Session: MON 327-337-Neuroendocrine Tumors
Poster Board MON-335
The neuroendocrine tumors (NET) represent a very complex, interdisciplinary field. The endocrinology interferences related to the thyroid includes the risk of a second malignancy, not necessary a medullar thyroid cancer (MTC) which may be genetic connected to the NET, the chance of thyroid metastases or incidental diseases as Autoimmune Thyroiditis (AT).
We registered the thyroid pathology in cases with NET confirmation.
Material and Method
This is a retrospective study in patients diagnosed with NET (histological confirmation after surgery or biopsy), between October 2008 and January 2013 at C.I. Parhon National Institute of Endocrinology from Bucharest, Romania. The patients diagnosed with MEN Syndrome or MTC were not included. The thyroid was evaluated by TSH, antityreoperoxidase antibodies or TPO (ELISA kit), serum calcitonin, thyroid ultrasound, fine needle aspiration (FNA) in selected cases (if thyroid ultrasound pointed a thyroid nodule of more than 1 cm maximum diameter).
31 patients were included (female/male ratio: 1.58, mean age: 56.03±13.43 years). The percent of cases based on WHO/ENETS grading was: G1 45.16%, G2 25.8%, G3 29.03%. The most frequent NET origins were: 25.8% unknown, 22.58% midgut, 16.12% lung, 12.9% pancreas. The TSH was mean 3.41±4.83 μUI/mL (normal ranges between 0.4 and 4 μUI/mL). 19.35% of patients had primary hypothyroidism. 9.67% of patients had AT. No case of hyperthyroidism was diagnosed. The ultrasound patterns were: 18.18% hypoechogenic, nodules of less 1 cm diameter where found in 31.81% of cases, macronodules (maximum diameter more than 1 cm) in 36.36% of patients. The total thyroidectomy was performed in 12.9% of cases (one G3 gastric NET female case with thyroid metastases, one G2 pancreatic NET female case had confirmed a follicular adenoma, one G3 ileon NET male case was diagnosed with papillary thyroid cancer, and one G1 NET female was operated for polynodular goiter and associated compressive elements). The calcitonin was mean 3.4±3.1ng/mL (normal level less than 11.5 ng/mL). No MTC was found at FNA. 2 female cases registered 10 times upper normal limit of calcitonin after mean 23.1±1.8 months from first evaluation but it was produced by lung, respective pancreas metastatic NET.
This is a pilot study and a larger database will extend the observations. It is difficult to correlate a second thyroid neoplasia with primary NET. The autoimmune thyroid disease is probably incidental.
A baseline minimum thyroid evaluation including ultrasound should be performed in NET patients.
Nothing to Disclose: CP, MC, RT, DP
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