췌장의 신경내분비 종양이라고 하며.. 크기 변화 추적중 - 동대문구 답십리, 용답동, 우리안애 우리안愛 내과
상기 60대 초반 남자
일차검진, 위암검진 위해 내원
위내시경 한지 10년전...
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췌장의 병변은 신경내분비종양, pancreatic neuroendorine tumor 으로 구별이 되었나보다. 크기 변화가 있는지 추적 검사 예정이라고 한다.
경련성 복통, 우상복부 압통? 담석 및 담낭염 배제하였으나 우연히 발견된 췌장의 종괴
과거 초음파에서 췌장종괴.. 무시하였다가
PNETs can present with a range of clinical behaviors; they may occur as small benign lesions, slow-growing indolent tumors with a favorable prognosis, locally invasive lesions, or as widespread metastatic disease. 예후가 좋은 천천히 자라는 종양에서 국소적으로 침범하는 혹은 전이성 질환으로 임상적 모습이 다양하다.
Unlike functional PNETs, the primary reason to resect asymptomatic nonfunctional PNETs is to prevent growth, spread, and impacts on patient survival. Given that their biologic behavior may range from slow-growing and indolent to aggressive with the potential to metastasize, a uniform approach is not obvious. 경과가 제각각이어서 단순하게 접근하기가 어렵다. A correlation between tumor size and risk of malignant characteristics has been demonstrated. Nonfunctional PNETs that are symptomatic, large (greater than 2 cm), and with atypical features such as pancreatic duct dilatation, should undergo surgical resection. 증상이 생기거나, 2 cm 보다 크거나, 췌도가 늘어나면 수술적 치료로 진행해야한다. However, the management of small nonfunctioning tumors has been an area of debate given their typically relatively indolent behavior. 작은 비기능성 종양은 특징적/상대적으로 느린 변화를 가지기에 관리/치료에서 논란의 분야였다. While additional tumor characteristics such as Ki-67 proliferative index could ideally guide decision making regarding resection, at present tumor size has been the most reliable determinant of tumor progression for well-differentiated PNET. 현재로서 분화가 좋은 췌장내분니종양에서 크기가 진행에 관련된 가장 신뢰되는 결정인자이다.
Per a recent consensus statement by the North American Neuroendocrine Tumor Society (NANETS), asymptomatic patients with tumors less than 1 cm and imaging consistent with PNET can be observed. However, for tumors 1–2 cm, it is advised that management be based on patient comorbidities, tumor grade, extent of resection if surgery is pursued, patient preference, and access to follow-up care. The National Comprehensive Cancer Network (NCCN) recommendations suggest that tumors less than or equal to 2 cm can be observed; however, evidence is stronger for surveillance of tumors less than or equal to 1 cm.
The Canadian National Expert Group consensus on nonfunctional PNET surgical management states for tumors less than 2 cm, active surveillance can reasonably be pursued; specifically, tumors should be solitary lesions with no evidence of invasive disease, have low Ki67, and continue to demonstrate stability on serial imaging and biochemical monitoring every 6 months. The European Neuroendocrine Tumor Society (ENETS) recommends active surveillance for nonfunctional PNETs that are less than or equal to 2 cm. Tumors should be low-grade (G2 or less), asymptomatic, and without radiographic evidence suspicious for malignancy. However, surgery is recommended if the tumor is symptomatic or patient’s preference is for resection. Active surveillance includes imaging every 6 to 12 months.
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타 대학병원 임상시험 참가 하려는 전이성 췌장 신경내분비종양
동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연
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