|ECR 2019 / C-3217|
|Unravelling the 'NET' - imaging of neuroendocrine tumours (NETs) and challenging cases|
- What are NETs?
- Neuroendocrine tumours of the gastrointestinal tract (GI-NETs) comprise a genetically diverse spectrum of malignant neoplasms arising from the secretory cells of the neuroendocrine system.
- The involved secretory cells produce peptides which may cause characteristic hormonal syndromes in some patients
- Where do we find them?
- GI-NETs are most commonly found in the pancreas
- Certain subtypes arise elsewhere;
- Gastrinomas primarily affect the pancreas but can also arise in the duodenum, lymph nodes and adrenal glands
- Vasoactive polypeptide secreting tumours (VIPomas) are primarily pancreatic in origin, but a small percentage are found in the adrenal gland
- Another atypical location for GI-NETs includes the biliary tree. These are challenging cases to diagnose and good knowledge of the imaging characteristics is critical in correctly identifying these lesions
- G-NETs are a heterogenous group of neoplasms with varied biological activity and behaviour
- The clinical course of GI-NETs may be indolent which can lead to a delayed diagnosis, after the development of metastasis
- Pretreatment prediction of stage and grade of these neoplasms is important to decide on the best management strategy for the patient
- How are these lesions treated?
- Prompt diagnosis of GI-NETs is essential for surgical planning as surgical resection remains the only definitive treatment
- This is not only reserved for low grade/stage lesions, but will also be considered in some cases presenting with metastatic disease, if it is deemed technically feasible
- There are several additional treatments available for metastatic GI-NET including; chemoembolization, radiofreqency and medical therapies including somatostatin analogues
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