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The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The small bowel and pancreas are the most common primary sites of neuroendocrine tumors (NETs) giving rise to metastatic disease. Some patients with small bowel NETs (SBNETs) present with synchronous or metachronous pancreatic NETs (PNETs), and it is unclear whether these are separate primaries or metastases from one site to the other.

Methods

A surgical NET database including patients undergoing operations for SBNETs or PNETs was reviewed. Patients with synchronous or metachronous tumors in both the small bowel and pancreas were identified, and available tissues from primary tumors and metastases were examined using a 4-gene quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) panel developed for evaluating NETs of unknown primary.

Results

Of 338 patients undergoing exploration, 11 had NETs in both the small bowel and pancreas. Tissues from 11 small bowel tumors, 9 pancreatic tumors, and 10 metastases were analyzed. qPCR and IHC data revealed that three patients had separate SBNET and PNET primaries, and five patients had SBNETs that metastasized to the pancreas. Pancreatic tissue was unavailable in two patients, and qPCR and IHC gave discrepant results in one patient.

Conclusions

NETs in both the small bowel and pancreas were found in 3% of our patients. In nearly two-thirds of evaluable patients, the pancreatic tumor was a metastasis from the SBNET primary, while in the remaining one-third of patients it represented a separate primary. Determining the origin of these tumors can help guide the choice of systemic therapy and surgical management.

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Acknowledgment

This work was supported by National Institutes of Health T32 Grant CA148062-0 (AS), National Cancer Institute SPORE Grant P50 CA174521-01 (JH, TO, AB, JD), and National Institutes of Health Grant CTSA UL1TR002537 (RedCap database). In addition, this work was presented as a poster at the Society of Surgical Oncology 2018 Annual Cancer Symposium, Chicago, IL, USA, 22 March 2018.

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Authors and Affiliations

  1. Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Aaron T. Scott MD, Jessica E. Maxwell MD, MBA, Kendall J. Keck MD, Guiying Li MD & James R. Howe MD

  2. Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Daniel Pelletier MD & Andrew M. Bellizzi MD

  3. Department of Surgery, University of Chicago, Chicago, IL, USA

    Scott K. Sherman MD

  4. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Joseph S. Dillon MD & Thomas M. O’Dorisio MD

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  1. Aaron T. Scott MD
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  2. Daniel Pelletier MD
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  3. Jessica E. Maxwell MD, MBA
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Correspondence to James R. Howe MD.

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Scott, A.T., Pelletier, D., Maxwell, J.E. et al. The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors. Ann Surg Oncol 26, 2525–2532 (2019). https://doi.org/10.1245/s10434-019-07370-3

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  • DOI: https://doi.org/10.1245/s10434-019-07370-3

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