Σταδιοποίηση Νευροενδοκρινών Όγκων

 

Νευροενδοκρινείς Όγκοι

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

IIA

T2

N0

M0

IIB

T3

N0

M0

IIIA

T4

N0

M0

IIIB

Any T

N1

M0

IV

Any T

Any N

M1

(T) Primary Tumor

Στομάχου

Χαρακτηριστικά

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ/dysplasia (tumor size < 0.5 mm), confined to mucosa

T1

Tumor invades lamina propria or submucosa and ≤ 1 cm in size

T2

Tumor invades muscularis propria or > 1 cm in size

T3

Tumor penetrates subserosa

T4

Tumor invades visceral peritoneum (serosal) or other organs or adjacent structures

For any T, add (m) for multiple tumors.

Λεπτού

Χαρακτηριστικά

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor invades lamina propria or submucosa and size ≤ 1 cm* (small intestinal tumors); tumor ≤ 1 cm (ampullary tumors)

T2

Tumor invades muscularis propria or size > 1 cm (small intestinal tumors); tumor > 1 cm (ampullary tumors)

T3

Tumor invades through the muscularis propria into subserosal tissue without penetration of overlying serosa (jejunal or ileal tumors) or invades pancreas or retroperitoneum (ampullary or duodenal tumors) or into nonperitonealized tissues

T4

Tumor invades visceral peritoneum (serosa) or invades other organs

For any T, add (m) for multiple tumors. 
*Tumor limited to ampulla of Vater for ampullary gangliocytic paraganglioma.

Παχέως Εντέρου

Χαρακτηριστικά

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor invades lamina propria or submucosa and size ≤ 2 cm

T1a

Tumor size < 1 cm in greatest dimension

T1b

Tumor size 1-2 cm in greatest dimension

T2

Tumor invades muscularis propria or size > 2 cm with invasion of lamina propria or submucosa

T3

Tumor invades through the muscularis propria into the subserosa or into nonperitonealized pericolic or perirectal tissues

T4

Tumor invades peritoneum or other organs

For any T, add (m) for multiple tumors.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

  • Most GI NETs have expansile rather than infiltrative growth pattern
    • Tumor growth by size increase rather than invasion of surrounding structures
  • GI NETs differ in their propensity for local spread
    • Gastric carcinoids
      • Types I & II are usually localized to gastric wall
      • Types III & IV are more likely to infiltrate into perigastric tissues
    • Duodenal carcinoids
      • Usually localized to duodenal wall
      • May infiltrate into pancreas and retroperitoneum
    • Jejunoileal carcinoids
      • Infiltrative growth pattern with tumor extension into mesentery
    • Colorectal carcinoids
      • Rarely infiltrate into surrounding structures

Nodal spread

  • Regional nodal spread can occur with GI NET
    • Rare in types I & II gastric carcinoids
  • Jejunoileal carcinoids
    • Frequently have metastatic foci in mesenteric lymph nodes surrounded by fibrotic reaction
    • Possible involvement of serotonin in pathogenesis of fibrosis
    • Probably mediated via 5HT2B receptor
  • Colorectal carcinoids
    • Drain to pericolorectal nodes
      • Eventually to superior and inferior mesenteric nodes with colonic carcinoids
      • Eventually to internal iliac and inguinal nodes with rectal carcinoids

Distant metastases

  • Liver is most common site of distant metastases
    • Hepatic involvement is usually needed to develop carcinoid syndrome
  • Other sites include lungs, bones, and brain

Peritoneal spread

  • Not as common as with adenocarcinoma of GI tract
  • Peritoneal metastases are considered distant metastases

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

In clinical practice, terms GI NET and carcinoid are used interchangeably

World Health Organization classification scheme for neuroendocrine tumors

  • Differentiates NET on basis of biologic behavior (malignant potential)
    • Well-differentiated endocrine tumors (carcinoids)
      • Proliferation index (PI) < 2%
      • Benign behavior or uncertain malignant potential
    • Well-differentiated endocrine carcinomas (malignant carcinoids)
    • PI > 2% but < 15%
    • Low-grade malignancy
    • PI > 15%
    • High-grade malignancy
    • Poorly differentiated endocrine Ca
    • Mixed exocrine-endocrine tumors
    • Tumor-like lesions

Classification schemes contain subdivisions based on location and morphologic criteria

  • Tumor locations include
    • Stomach
      • Type I
      • Type II
      • Type III
      • Type IV
    • Duodenum and proximal jejunum
    • Distal jejunum and ileum
    • Appendix
    • Colorectum
    • Pancreas
  • Morphologic biologic criteria include
  • Tumor size
  • Vascular invasion
  • Mitotic activity
  • Histologic differentiation
  • Presence of metastases
    • Invasion of adjacent organs

 

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