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Interesting Case Presentation Neuroendocrine Lung Tumors

Interesting Case Presentation Neuroendocrine Lung Tumors. M. Demiri B Oncology Clinic Director Saint Savvas Anticancer Hospital. Male patient, 40 years old No previous medical history

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Interesting Case Presentation Neuroendocrine Lung Tumors

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  1. Interesting Case PresentationNeuroendocrine Lung Tumors M. Demiri B Oncology Clinic Director Saint Savvas Anticancer Hospital

  2. Male patient, 40 years old • No previous medical history • 6ος/2009: hemoptysis, imaging shows a left lower pulmonary lobe mass. Patient was subjected to a left lower lobectomy.

  3. Pathology Report: neuroendocrine neoplasm; atypical carcinoid (AC) [mild cellular pleomorphism, necrosis, 3 mitoses/2 mm2, chromogranin +, NSE +, CD 56 +, CK8/18+]

  4. 6/2009 up to 7/2012: follow up

  5. 7/2012: scheduled upper abdomen MRI: at least 22 new lesionswith a maximum diameter about 1.5 cm in the left, right and caudate liver lobe, with abnormal signal intensity and contrast agent uptake.

  6. 10/2012: patient was admitted to the clinic for diagnostic workout and further treatment planning. • NSE, CA19-9, CEA, urine-5-HIAA: normal • Chromogranin: 108 ng/ml (normal values: in serum 10-110,in plasma 18-150) Due to their small size the liver lesions could not be biopsied under CT scan and a laparoscopic liver biopsy could not be done 11/2012: Octreoscan: diffuse abnormal uptake of the radioactive substancein the liver, which shows hyperexpression of somatostatin receptors, primarily sst2

  7. 11/2012: starts 1st line chemotherapy withCDDP 80 mg/m2 and Vepesid 100 mg/m2

  8. 1/2013: 3rdchemotherapy cycle, good tolerance, CT scan restaging:SD • 4thcycle: exertionaldyspnea. Heart U/S: marginally normal dimensions of the heart chambers and E.F. 60%. Strict fluid equilibrium control was advisedas well as cardiology follow up before chemotherapy. CDDP was changed withCarboAUC5 from the 5th cycle.

  9. 4/2013: completion of 1st line chemotherapy Restaging: PD with increase in the dimensions of most of the lesions which are noted in all the hepatic lobes, while one left lobe lesion presents a significant enlargement(4 cm from 1.5 cm)

  10. 5/2013: starts 2nd line chemotherapy with Xeloda- Temodal

  11. 9/2013: restaging: hepatic lesions remaining, with increase of the dimensions in certain and a decrease in others. Greater enlargement of the left lobe lesion (6 cm from 4 cm)

  12. 11/2013: restaging: SD • 02/2014: restaging: mild increase of the dimensions in most lesions

  13. 04/2014: SD

  14. Other therapeutic options are • Everolimus + Somatostatin analog • Lu-Dotatate • LUNA trial (pasireotide)

  15. Thank you for your attention.

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