Insulinoma staging: Difference between revisions

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According to The American Joint Committee on Cancer (AJCC), there are four stages of insulinoma based on the TNM staging sysytem.<ref name=stage>Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_199</ref>
According to The American Joint Committee on Cancer (AJCC), there are four stages of insulinoma based on the TNM staging sysytem.<ref name=stage>Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_199</ref>
==Staging==
==Staging==
According to The American Joint Committee on Cancer (AJCC), there are four stages of insulinoma based on the TNM staging sysytem.<ref name=stage>Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_199</ref>
* The staging of malignant insulinoma being a [[pancreatic neuroendocrine tumor]] may be classified into several subtypes based on 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> :
===TNM Classification===


{| class="wikitable"
{| class="wikitable" align="right"
! style="font-weight: bold;" | T
| '''Stage'''
! style="text-align: center; font-weight: bold;" | Primary Tumor
|'''T'''
|'''N'''
|'''M'''
|-
|-
| style="font-weight: bold;" | Tx
|IA
| style="text-align: center;" | Primary tumor cannot be assessed
|T1
|N0
|M0
|-
|-
| style="font-weight: bold;" | T0
|IB
| style="text-align: center;" | No evidence of primary tumor
|T2
|N0
|M0
|-
|-
| style="font-weight: bold;" | Tis
|IIA
| style="text-align: center;" | Carcinoma in situ
|T3
|N0
|M0
|-
|-
| style="font-weight: bold;" | T1
|IIB
| style="text-align: center;" | Tumor limited to the pancreas, ≤2 cm in greatest dimension
|T1-3
|N1
|M0
|-
|-
| style="font-weight: bold;" | T2
|III
| style="text-align: center;" | Tumor limited to the pancreas, >2 cm in greatest dimension
|T4
|Any N
| M0
|-
|IV
|Any T
|Any N
|M1
|}
{| class="wikitable" style="text-align:center"
|+'''AJCC 2010'''
! rowspan="4" | T
| T1
|<2 cm in greatest dimension
|-
|-
| style="font-weight: bold;" | T3
|T2
| style="text-align: center;" | Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
|>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)
|-
! rowspan="2" | N
|N0
|No regional lymph node metastasis
|-
|N1
|Regional lymph node metastasis
|-
! rowspan="2" | M
|M0
|No distant metastasis
|-
|M1
|Distant metastasis
|-
|-
| style="font-weight: bold;" | T4
| style="text-align: center;" | Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor)
|}
|}


{| class="wikitable"
* Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS)as <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>:
! N
{| class="wikitable" align="right"
! Regional Lymph Nodes
| '''Stage'''
|'''T'''
|'''N'''
|'''M'''
|-
|-
| '''NX'''
|I
| Regional lymph nodes cannot be assessed
|T1
|N0
|M0
|-
|-
| '''N0'''
|IIA
| No regional lymph node metastasis
|T2
|N0
|M0
|-
|-
| '''N1'''
|IIB
| Regional lymph node metastasis
|T3
|N0
|M0
|-
|IIIA
|T4
|N0
|M0
|-
|III B
|Any T
|N1
|M0
|-
|IV
|Any T
|Any N
|M1
|}
|}
 
{| class="wikitable" style="text-align:center"
{| class="wikitable"
|+'''ENETS'''
! style="font-weight: bold;" | M
! rowspan="4" | T
! Distant Metastases
| 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
|-
! rowspan="2" | N
|N0
|No regional lymph node metastasis
|-
|N1
|Regional lymph node metastasis
|-
! rowspan="2" | M
|M0
|No distant metastasis
|-
|M1
|Distant metastasis
|-
|}
*WHO 2010 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<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"
|'''Grade of tumor'''
|'''Mitotic Count'''(Mitoses per 10 high powerfields)
|'''Expression of Ki 67'''
|-
|Grade 1
|<2
|≤3%
|-
|Grade 2
|2-10
|3-20%
|-
|-
| style="font-weight: bold;" | M0
|Grade 3
| No distant metastasis
|>20
|>20%
|-
|-
| style="font-weight: bold;" | M1
| Distant metastasis
|}
|}
*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<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:


===Anatomic Stage/Prognostic Groups===
{| class="wikitable" align="right"
{| class="wikitable"
| '''Stage'''
! style="font-weight: bold;" | Stage
|'''T'''
! style="font-weight: bold;" | T
|'''N'''
! style="font-weight: bold;" | N
|'''M'''
! style="font-weight: bold;" | M
|-
|IA
|T1
|N0
|M0
|-
|IB
|T2
|N0
|M0
|-
|IIA
|T3
|N0
|M0
|-
|IIB
|T1-3
|N1
|M0
|-
|-
| style="font-weight: bold;" | 0
|III
| Tis
|T4
| N0
|Any N
| M0
| M0
|-
|-
| style="font-weight: bold;" | IA
|IV
|Any T
|Any N
|M1
|}
{| class="wikitable" style="text-align:center"
|+'''mENETS'''
! rowspan="4" | T
| T1
| T1
| N0
|Tumor limited to pancreas,<2 cm
| M0
|-
|T2
|Tumor limited to pancreas,2-4 cm
|-
|-
| style="font-weight: bold;" | IB
|T3
| T2
|>4cm, or invading the duodenum or common bile duct
| N0
| M0
|-
|-
| style="font-weight: bold;" | IIA
|T4
| T3
|Tumor invades adjacent structures
| N0
| M0
|-
|-
| rowspan="3" style="font-weight: bold;" | IIB
! rowspan="2" | N
| T1
|N0
| N1
|No regional lymph node metastasis
| M0
|-
|-
| T2
|N1
| N1
|Regional lymph node metastasis
| M0
|-
|-
| T3
! rowspan="2" | M
| N1
|M0
| M0
|No distant metastasis
|-
|-
| style="font-weight: bold;" | III
|M1
| T4
|Distant metastasis
| Any N
| M0
|-
|-
| style="font-weight: bold;" | IV
| Any T
| Any N
| M1
|}
|}


Revision as of 15:00, 15 September 2017

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

Overview

According to The American Joint Committee on Cancer (AJCC), there are four stages of insulinoma based on the TNM staging sysytem.[1]

Staging

  • The staging of malignant insulinoma being a pancreatic neuroendocrine tumor may be classified into several subtypes based on American Joint Cancer Committee(AJCC) 7th edition 2010 [2][3] :
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
  • Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS)as [2][3]:
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 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[4][5]:
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[2] had developed a modified ENETS (mENETS) staging classification:
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. ↑ Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors). http://www.cancer.gov/types/pancreatic/hp/pnet-treatment-pdq#section/_199
  2. ↑ 2.0 2.1 2.2 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.
  3. ↑ 3.0 3.1 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.
  4. ↑ Bosman, F. T. (2010). WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer. ISBN 978-9283224327.
  5. ↑ 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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