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Z Gastroenterol 2013; 51(11): 1240-1250
DOI: 10.1055/s-0033-1335461
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Nicht-funktionelle duodenale neuroendokrine Neoplasien im proximalen Duodenum – Fallserie und Vorschlag für ein „High-Risk-/Low-Risk-Konzept“ zur Entscheidung für eine lokale endoskopische Therapie

Non-Functional Duodenal Neuroendocrine Neoplasia in the Proximal Duodenum – Case Reports and Proposal for a “High-Risk-/Low-Risk-Concept” in the Decision for Local Endoscopic Therapy
F. Scheerer
,
W. Schmitt
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Publication History

19 October 2012

15 April 2013

Publication Date:
15 November 2013 (online)

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Zusammenfassung

Frühe duodenale neuroendokrine Neoplasien (dNEN) werden vermehrt diagnostiziert. Im Bulbus lokalisierte nicht-funktionelle dNEN, welche Gastrin exprimieren, sind die mit Abstand häufigste Entität. Im Zeitraum zwischen 2004 und 2012 wurden 17 Fälle von 16 Patienten mit NEN im Bulbus duodeni ausgewertet. Ampullär bzw. periampullär gelegene und funktionelle dNEN/Gastrinome wurden aufgrund eines möglichen unterschiedlichen malignen Potenzials nicht berücksichtigt. Das Durchschnittsalter der Patienten lag bei 65,7 Jahren, die mittlere Tumorgröße bei 10,2 mm, der Proliferationsindex Ki67 maximal bei 5 % (NET G2). Zumeist zeigte sich eine maximale Tiefeninvasion bis in die Submucosa. Bei dNEN ohne Risikofaktoren (Größe bis max. 10 mm, G1-Situation, keine Invasion der Muscularis propria, keine Angioinvasion) war in 10 von 11 Fällen (90,9 %) die endoskopische Therapie ausreichend. Bei bestehenden Riskofaktoren war lediglich in einem von 5 Fällen eine alleinige endoskopische Therapie möglich. Bei Fehlen von Risikofaktoren konnte im bisherigen Nachbeobachtungszeitraum (im Mittel 36,7 Monate) keine lymphonoduläre Metastasierung festgestellt werden. Allerdings zeigte sich bei Vorhandensein von Risikofaktoren bzw. vorliegender Operationsindikation ein deutlicher Anstieg der Rate von Lymphknotenmetastasen. Die eigenen Daten weisen darauf hin, dass bei frühen nichtfunktionellen dNEN im Bulbus mit Vorhandensein einer G2-Situation oder einer Tumorgröße > 10 mm oder Infiltration der Muscularis propria, die Notwendigkeit einer operativen Versorgung deutlich ansteigt. Ein High-Risk-/Low-Risk-Konzept für die endoskopische Therapie früher nicht-funktioneller dNEN wird etabliert.

Abstract

Early duodenal neuroendocrine neoplasms (dNENs) are being increasingly diagnosed. Non-functional dNENs in the bulb expressing gastrin are by far the most frequent entity. In the period from 2004 to 2012, 17 cases of 16 patients with NET in the duodenal bulb were evaluated. dNENs of the ampulla of Vater and functional dNEN/gastrinoma were not included due to possibly different malignant potentials. The average age of the patients was 65.7 years, the mean tumour size was 10.2 mm, the maximum proliferation index Ki 67 was 5 % (NET G2). In most cases the maximum depth of invasion was down to the submucosa. In cases of dNEN without risk factors (size up to 10 mm, G1 situation, no invasion of the muscularis propria, no angioinvasion) in 10 out of 11 cases (90.9 %), endoscopic therapy was sufficient. In cases of existing risk factors, sole endoscopic treatment was only possible in 1 out of 5 cases (20 %). In the absence of risk factors in the current follow-up period (mean: 36.7 months) no lymph node metastases were detected. In the presence of risk factors or indications for surgery we found an increase in the rate of lymph node metastases. Our own data indicate that in case of a G2 situation, a tumour size >10 mm or infiltration of the muscularis propria the need for surgical treatment increases significantly for early non-functional dNENs in the duodenal bulb. A high-risk-/low-risk-concept for the endoscopic therapy for early non-functional dNEN has been established.

Schlüsselwörter

neuroendokriner Tumor - NEN - Duodenum - gastro-entero-pankreatische Tumoren - Gastrinom - MEN

Key words

neuroendocrine tumours - NEN - duodenum - gastroenteropancreatic tumours - gastrinoma - MEN
 

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