Interesting Case Presentation Neuroendocrine Lung Tumors

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
• 6??/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 lesions with 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 substance in the liver, which
  shows hyperexpression of somatostatin receptors,
  primarily sst2

7

• 11/2012 starts 1st line chemotherapy with CDDP
  80 mg/m2 and Vepesid 100 mg/m2

8

• 1/2013 3rd chemotherapy cycle, good tolerance,
  CT scan restaging SD
• 4th cycle exertional dyspnea. Heart U/S
  marginally normal dimensions of the heart
  chambers and E.F. 60. Strict fluid equilibrium
  control was advised as well as cardiology follow
  up before chemotherapy. CDDP was changed with
  CarboAUC5 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
(No Transcript)
11

• 5/2013 starts 2nd line chemotherapy with Xeloda-
  Temodal

12

• 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)

13
(No Transcript)
14

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

15
(No Transcript)
16

• 04/2014 SD

17
(No Transcript)
18

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

19
Thank you for your attention.