE databases were searched for articles on the treatment of rectal carcinoid tumors using ESD vs EMR published up to October 2020 for outcomes including en bloc and complete resection, margin involvement, procedure time, requirement for additional surgery, bleeding, perforation and recurrence. Risk ratio and weighted mean differences were used for a DerSimonian and Laird random effects pairwise meta-analysis. Single-arm meta-analyses of proportions and random effects meta-regression analysis were also conducted. Twenty-two studies involving 1360 rectal carcinoid tumors were included, in which 655 and 705 rectal carcinoid tumors were resected with ESD and EMR, respectively. The resection efficacy of ESD was comparable to that of EMR for tumors <10 mm. However, there were a significantly higher complete resection rate, and lower rates of vertical margin involvement and requirement for additional surgery using ESD than using EMR for tumors ≤20 mm. ESD had a longer procedure time and an increased likelihood of bleeding than EMR. ESD is more effective in providing a curative treatment for rectal carcinoid tumors ≤20 mm in size as ESD can achieve a higher complete resection rate with lower vertical margin involvement than EMR. While they are suitable for treating rectal carcinoid tumors <10 mm as both techniques provide similar efficacy.

S1050 An Experience of Endoscopic Band Ligation Without Resection (EBL-WR) for Grade One, Well Differentiated Duodenal and Rectal Carcinoid Tumors

S1050 An Experience of Endoscopic Band Ligation Without Resection (EBL-WR) for Grade One, Well Differentiated Duodenal and Rectal Carcinoid Tumors

Contributions of Adenocarcinoma and Carcinoid Tumors to Early-Onset Colorectal Cancer Incidence Rates in the United States.

Early-onset colorectal cancer (EOCRC) incidence rates (IRs) are rising, according to previous cancer registry analyses. However, analysis of histologic subtypes, including adenocarcinoma (the focus of CRC screening and diagnostic testing) and carcinoid tumors (which are classified as "colorectal cancer" in SEER [Surveillance, Epidemiology, and End Results] databases but have a distinct pathogenesis and are managed differently from adenocarcinoma), has not been reported. To assess EOCRC IRs and changes in IRs over time, stratified by histology. Retrospective analysis. Yearly IRs according to SEER 18 data from 2000 to 2016 on age-specific colon-only, rectal-only, and combined-site CRC cases, stratified by histology ("overall" CRC [all histologic subtypes], adenocarcinoma, and carcinoid tumors) and age. 119 624 patients with CRC. IRs per 100 000 population, changes in 3-year average annual IRs (pooled IRs from 2000 to 2002 vs. those from 2014 to 2016), and annual percentage change (APC) in persons aged 20 to 29, 30 to 39, 40 to 49, and 50 to 54 years. The steepest changes in adenocarcinoma 3-year average annual IRs were for rectal-only cases in persons aged 20 to 29 years (+39% [0.33 to 0.46 per 100 000]; P < 0.050) and 30 to 39 years (+39% [1.92 to 2.66 per 100 000]; P < 0.050) and colon-only cases in those aged 30 to 39 years (+20% [3.30 to 3.97 per 100 000]; P < 0.050). Corresponding APCs were 1.6% (P < 0.050), 2.2% (P < 0.050), and 1.2% (P < 0.050), respectively. In persons aged 40 to 49 years, 3-year average annual IRs increased in both colon-only (+13% [12.21 to 13.85 per 100 000]; P < 0.050) and rectal-only (+16% [7.50 to 8.72 per 100 000]; P < 0.050) subsites. Carcinoid tumors were common, representing approximately 4% to 20% of all colorectal and 8% to 34% of all rectal cancer cases, depending on age group and calendar year. Colon-only carcinoid tumors were rare. Colorectal carcinoid tumor IRs increased more steeply than adenocarcinoma in all age groups, thus affecting the contribution of carcinoid tumors to overall cancer cases over time. These changes were driven by rectal subsites and were most pronounced in persons aged 50 to 54 years, in whom rectal carcinoid tumors increased by 159% (2.36 to 6.10 per 100 000) between 2000 to 2002 and 2014 to 2016, compared with 10% for adenocarcinoma (18.07 to 19.84 per 100 000), ultimately accounting for 22.6% of all rectal cancer cases. Population-based data. These findings underscore the importance of assessing histologic CRC subtypes independently. Doing so may lead to a better understanding of the drivers of temporal changes in overall CRC incidence and a more accurate measurement of outcomes from efforts to reduce adenocarcinoma risk, and can guide future research. None.

Transanal minimally invasive surgery vs endoscopic mucosal resection for rectal benign tumors and rectal carcinoids: A retrospective analysis.

BACKGROUNDTransanal minimally invasive surgery (TAMIS) is a good choice for resection of rectal neoplasms. Endoscopic mucosal resection (EMR) is also widely used in the treatment of benign rectal tumors such as rectal polyps and rectal adenomas. However, no studies have compared the outcome of TAMIS and EMR.AIMTo compare the short-term outcomes after TAMIS and EMR for rectal carcinoid and benign tumors (including rectal polyps and adenomas).METHODSFrom January 2014 to January 2019, 44 patients who received TAMIS and 53 patients who received EMR at The Fifth People’s Hospital of Shanghai were selected. Primary outcomes (surgical-related) were operating time, blood loss, length of postoperative hospital stay, rate of resection margin involvement and lesion fragmentation rate. The secondary outcomes were complications such as hemorrhage, urinary retention, postoperative infection and reoperation.RESULTSNo significant differences were observed in terms of blood loss (12.48 ± 8.00 mL for TAMIS vs 11.45 ± 7.82 mL for EMR, P = 0.527) and length of postoperative hospital stay (3.50 ± 1.87 d for TAMIS vs 2.72 ± 1.98 d for EMR, P = 0.065) between the two groups. Operating time was significantly shorter for EMR compared with TAMIS (21.19 ± 9.49 min vs 49.95 ± 15.28 min, P = 0.001). The lesion fragmentation rate in the EMR group was 22.6% (12/53) and was significantly higher than that (0%, 0/44) in the TAMIS group (P = 0.001). TAMIS was associated with a higher urinary retention rate (13.6%, 6/44 vs 1.9%, 1/53 P = 0.026) and lower hemorrhage rate (0%, 0/44 vs 18.9%, 10/53 P = 0.002). A significantly higher reoperation rate was observed in the EMR group (9.4%, 5/53 vs 0%, 0/44 P = 0.036).CONCLUSIONCompared with EMR, TAMIS can remove lesions more completely with effective hemostasis and lower postoperative hemorrhage and reoperation rates. TAMIS is a better choice for the treatment of rectal carcinoids.

Prevalence of Neuroendocrine Tumors in the Gastrointestinal and Hepatobiliary Systems

Background: Carcinoid tumors are the most common neuroendocrine tumors. In recent years, these tumors have had an increasein incidence, which is probably due to a higher number of them being incidentally found as a result of the rise of preventivemedicine.Objectives: This study aimed to analyze a series of digestive carcinoid tumors detected by conventional endoscopy and/or echoendoscopyto evaluate the prevalence of those located in the colon and rectum, and subsequently make a comparison with data availablein the literature.Methods: In this retrospective, multicenter study (two centers), the clinical records of 100 white patients with more than 100 digestivecarcinoid tumors (some multiple) diagnosed from 1994 to 2018 were reviewed.Results: The mean age of presentation was 52 years and 57% of the patients were men. The mean tumor size was 10 mm. The localizationof the tumors was: stomach 43% (n = 43); duodenum 5% (n = 5); intestine 8% (n = 8); appendix 14% (n = 14); colon 4% (n = 4);rectum 19% (n = 19); pancreas 3% (n = 3); liver 2% (n = 2); gallbladder 1% (n = 1); primary tumor of unknown origin 1% (n = 1). Mostmultifocal tumors were in the stomach (20%; n = 20), followed by the duodenum (1%; n = 1) and intestine (1%; n = 1). Metastases andcarcinoid syndrome were observed in 6% and 5% of the cases, respectively. General survival at the closure of the study was 80%.Conclusions: Age and sex were similar to those described in the literature, while the colon and rectum represented 23% of all carcinoidtumors. There was a predominance of gastroduodenal and rectal carcinoid tumors, probably because the series analyzedwas essentially endoscopic. In comparison with the literature, less cases of metastases or carcinoid syndrome were recorded andsurvival was greater, perhaps due to earlier diagnosis and treatment.

Incomplete cold snare polypectomy for rectal carcinoid tumour

Incomplete cold snare polypectomy for rectal carcinoid tumour

A case of metastatic carcinoid tumor of the pancreas resected by laparoscopic distal pancreatectomy.

Background: Surgery for metastatic tumor of the pancreas has increased. However, rectal carcinoid tumor is considered to be quite uncommon as primary tumor. We reported a case that metastatic pancreatic tumor of rectal carcinoid tumor was successfully resected by laparoscopic distal pancreatectomy. Methods: The patient was a 70-year-old woman who underwent local excision of rectal submucosal tumor, which was pathologically diagnosed as a so-called carcinoid tumor, at another hospital in 2003. In 2009 and 2012, she received two times of hepatectomies for liver metastases of rectal carcinoid tumor at our hospital. In 2013, abdominal computed tomography revealed a 1 cm hypovascular tumor in the pancreatic body. We suspected the metastatic pancreatic tumor of rectal carcinoid and performed laparoscopic spleen-preserving distal pancreatectomy subsequently. Pathological examination of the resected specimen demonstrated that the tumor was metastatic carcinoid tumors of the pancreas. Results: Three years and 6 months have passed since pancreatic resection was performed and the patient is now still alive. Unfortunately, liver and bone metastases present, however, her quality of life has been very good under administration of octreotide once a month in the outpatient. Conclusion: We reported a rare case of metastatic carcinoid tumor of the pancreas. Laparoscopic distal pancreatectomy for metastatic tumor of the pancreas is thought to be feasible and acceptable.

Cardiac Metastasis in Patient with Rectal Carcinoid Tumor

Cardiac Metastasis in Patient with Rectal Carcinoid Tumor

A case of metastatic carcinoid tumor of the pancreas resected by laparoscopic distal pancreatectomy

Background: Surgery for metastatic tumor of the pancreas has increased. However, rectal carcinoid tumor is considered to be quite uncommon as primary tumor. We reported a case that metastatic pancreatic tumor of rectal carcinoid tumor was successfully resected by laparoscopic distal pancreatectomy. Methods: The patient was a 70-year-old woman who underwent local excision of rectal submucosal tumor, which was pathologically diagnosed as a so-called carcinoid tumor, at another hospital in 2003. In 2009 and 2012, she received two times of hepatectomies for liver metastases of rectal carcinoid tumor at our hospital. In 2013, abdominal computed tomography revealed a 1 cm hypovascular tumor in the pancreatic body. We suspected the metastatic pancreatic tumor of rectal carcinoid and performed laparoscopic spleen-preserving distal pancreatectomy subsequently. Pathological examination of the resected specimen demonstrated that the tumor was metastatic carcinoid tumors of the pancreas. Results: Three years and 6 months have passed since pancreatic resection was performed and the patient is now still alive. Unfortunately, liver and bone metastases present, however, her quality of life has been very good under administration of octreotide once a month in the outpatient. Conclusion: We reported a rare case of metastatic carcinoid tumor of the pancreas. Laparoscopic distal pancreatectomy for metastatic tumor of the pancreas is thought to be feasible and acceptable.

Prevalence of metastasis and survival of 788 patients with T1 rectal carcinoid tumors

Prevalence of rectal carcinoids is increasing, partly because of increased colorectal cancer screening. Local excision (endoscopic or transanal excision) is usually performed for small (<1-2 cm) rectal carcinoids, but data on clinical outcomes from large population-based U.S. studies are lacking. The aims of this study were to determine the prevalence of metastasis of resected small rectal carcinoid tumors using a large national cancer database and to evaluate the long-term survival of patients after local resection as compared with radical surgery. The Surveillance Epidemiology and End Results database was used to identify 788 patients with rectal T1 carcinoids<2 cm in size. Prevalence of metastases at initial diagnosis and risk factors for metastases were analyzed. Cancer-specific survival (CSS) was calculated. A total of 727 patients (92.3%) had tumors≤10mm in diameter and 61 (7.7%) had tumors 11 to 19mm. Overall, 12 patients (1.5%) had metastasis at the time of diagnosis with prevalence of 1.1% in lesions≤10mm and 6.6% in lesions 11 to 19mm (P= .01). Survival of patients with T1 rectal carcinoids without metastasis was significantly better than those with metastasis (5-year CSS of 100% vs 78%, P< .001). Of 559 patients with T1N0M0 rectal carcinoids≤10mm, 5-year CSS was 100% in both groups who underwent local excision and those who underwent radical surgery. Larger T1 rectal carcinoid tumors (11-19mm) have significantly higher risk of lymph node metastases compared with those≤10mm. Survival is worse with metastatic disease. Local therapy is adequate for T1N0M0 rectal carcinoids≤10mm in size with excellent long-term outcomes.

Local Recurrence Rate of Rectal Carcinoid Tumors After Endoscopic Mucosal Resection With Transrectal Ultrasound

Introduction: Rectal carcinoids are the most common neuroendocrine tumors of the GI tract. They constitute 1-2% of all rectal tumors. Incidence of rectal carcinoids is on the rise due to more frequent surveillance colonoscopies. The overall metastatic risk of small well-differentiated rectal carcinoids tumor is low but not negligible. However, local recurrence of the tumors, especially with respect to resection margin status has not been clearly established. Methods: We performed a retrospective cohort study (2007-2017) of a single tertiary center using pathology database for well differentiated neuroendocrine tumors of the rectum as well as electronic medical record search for all transrectal ultrasound procedures performed. All patients over age of 18 were included. Patient with malignant neuroendocrine tumors with distal metastases and patients who underwent surgical resection of the tumors were excluded. Results: We identified 74 patients. (34 males, 40 females; 44 African Americans, 20 Whites, 5 Asians, 5 Others; Age 54.4, 23-77). The average resected tumor size was 0.49 cm (0.1-1.2cm). All tumors were initially discovered on colonoscopy. Endoscopic technique used for resection: 51 Colonoscopy (hot/cold snare polypectomy), 28 transrectal ultrasound (RUS) (endoscopic mucosal resection). Endoscopic mucosal resection under ultrasound was more likely to achieve negative margin (Resection rate (28/28, 100%, P < 0.0001). 5 cases of incomplete resection with colonoscopic polypectomy (5/51, resection rate of 90.2%) were later resected with follow up RUS EMR without recurrence. There is no difference between resection margin and recurrence with EMR under RUS (P = 0.99). There is 1 case of synchronous NET with EMR during follow up at a different location in the rectum. Average endoscopic follow up time is 14.8 months (0-138). 48 Patients had endoscopic follow up, 25 patients had imaging follow up (MRI and CT). 19 Patients did not have any follow up. Conclusion: Local recurrence rate of small well differentiated rectal carcinoid tumors after endoscopic mucosal resection under rectal ultrasound is very low and independent of resection margin status. Resection of rectal carcinoids with conventional, colonoscopic polypectomy may be incomplete if the margins are positive, necessitating close endoscopic follow up.818 Figure 1. Comparison between colonoscopy (Polypectomy) and rectal ultrasound (EMR) with respect to resection margin status and recurrence/incomplete resection.

A case of anastomotic stenosis of the small intestine caused by cholesterol crystal embolism

BackgroundCholesterol crystal embolism (CCE) is caused by small crystals of cholesterol dispersed from atherosclerotic plaques of the aorta. There is an increasing interest in CCE because of the increased use of endovascular treatments. Here, we report a rare case of intestinal stenosis caused by CCE after functional end-to-end anastomosis (FEEA). To our knowledge, this is the first report of CCE causing such an anastomotic stenosis.Case presentationA 77-year-old male patient underwent laparoscopy-assisted low anterior resection and protective ileostomy for rectal carcinoid tumor. He was admitted to our hospital with ileus 1 year after stoma closure. Eosinophils and creatine kinase level were slightly elevated. Computed tomography revealed a stricture with thickened intestinal wall just distal to the anastomosis site of the ileostomy. The wall of the descending aorta appeared shaggy due to thrombosis. The patient underwent laparoscopic small-bowel resection because ileus reoccurred after any oral intake.Histopathological findings of the resected specimen showed fibrotic changes distal to the anastomosis site, and needle-shaped cholesterol embolus was observed in the submucosal layer. Thus, the stenosis was considered to be caused by CCE.ConclusionThis appears to be the first published report of stenosis due to CCE at such an anastomotic site. Intestinal CCE is difficult to diagnose preoperatively and is associated with poor prognosis. If eosinophilia is present or shaggy aorta is observed, CCE should be suspected to make correct diagnosis and prevent recurrence of CCE.

29 Paired Box 5 (PAX5) Cytoplasmic Immunoreactivity in Rectal Carcinoid Tumors: A Novel Finding With Potential for Diagnostic and Prognostic Utility

29 Paired Box 5 (PAX5) Cytoplasmic Immunoreactivity in Rectal Carcinoid Tumors: A Novel Finding With Potential for Diagnostic and Prognostic Utility