Insulinoma staging: Difference between revisions

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==Overview==
==Overview==
The staging had been done according to American Joint Cancer Committee (AJCC) 7th edition 2010. <ref name="pmid27646952" /><ref name="pmid25816036" /> Being a [[pancreatic neuroendocrine tumor]], it is also staged by European Neuroendocrine Tumor Society (ENETS). In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification.
The staging had been done according to American Joint Cancer Committee (AJCC) 7th edition 2010. Being a [[pancreatic neuroendocrine tumor]], it is also staged by European Neuroendocrine Tumor Society (ENETS). In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification.


==Staging==
==Staging==
=== [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010 calssification ===
=== [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010 classification ===
The staging of [[malignant]] insulinoma being a [[pancreatic neuroendocrine tumor]] may be classified into several subtypes based on [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010: <ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref><ref name="pmid25816036">{{cite journal| author=Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW et al.| title=TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution. | journal=Medicine (Baltimore) | year= 2015 | volume= 94 | issue= 12 | pages= e660 | pmid=25816036 | doi=10.1097/MD.0000000000000660 | pmc=4554009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25816036  }} </ref>  
The staging of [[malignant]] insulinoma being a [[pancreatic neuroendocrine tumor]] may be classified into several sub types based on [[American Joint Committee on Cancer|American Joint Cancer Committee]] ([[AJCC]]) 7th edition 2010: <ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref><ref name="pmid25816036">{{cite journal| author=Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW et al.| title=TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution. | journal=Medicine (Baltimore) | year= 2015 | volume= 94 | issue= 12 | pages= e660 | pmid=25816036 | doi=10.1097/MD.0000000000000660 | pmc=4554009 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25816036  }} </ref>  
{| class="wikitable" align="right"
{| class="wikitable" align="right"
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
Line 150: Line 150:
*The aggressiveness of tumor was expressed in form of [[mitotic]] count and staining of a nuclear antigen called [[Ki-67]]: <ref>{{cite book | last = Bosman | first = F. T. | title = WHO classification of tumours of the digestive system | publisher = International Agency for Research on Cancer | location = Lyon | year = 2010 | isbn = 978-9283224327 }}</ref><ref name="pmid28357177">{{cite journal |vauthors=Sun J |title=Pancreatic neuroendocrine tumors |journal=Intractable Rare Dis Res |volume=6 |issue=1 |pages=21–28 |year=2017 |pmid=28357177 |pmc=5359348 |doi=10.5582/irdr.2017.01007 |url=}}</ref>
*The aggressiveness of tumor was expressed in form of [[mitotic]] count and staining of a nuclear antigen called [[Ki-67]]: <ref>{{cite book | last = Bosman | first = F. T. | title = WHO classification of tumours of the digestive system | publisher = International Agency for Research on Cancer | location = Lyon | year = 2010 | isbn = 978-9283224327 }}</ref><ref name="pmid28357177">{{cite journal |vauthors=Sun J |title=Pancreatic neuroendocrine tumors |journal=Intractable Rare Dis Res |volume=6 |issue=1 |pages=21–28 |year=2017 |pmid=28357177 |pmc=5359348 |doi=10.5582/irdr.2017.01007 |url=}}</ref>
{| class="wikitable" style="text-align:center"
{| class="wikitable" style="text-align:center"
|'''Grade of tumor'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Grade of tumor'''
|'''Mitotic Count'''(Mitoses per 10 high powerfields)
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Mitotic Count'''(Mitoses per 10 high powerfields)
|'''Expression of Ki 67'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Expression of Ki 67'''
|-
|-
|Grade 1
| style="background:#DCDCDC;" align="center" + |Grade 1
|<2
| style="background:#F5F5F5;" + |<2
|≤3%
| style="background:#F5F5F5;" + |≤3%
|-
|-
|Grade 2
| style="background:#DCDCDC;" align="center" + |Grade 2
|2-10
| style="background:#F5F5F5;" + |2-10
|3-20%
| style="background:#F5F5F5;" + |3-20%
|-
|-
|Grade 3
| style="background:#DCDCDC;" align="center" + |Grade 3
|>20
| style="background:#F5F5F5;" + |>20
|>20%
| style="background:#F5F5F5;" + |>20%
|-
|-
|}
|}
*Grade 1 and 2 tumors were classified as [[Neuroendocrine|neuroendocrine neoplasm]] (NET) and grade 3 were classified as neuroendocrine carcinoma (NEC).
*Grade 1 and 2 tumors were classified as [[Neuroendocrine|neuroendocrine neoplasm]] (NET) and grade 3 were classified as neuroendocrine carcinoma (NEC).


* In its new 8th edition of [[AJCC]] which is planned to be published on January 1, 2018; [[AJCC]] <ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref> had developed a modified ENETS (mENETS) staging classification:
* In its new 8th edition of [[AJCC]] which is planned to be published on January 1, 2018; [[AJCC]] had developed a modified ENETS (mENETS) staging classification:<ref name="pmid27646952">{{cite journal| author=Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C et al.| title=Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. | journal=J Clin Oncol | year= 2017 | volume= 35 | issue= 3 | pages= 274-280 | pmid=27646952 | doi=10.1200/JCO.2016.67.8193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27646952  }} </ref>


{| class="wikitable" align="right"
{| class="wikitable" align="right"
| '''Stage'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
|'''T'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''T'''
|'''N'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''N'''
|'''M'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''M'''
|-
|-
|IA
| style="background:#DCDCDC;" align="center" + |IA
|T1
| style="background:#F5F5F5;" + |T1
|N0
| style="background:#F5F5F5;" + |N0
|M0
| style="background:#F5F5F5;" + |M0
|-
|-
|IB
| style="background:#DCDCDC;" align="center" + |IB
|T2
| style="background:#F5F5F5;" + |T2
|N0
| style="background:#F5F5F5;" + |N0
|M0
| style="background:#F5F5F5;" + |M0
|-
|-
|IIA
| style="background:#DCDCDC;" align="center" + |IIA
|T3
| style="background:#F5F5F5;" + |T3
|N0
| style="background:#F5F5F5;" + |N0
|M0
| style="background:#F5F5F5;" + |M0
|-
|-
|IIB
| style="background:#DCDCDC;" align="center" + |IIB
|T1-3
| style="background:#F5F5F5;" + |T1-3
|N1
| style="background:#F5F5F5;" + |N1
|M0
| style="background:#F5F5F5;" + |M0
|-
|-
|III
| style="background:#DCDCDC;" align="center" + |III
|T4
| style="background:#F5F5F5;" + |T4
|Any N
| style="background:#F5F5F5;" + |Any N
| M0
| style="background:#F5F5F5;" + |M0
|-
|-
|IV
| style="background:#DCDCDC;" align="center" + |IV
|Any T
| style="background:#F5F5F5;" + |Any T
|Any N
| style="background:#F5F5F5;" + |Any N
|M1
| style="background:#F5F5F5;" + |M1
|}
|}
{| class="wikitable" style="text-align:center"
{| class="wikitable" style="text-align:center"
|+'''mENETS'''
| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" coolspan="4" + |'''mENETS'''
! rowspan="4" | T
| T1
|Tumor limited to pancreas,<2 cm
|-
|-
|T2
! rowspan="4" style="background:#DCDCDC;" align="center" + |T
|Tumor limited to pancreas,2-4 cm  
| style="background:#DCDCDC;" align="center" + |T1
| style="background:#F5F5F5;" + |[[Tumor-associated calcium signal transducer 1|Tumor]] limited to [[pancreas]], <2 cm
|-
|-
|T3
| style="background:#DCDCDC;" align="center" + |T2
|>4cm, or invading the duodenum or common bile duct
| style="background:#F5F5F5;" + |[[Tumor]] limited to [[pancreas]], 2-4 cm
|-
| style="background:#DCDCDC;" align="center" + |T3
| style="background:#F5F5F5;" + |>4cm, or invading the [[duodenum]] or [[common bile duct]]
|-
|-
|T4
| style="background:#DCDCDC;" align="center" + |T4
|Tumor invades adjacent structures
| style="background:#F5F5F5;" + |[[Tumor]] invades adjacent structures
|-
|-
! rowspan="2" | N
! rowspan="2" style="background:#DCDCDC;" align="center" + | N
|N0
| style="background:#DCDCDC;" align="center" + |N0
|No regional lymph node metastasis
| style="background:#F5F5F5;" + |No regional [[lymph node]] metastasis
|-
|-
|N1
| style="background:#DCDCDC;" align="center" + |N1
|Regional lymph node metastasis
| style="background:#F5F5F5;" + |Regional [[lymph node]] metastasis
|-
|-
! rowspan="2" | M
! rowspan="2" style="background:#DCDCDC;" align="center" + | M
|M0
| style="background:#DCDCDC;" align="center" + |M0
|No distant metastasis
| style="background:#F5F5F5;" + |No distant [[metastasis]]
|-
|-
|M1
| style="background:#DCDCDC;" align="center" + |M1
|Distant metastasis
| style="background:#F5F5F5;" + |Distant [[metastasis]]
|-
|-
|}
|}


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}
 
[[Category:Medicine]]
[[Category:Endocrinology]]
​
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 15:07, 5 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

The staging had been done according to American Joint Cancer Committee (AJCC) 7th edition 2010. Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS). In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification.

Staging

American Joint Cancer Committee (AJCC) 7th edition 2010 classification

The staging of malignant insulinoma being a pancreatic neuroendocrine tumor may be classified into several sub types based on American Joint Cancer Committee (AJCC) 7th edition 2010: [1][2]

Stage T N M
IA T1 N0 M0
IB T2 N0 M0
IIA T3 N0 M0
IIB T1-3 N1 M0
III T4 Any N M0
IV Any T Any N M1
AJCC 2010
T T1 <2 cm in greatest dimension
T2 >2 cm in greatest dimension
T3 Beyond the pancreas but without involvement of the superior mesenteric artery
T4 Involvement of the celiac axis or superior mesenteric artery (unresectable tumor)
N N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
M M0 No distant metastasis
M1 Distant metastasis

European Neuroendocrine Tumor Society (ENETS) classification:

Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS) as: [1][2]

Stage T N M
I T1 N0 M0
IIA T2 N0 M0
IIB T3 N0 M0
IIIA T4 N0 M0
III B Any T N1 M0
IV Any T Any N M1
ENETS
T T1 Tumor limited to pancreas, <2 cm
T2 Tumor limited to pancreas, 2-4 cm
T3 >4cm, or invading the duodenum or common bile duct
T4 Tumor invades adjacent structures
N N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
M M0 No distant metastasis
M1 Distant metastasis

WHO 2010 classification system

  • WHO classification system combined differentiation and grading characteristics to classify the belligerence of a pancreatic neuroendocrine tumor.
  • The aggressiveness of tumor was expressed in form of mitotic count and staining of a nuclear antigen called Ki-67: [3][4]
Grade of tumor Mitotic Count(Mitoses per 10 high powerfields) Expression of Ki 67
Grade 1 <2 ≤3%
Grade 2 2-10 3-20%
Grade 3 >20 >20%
  • Grade 1 and 2 tumors were classified as neuroendocrine neoplasm (NET) and grade 3 were classified as neuroendocrine carcinoma (NEC).
  • In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC had developed a modified ENETS (mENETS) staging classification:[1]
Stage T N M
IA T1 N0 M0
IB T2 N0 M0
IIA T3 N0 M0
IIB T1-3 N1 M0
III T4 Any N M0
IV Any T Any N M1
mENETS
T T1 Tumor limited to pancreas, <2 cm
T2 Tumor limited to pancreas, 2-4 cm
T3 >4cm, or invading the duodenum or common bile duct
T4 Tumor invades adjacent structures
N N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
M M0 No distant metastasis
M1 Distant metastasis

References

  1. ↑ 1.0 1.1 1.2 Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C; et al. (2017). "Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems". J Clin Oncol. 35 (3): 274–280. doi:10.1200/JCO.2016.67.8193. PMID 27646952.
  2. ↑ 2.0 2.1 Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW; et al. (2015). "TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution". Medicine (Baltimore). 94 (12): e660. doi:10.1097/MD.0000000000000660. PMC 4554009. PMID 25816036.
  3. ↑ Bosman, F. T. (2010). WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer. ISBN 978-9283224327.
  4. ↑ Sun J (2017). "Pancreatic neuroendocrine tumors". Intractable Rare Dis Res. 6 (1): 21–28. doi:10.5582/irdr.2017.01007. PMC 5359348. PMID 28357177.

​

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