Abstract

Background. Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare in children and adolescents. Standard management of these tumors has not been well established due to their rarity in this age group. We aimed to report the clinical and pathological characteristics of patients with this rare disease followed and treated between the years 1993-2022.

Materials and methods. The medical records of patients with GEP-NETs were reviewed.

Results. Fourteen patients (11 girls, 3 boys) were diagnosed with GEP-NET. The median age was 13 (9-18) years. Tumor localization was the appendix in 12, stomach in one and pancreas in one patient. Mesoappendix invasion was detected in four patients two of whom underwent right hemicolectomy (RHC) and lymph node dissection (LND). Of those, one patient had lymph node involvement. The other two had not further operations. Somatostatin was used in one with pancreatic metastatic disease and the other with gastric disease after surgery. No additional treatment was given in other patients. All patients are under follow-up without evidence of disease at a median follow-up of 85 months (7-226 months).

Conclusion. GEP-NETs should be considered in the differential diagnosis of acute appendicitis and in cases with persistent abdominal pain. In children, there is invariably a favorable prognosis, and additional surgical interventions other than simple appendectomies generally do not provide benefits. Mesoappendix invasion may not necessitate RHC and LND.

Keywords: gastroenteropancreatic neuroendocrine tumors, appendiceal neuroendocrine tumors, appendix, children and adolescents

How to cite

1.
Yıldırım ÜM, Koca D, Kebudi R. Gastroenteropancreatic neuroendocrine tumors in children and adolescents. Turk J Pediatr 2024; 66: 332-339. https://doi.org/10.24953/turkjpediatr.2024.4526

References

  1. Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas 2010; 39: 707-712. https://doi.org/10.1097/MPA.0b013e3181ec124e
  2. Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017; 3: 1335-1342. https://doi.org/10.1001/jamaoncol.2017.0589
  3. Navalkele P, O’Dorisio MS, O’Dorisio TM, Zamba GKD, Lynch CF. Incidence, survival, and prevalence of neuroendocrine tumors versus neuroblastoma in children and young adults: nine standard SEER registries, 1975-2006. Pediatr Blood Cancer 2011; 56: 50-57. https://doi.org/10.1002/pbc.22559
  4. Díez M, Teulé A, Salazar R. Gastroenteropancreatic neuroendocrine tumors: diagnosis and treatment. Ann Gastroenterol 2013; 26: 29-36.
  5. Anlauf M. Neuroendocrine neoplasms of the gastroenteropancreatic system: pathology and classification. Horm Metab Res 2011; 43: 825-831. https://doi.org/10.1055/s-0031-1291307
  6. Boxberger N, Redlich A, Böger C, et al. Neuroendocrine tumors of the appendix in children and adolescents. Pediatr Blood Cancer 2013; 60: 65-70. https://doi.org/10.1002/pbc.24267
  7. Tremmel T, Holland-Cunz S, Günther P. Metastasized pancreatic neuroendocrine tumor in a teenage girl: a case report. J Med Case Rep 2015; 9: 230. https://doi.org/10.1186/s13256-015-0708-3
  8. Elayan A, Batah H, Badawi M, Saadeh A, Abdel Hafez S. Primary hepatic neuroendocrine tumor: a case report and literature review. Cureus 2022; 14: e22370. https://doi.org/10.7759/cureus.22370
  9. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4 ed. World Health Organization; 2010.
  10. Das S, Dasari A. Epidemiology, incidence, and prevalence of neuroendocrine neoplasms: are there global differences? Curr Oncol Rep 2021; 23: 43. https://doi.org/10.1007/s11912-021-01029-7
  11. Tang LH, Untch BR, Reidy DL, et al. Well-differentiated neuroendocrine tumors with a morphologically apparent high-grade component: a pathway distinct from poorly differentiated neuroendocrine carcinomas. Clin Cancer Res 2016; 22: 1011-1017. https://doi.org/10.1158/1078-0432.CCR-15-0548
  12. Han X, Xu X, Ma H, et al. Clinical relevance of different WHO grade 3 pancreatic neuroendocrine neoplasms based on morphology. Endocr Connect 2018; 7: 355-363. https://doi.org/10.1530/EC-17-0388
  13. Kim JY, Hong SM, Ro JY. Recent updates on grading and classification of neuroendocrine tumors. Ann Diagn Pathol 2017; 29: 11-16. https://doi.org/10.1016/j.anndiagpath.2017.04.005
  14. Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World J Gastrointest Oncol 2020; 12: 791-807. https://doi.org/10.4251/wjgo.v12.i8.791
  15. Coursey CA, Nelson RC, Moreno RD, Dodd LG, Patel MB, Vaslef S. Carcinoid tumors of the appendix: are these tumors identifiable prospectively on preoperative CT? Am Surg 2010; 76: 273-275. https://doi.org/10.1177/000313481007600306
  16. Gaiani F, de’Angelis N, Minelli R, Kayali S, Carra MC, de’Angelis GL. Pediatric gastroenteropancreatic neuroendocrine tumor: A case report and review of the literature. Medicine (Baltimore) 2019; 98: e17154. https://doi.org/10.1097/MD.0000000000017154
  17. Johnson PR. Gastroenteropancreatic neuroendocrine (carcinoid) tumors in children. Semin Pediatr Surg 2014; 23: 91-95. https://doi.org/10.1053/j.sempedsurg.2014.03.007
  18. Khanna G, O’Dorisio SM, Menda Y, Kirby P, Kao S, Sato Y. Gastroenteropancreatic neuroendocrine tumors in children and young adults. Pediatr Radiol 2008; 38: 251-259, quiz 358-359. https://doi.org/10.1007/s00247-007-0564-4
  19. Castle JT, Levy BE, Chauhan A. Pediatric neuroendocrine neoplasms: rare malignancies with incredible variability. Cancers (Basel) 2022; 14: 5049. https://doi.org/10.3390/cancers14205049
  20. Ruggeri RM, Benevento E, De Cicco F, et al. Neuroendocrine neoplasms in the context of inherited tumor syndromes: a reappraisal focused on targeted therapies. J Endocrinol Invest 2023; 46: 213-234. https://doi.org/10.1007/s40618-022-01905-4
  21. Diets IJ, Nagtegaal ID, Loeffen J, et al. Childhood neuroendocrine tumours: a descriptive study revealing clues for genetic predisposition. Br J Cancer 2017; 116: 163-168. https://doi.org/10.1038/bjc.2016.408
  22. Lewis MA. Hereditary syndromes in neuroendocrine tumors. Curr Treat Options Oncol 2020; 21: 50. https://doi.org/10.1007/s11864-020-00749-5
  23. Kebudi R, Yıldırım UM, Bouffet E. Predisposing genetic variants and potent genetic mutations in cancer. In: Lakhoo K, Abdelhafeez AH, Abib S, editors. Pediatric Surgical Oncology. Springer Nature; 2023. https://doi.org/10.1007/978-3-030-71113-9_3-1
  24. Farooqui ZA, Chauhan A. Neuroendocrine tumors in pediatrics. Glob Pediatr Health 2019; 6: 2333794X19862712. https://doi.org/10.1177/2333794X19862712
  25. Goel R, Shukla J, Bansal D, et al. (68)Ga-DOTATATE positron emission tomography/computed tomography scan in the detection of bone metastases in pediatric neuroendocrine tumors. Indian J Nucl Med 2014; 29: 13-17. https://doi.org/10.4103/0972-3919.125762
  26. Moertel CG, Weiland LH, Nagorney DM, Dockerty MB. Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med 1987; 317: 1699-1701. https://doi.org/10.1056/NEJM198712313172704
  27. Virgone C, Cecchetto G, Alaggio R, et al. Appendiceal neuroendocrine tumours in childhood: Italian TREP project. J Pediatr Gastroenterol Nutr 2014; 58: 333-338. https://doi.org/10.1097/MPG.0000000000000217
  28. Anderson JR, Wilson BG. Carcinoid tumours of the appendix. Br J Surg 1985; 72: 545-546. https://doi.org/10.1002/bjs.1800720715
  29. Syracuse DC, Perzin KH, Price JB, Wiedel PD, Mesa-Tejada R. Carcinoid tumors of the appendix. Mesoappendiceal extension and nodal metastases. Ann Surg 1979; 190: 58-63. https://doi.org/10.1097/00000658-197907000-00013
  30. Volante M, Daniele L, Asioli S, et al. Tumor staging but not grading is associated with adverse clinical outcome in neuroendocrine tumors of the appendix: a retrospective clinical pathologic analysis of 138 cases. Am J Surg Pathol 2013; 37: 606-612. https://doi.org/10.1097/PAS.0b013e318275d1d7
  31. Pape UF, Perren A, Niederle B, et al. ENETS Consensus Guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology 2012; 95: 135-156. https://doi.org/10.1159/000335629
  32. Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas 2010; 39: 753-766. https://doi.org/10.1097/MPA.0b013e3181ebb2a5
  33. Dall’Igna P, Ferrari A, Luzzatto C, et al. Carcinoid tumor of the appendix in childhood: the experience of two Italian institutions. J Pediatr Gastroenterol Nutr 2005; 40: 216-219. https://doi.org/10.1097/00005176-200502000-00025
  34. Bamboat ZM, Berger DL. Is right hemicolectomy for 2.0-cm appendiceal carcinoids justified? Arch Surg 2006; 141: 349-352; discussion 352. https://doi.org/10.1001/archsurg.141.4.349
  35. Njere I, Smith LL, Thurairasa D, et al. Systematic review and meta-analysis of appendiceal carcinoid tumors in children. Pediatr Blood Cancer 2018; 65: e27069. https://doi.org/10.1002/pbc.27069
  36. Yalçın B, Karnak İ, Orhan D, et al. Paediatric appendiceal neuroendocrine tumours: a review of 33 cases from a single center. ANZ J Surg 2022; 92: 742-746. https://doi.org/10.1111/ans.17284
  37. Pogorelić Z, Ercegović V, Bašković M, Jukić M, Karaman I, Mrklić I. Incidence and management of appendiceal neuroendocrine tumors in pediatric population: a bicentric experience with 6285 appendectomies. Children (Basel) 2023; 10: 1899. https://doi.org/10.3390/children10121899
  38. Yau H, Kinaan M, Quinn SL, Moraitis AG. Octreotide long-acting repeatable in the treatment of neuroendocrine tumors: patient selection and perspectives. Biologics 2017; 11: 115-122. https://doi.org/10.2147/BTT.S108818
  39. Douangprachanh S, Joo HJ, Park HM, et al. Capecitabine and temozolomide for metastatic intermediate to high-grade pancreatic neuroendocrine neoplasm: a single center experience. Korean J Intern Med 2022; 37: 1216-1222. https://doi.org/10.3904/kjim.2022.100
  40. Yamaguchi T, Machida N, Morizane C, et al. Multicenter retrospective analysis of systemic chemotherapy for advanced neuroendocrine carcinoma of the digestive system. Cancer Sci 2014; 105: 1176-1181. https://doi.org/10.1111/cas.12473
  41. Yao JC, Fazio N, Singh S, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet 2016; 387: 968-977. https://doi.org/10.1016/S0140-6736(15)00817-X