Neuroendocrine tumors of the ovary: What support?

doi:10.4236/ojog.2013.310136

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Open Journal of Obstetrics and Gynecology, 2013, 3, 739-742 OJOG

http://dx.doi.org/10.4236/ojog.2013.310136 Published Online December 2013 (http://www.scirp.org/journal/ojog/)

Neuroendocrine tumors of the ovary: What support?

H. Al Moubaker1, S. Errarhay1, S. Mahmoud1, Amal Bennani2, C. Bouchikhi1,

Affaf Amarti2, A. Banani1

1Service Gynecology Obstetricsi Chuhassan Iifes, Fez, Morocco

2Service Pathological Anatomy Chuhassan Iifes, Fez, Morocco

Email: [email protected]

Received 20 November 2013; revised 12 December 2013; accepted 20 December 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In accor-

ABSTRACT

Neuroendocrine tumors of the ovary tumors are little

known and infrequent. They are made up of cells ap-

pearing in the endocrine and nervous systems. These

tumors are rare, but most of them are very aggressive,

especially when they are diagnosed beyond FIGO Sta-

ge I. The distinction among the different subtypes is

difficult and requires efficient techniques. Symptoms

of neuroendocrine tumors are often nonspecific (red-

ness in the face, diarrhea, asthma, abdominal pain

and etc.,) and confused with more common diseases.

Misdiagnosis is often asked: menopause or irritable

bowel syndrome. Often the correct diagnosis is not

made until years after the onset of symptoms. The

relative rarity of these diseases and the lack of speci-

ficity of the symptoms make them often be diagnosed

several years after onset. Fortunately, science has

made significant advances in the diagnosis and

treatment of neuroendocrine tumors. We report the

case of a woman of 54 years, with abdominopelvic

mass, in whom abdominal ultrasound revealed a mass

avascular tissue Doppler taking the screen. The abdo-

minopelvic CT showed a large cystic mass solido—

abdominopelvic whose origin is difficult to determine.

The patient underwent an exploratory laparotomy.

Anapath the results of the right ovary were in favor

of a well-differentiated neuroendocrine lesion.

Keywords: Tumor

Neuroendocrine-Diagnosis-Treatment

1. INTRODUCTION

Neuroendocrine tumors are tumors that develop from

hormone-producing cells located in the endocrine (hor-

monal) system and the nervous system [1].

During their growth, these tumors, in some cases,

produce more hormones. Others are called non-secreting:

although formed from neuroendocrine cells, they do not

produce hormones.

Carcinoid tumors represent 0.1 % of organic lesions of

the ovary. This type of tumor, resulting in germ cells, is

considered in the WHO classification as a highly spe-

cialized teratoma. A mature teratoma is associated in

75% of cases [ 2,3].

These particular tumors can metastasize easily. Most

are formed in the gut and the lung, but are found else-

where in the body. The members have functions of

glands. Althoug h ther e ar e man y type s of neu roen doc rine

tumor, they are treated as a separate group because the

cells of these tumors have several common features: they

are physically quite similar neoplasms and produce a

secretory granule often with a production biogenic ami-

nes and hormones (polypeptides). We can distinguish

four groups of carcinoid tumors of the ovary: the insular

carcinoid, trabecular, and mucinous stroma .

2. OBSERVATION

54-years-old patient, single, no significant pathological

history, which has pelvic pain associated with a progres-

sive increase in abdominal volume, in which the clinical

examination is a farm abdomino-pelvic mass, fixed, two

finger breadths above the umbilicus, the rest of the ex-

aminati on was no rmal.

Abdominal ultrasound revealed a mass non-vascula-

rized tissue Doppler taking the screen, the uterus and an-

nexes seen.

The abdomino-pelvic CT objectified an important so-

lido—abdominopelvic cystic mass whose origin is diffi-

cult to determine. (Figure 1)

The patient underwent an exploratory laparotomy

showing an increased uterus size by 20 weeks of gesta-

OPEN ACCESS

H. Al Moubaker et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 739-742

740

Figure 1. Clearlydifferentiat edneuroendocrine tumor (×10).

tion seat multiple myomas, the largest landlocked is ear-

lier in the right broad ligament, the 2 annexes were unre-

markable .

A total hysterectomy with bilateral salpingo-oopho-

rectomy were performed and the cell proliferation and

histological immunohistochemical analysis was in favor

of a well-differentiated neuroendocrine lesion on the right

ovary (Figure 2). The patient underwent clinical moni-

toring was unremarkable for a year.

3. DISCUSSION

The neuroendocrine tumors are classified according to

several criteria: location of the tumor; type of secretion

of tumor (or lack of secretion); level of proliferation:

speed cell division; level of differentiation of cells: can-

cer cells are they close to normal cell or have they lost

their basic characteristics; size of the tumor and the

presence or absence of metastases; etc.

The diagnosis is difficult and of ten delayed [4]. Sev-

eral factors are responsible for the late diagnosis of neu-

roendocrine tumors: slow evolution, primary tumor of

ten small and little talking symptoms.

The symptoms of neuroendocrine tumors are nonspe-

cific. These slow-growing tumors are often confused

with more common diseases. This feature, as well as

their relative rarity, they are often diagnosed several

years after onset. Fortunately, research evolves impress-

Figure 2. AbdominopelvicCT: A massive mass abdomin-

opelvic solido-cystic.

sive in the diagnosis and management of these tumors

[5-7].

Some of these tumors secrete substances such as sero-

tonin and may be responsible for: episodes of redness in

the face and neck (flushing); episodes of infectious diar-

rhea without cause; asthma attacks; abdominal pain ; red

digestive after meals ; chest pain etc.

However, there are some symptoms that typical and

often attributed to other illnesses such as irritable bowel

syndrome or Crohn’s disease [6], for example. Further-

more 50% of neuroendocrine tumors are not accompa-

nied by these symptoms and are therefore diagnosed only

when their size becomes too large or by chance during

H. Al Moubaker et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 739-742 741

gastrointestinal or pulmonary examinations.

In recent years, specific blood tests have been devel-

oped and proved to be very useful in the diagnosis and

monitoring of neuroendocrine tumors [8-10]. Various

hormones can be secreted by type of neuroendocrine

tumor. In addition, it is very difficult to dose dozens of

hormones that may be secreted by a neuroendocrine tu-

mor. Special substance called chromogranin A seems to

be commonly found in the blood sample, regardless of

the location and type of neuroendocrine tumor. In case of

increased blood levels of the chromogranin, dosages of

specific hormones can be considered to specify what

type of tumor neuroencocrine it is.

The majority of neuroendocrine tumors secretes a sub-

stance called serotonin. As blood serotonin level varies

during the day, its measurement is unreliable. For cons,

the measurement in urine collected for 24 hours a sub-

stance derived from serotonin, acid-5-hydroxyindole (5

HIAA), may be useful in diagnosis.

Colonoscopies are more frequently used in screening

for colon cancer. A neuroendocrine tumor can therefore

be discovered by chance during an examination of this

type [11,12].

Colonoscopy also allows, in case of discovery of a

tumor, to take to make microscopic analysis a piece of it

by biopsy. This deduction can confirm the diagnosis.

CT and magnetic resonance canlocate the neuro-endo-

crine tumor; determine the size of the tumor; whether

there are metastases in other organs such as the liver.

Both tests, however, are limited by the size of the tumor

[13-15].

Isotopic consideration (scintigraphy) is injected into

the circulation of the patient and the radioactive octreo-

tide measuring cell activity [14].

In the context of neuroendocrine tumors, the injected

product is called somatostatin. This product binds to the

majority of cancer cells neuroendocrine tumors. We can

in this way determine if treatment with octreotid e is pos-

sible.

Many parameters will influence the choice of treat-

ment. We must first keep in mind that more than half of

neuroendocrine tumors have metastasized at diagnosis.

This is partly due to the fact that it often takes several

years before the diagnosis.

The treatment therefore concerns not only the primary

tumor but also any metastases and symptoms often pre-

sent for some time.

If the tumor is diagnosed early enough, and therefore

localized and small, a cure can sometimes be considered.

This treatment will be achieved by surgical removal of

the tumor. In other cases, if the primary tumor is larger or

if there are metastases, the goal is to stabilize the tumor

progression and improve quality of life of the patient.

The patient’s age, background, his general health, are

parameters that will influence the choice of treatment.

Surgery plays an important role in the treatment of

neuroendocrine tumors. It has three objectives:

 healing when possible; When neuroendocrine tumor

is localized and small, curative surgery may be con-

sidered. It is to remove the entire tumor.

 improving the quality of life of the patient; Some-

neuroendocrine tumors are large, for example, block

the digestive tract and prevent the passage of stool.

An operation is then performed to relieve the patient.

 support some metastases: liver metastases (liver) are

common. Surgery can help remove one or more liver

metastases. Unlike some tumors very rapidly chang-

ing the surgical treatment of metastatic neuroendo-

crine tumors is one of the mainstays of treatment

[16-18].

In the case of ovarian tumor, Standard surgical princi-

ples apply for neuroendocrine tumors.

However, for young patients with an ovarian tumor

isolated, conservative surgery of fertility may be consid-

ered in combination with adjuvant chemotherapy. This

chemotherapy is generally based on platinum derivatives

and drugs etoposide.

Availability since 1988 (16,18) Octreotide has signifi-

cantly changed the management of patients with neuro-

endocrine tumors (NET). Octreotide is a somatostatin

analog. After octreotide, other somatostatin analogs such

as lanreotide, have appeared.

Scientists recent studies have shown that ocrétotide

allow stabilization of the tumor. It is reserved for patients

in whom the tumor can not be treated by simple surgical

resection. The drug slows the growth of cancer cells and

reduces the risk of tumor progression by 66% compared

to placebo.

Octreotide and lanreotide also seem to have an effect

on certain symptoms such as episodes of flushes (sudden

redness in the face and neck) and diarrhea.

Many other treatments are sometimes offered to pa-

tients with neuroendocrine tumors: radiotherapy, chemo-

therapy, liver transplant, etc.

Prognosis: well-differentiated neuroendocrine tumors

have a slow evolution, long time locally contrast to un-

differentiated tumors. The risk of lymph node metastasis

and visceral extension is important when the tumor is

large and when the mitotic activity is greater. The vis-

ceral metastases are usually hepatic. Survival is related

with the degree of differentiation.

4. CONCLUSIONS

The discovery of a neuroendocrine tumor is difficult to

live, with regard to the rarity of this tumor and the lack

of information available. However, many patients are

relieved to finally have found the cause of the symptoms

they suffer for se ve ra l ye ars.

H. Al Moubaker et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 739-742

742

Neuroen docrine tumors are often growing slowly. Pa-

radoxically, this slow evolution is often responsible for

late diagnosis. Upon detection of neuroendocrine tumor

is often add that the existence of metastases.

OPEN ACCESS

Fortunately, research evolves impressive in the diag-

nosis and management of these tumors. Moreover, their

relatively good prognosis for some of them can hope.

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