Multimodality Management of a Polyfunctional Pancreatic Endocrine Carcinoma With Markedly Elevated Serum Vasoactive Intestinal Polypeptide and Calcitonin Levels
| Autor: | Nazeel Ahmad, Larry K. Kvols, Mokenge P. Malafa, Jaap J.M. Teunissen, Nancy Gardner, Domenico Coppola, Jonathan R. Strosberg, Dik J. Kwekkeboom, Junsung Choi, Aejaz Nasir |
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| Přispěvatelé: | Radiology & Nuclear Medicine |
| Rok vydání: | 2008 |
| Předmět: |
Calcitonin
Diarrhea medicine.medical_specialty Endocrinology Diabetes and Metabolism Vasoactive intestinal peptide Octreotide Lutetium Peptides Cyclic Gastroenterology Paraneoplastic Endocrine Syndromes Heterocyclic Compounds 1-Ring chemistry.chemical_compound Endocrinology SDG 3 - Good Health and Well-being Internal medicine Internal Medicine medicine Humans Etoposide Octreotate Hepatology biology business.industry Middle Aged Combined Modality Therapy Pancreatic Neoplasms medicine.anatomical_structure chemistry Radionuclide therapy Synaptophysin biology.protein Female Radiopharmaceuticals Pancreas business Vasoactive Intestinal Peptide medicine.drug |
| Zdroj: | Pancreas, 36(3), 309-313. Lippincott Williams & Wilkins |
| ISSN: | 0885-3177 |
| Popis: | We present an unusual case of a 52-year-old woman with severe, uncontrollable, refractory diarrhea attributable to pancreatic endocrine carcinoma (ECA) with markedly elevated serum vasoactive intestinal polypeptide (VIP) and calcitonin levels. After initial correction of fluid and electrolyte abnormalities, the patient was treated with high-dose octreotide. Shortly thereafter, due to the intractable nature of her diarrhea, she underwent cytoreductive hepatic surgery. The pancreatosplenectomy specimen showed a poorly differentiated ECA of the distal pancreas, immunoreactive for synaptophysin, CD56, and S100 protein, with morphologically similar hepatic and lymph node metastases. Postoperatively, her diarrhea improved, along with decline in serum VIP and calcitonin levels. Systemic chemotherapy with etoposide and cisplatin did not result in any radiographic and biochemical improvement. Having radiologically stable disease with depot-octreotide and short-acting octreotide (Sandostatin), she was subjected to peptide receptor radiotherapy with [Lu-177-DOTA(0), Tyr(3)] octreotate (LuTate) that resulted in marked clinical and biochemical improvement, along with dramatic reduction in the number and size of hepatic metastases. In summary, this is a unique case of metastatic VIP- and calcitonin-secreting pancreatic ECA with dramatic sustained clinical, biochemical, and objective tumor response to peptide receptor radionuclide therapy. |
| Databáze: | OpenAIRE |
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