LARGE CELL METASTATIC PANCREATIC NEUROENDOCRINE CARCINOMA TREATED WITH SOMATOSTATIN ANALOGUES - CASE REPORT AND LITERATURE REVIEW.

We report the case of a 55-year-old-male with a large cell metastatic pancreatic neuroendocrine carcinoma treated for 14 months with lanreotide autogel having a stable disease (SD) and not responding to chemotherapy. The somatostatin analogues (SSA) were introduced after an episode of diarrhea and controlled the disease. Progression-free survival (PFS) as determined by Computerized Tomography (CT) scans was obtained for 14 months. After more than a year, the patient's health state deteriorated along with progressive disease. The capecitabine-temozolomide regimen was challenged, but after three cycles, a rapid clinical decline was noted. CONCLUSION: This unexpected event (diarrhea) in the course of the disease could represent the beginning of carcinoid syndrome. While the lanreotide autogel helped the episode of diarrhea pass, it also helped gain control over the disease itself.

PROGNOSTIC FACTORS IN PATIENTS WITH SURGICAL RESECTION OF PANCREATIC NEUROENDOCRINE TUMOURS.

CONTEXT: Pancreatic neuroendocrine tumours (PanNETs) are rare pancreatic neoplasms. PanNETs can be treated by multimodal approach including surgery, locoregional and systemic therapy. OBJECTIVE: The aim of the present study is to evaluate predictive factors of overall survival in patients with PanNETs surgically treated at a single center. SUBJECTS AND METHODS: The study group consisted of 120 patients with PanNETs who had undergone surgery at the Center of Digestive Diseases and Liver Transplantation of Fundeni Clinical Institute, Bucharest, Romania. Surgical resection of the primary tumor was performed in 110 patients. RESULTS: Tumor size > 2 cm (p=0.048) (90% CI) lymph node involvement (p=0.048), ENET grade (p<0.001), distant metastases (p<0.001), Ki 67 index (<2%, 2-5%, 5-10%, 10-20%, >20%) (p<0.001) were identified as significant prognostic factors for OS on univariate analysis. Using multivariate Cox proportional regression model we found that distant metastases and Ki 67 index were independent risk factors for the survival outcome. CONCLUSIONS: Surgery with curative intent should be considered in all cases if clinically appropriate and technically feasible. High grade (Ki67 index ≥10%) tumours were associated with a 2- fold increase in risk of death as compared to those with a Ki67 <10%.

Technical aspects involved in the harvesting and preservation of the pancreas used for pancreatic islet allotransplantation.

The pancreas procurement from brain-dead donors used for pancreatic islet isolation and transplantation, was analyzed between 2007-2012. The pancreas was transported to the Fundeni Clinical Institute and the islet isolation process was performed in the Cell Therapy Laboratory. There were 20 en bloc pancreas-duodenum-spleen procurement during multiorgan harvesting. Eighteen pancreata were used for islet isolation and two were used for whole pancreas transplantation.One pancreas was used for whole pancreas transplant alone and the other one was used for simultaneous pancreas and kidney transplantation. Donor age ranged between 12 and 61 years, with a median age of 35 years old. The donors were 9 females and 11 males. The causes of death were in 8 cases ­brain injury, in 7 cases ­ aneurism rupture, and in 5 cases stroke. The donors' blood group was A(II) in 11 cases, O(I) in7 cases, and B(III) in 2 cases. The calculated BMI of the donors ranged between 15.6 and 27.8, with a median value of 24.1. The median calculated Vinkers score for our study group was 11. Cold ischemia time ranged between 1.5 and 8 hours,with a median value of 5 hours.