2024 Resistant gastroenteropancreatic neuroendocrine tumors: a definition and guideline to medical and surgical management
Gastroenteropancreatic neuroendocrine tumors (NETs), also historically known as carcinoids, are tumors derived of hormone-secreting enteroendocrine cells. Carcinoids may be found in the esophagus, stomach, small intestine, appendix, colon, rectum, or pancreas. The biologic behavior of carcinoids differs based on their location, with gastric and appendiceal NETs among the least aggressive and small intestinal and pancreatic NETs among the most aggressive. Ultimately, however, biologic behavior is most heavily influenced by tumor grade. The incidence of NETs has increased by 6.4 times over the past 40 years. Surgery remains the mainstay for management of most carcinoids. Medical management, however, is a useful adjunct and/or definitive therapy in patients with symptomatic functional carcinoids, in patients with unresectable or incompletely resected carcinoids, in some cases of recurrent carcinoid, and in postoperative patients to prevent recurrence. Functional tumors with persistent symptoms or progressive metastatic carcinoids despite therapy are called “resistant” tumors. In patients with unresectable disease and/or carcinoid syndrome, an array of medical therapies is available, mainly including somatostatin analogues, molecular-targeted therapy, and peptide receptor radionuclide therapy. Active research is ongoing to identify additional targeted therapies for patients with resistant carcinoids.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 American Board of Surgery (ABS) Accredited CME
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance
2024 Clinician Corner - Enterohemorrhagic Escherichia Coli: Trigger for Small Vessel Vasculitis
AbstractWe describe the case of a 19-year-old woman who presented with abdominal pain, vomiting, and a palpable purpuric rash. The patient subsequently developed dysentery and was found to have an infection from Shiga toxin–producing Escherichia coli.
Category
  • BUMC Proceedings
Format
  • Journal
Credits
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 Attendance

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