Insulinoma staging
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Insulinoma staging On the Web |
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American Roentgen Ray Society Images of Insulinoma staging |
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. [1][2] 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
- According to WHO, functioning pancreatic endocrine tumors are classified as:
- Well-differentiated endocrine tumors, with benign or uncertain behavior.
- Well differentiated endocrine carcinomas with low-grade malignant behavior.
- Poorly differentiated endocrine carcinomas with high-grade malignant behavior.
Previously insulinoma was classified into 2 subtypes based on hormonal level as determined by radioimmunoassay [7] :
- Group A of abundant B cells with trabecular arrangement and uniform insulin immunofluorescence.
- Group B of scarce B cells with medullary arrangement and irregular immunofluorescence.
American Joint Cancer Committee (AJCC) 7th edition 2010 calssification
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 [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 |
| 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 |
| 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[8][6]:
| 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 [1] 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 |
| 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
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 2.1 2.2 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.
- ↑ de Herder, Wouter W.; Niederle, Bruno; Scoazec, Jean-Yves; Pauwels, Stanislas; Klöppel, Günter; Falconi, Massimo; Kwekkeboom, Dik J.; Öberg, Kjel; Eriksson, Barbro; Wiedenmann, Bertram; Rindi, Guido; O’Toole, Dermot; Ferone, Diego (2007). "Well-Differentiated Pancreatic Tumor/Carcinoma: Insulinoma". Neuroendocrinology. 84 (3): 183–188. doi:10.1159/000098010. ISSN 0028-3835.
- ↑ Schott M, Klöppel G, Raffel A, Saleh A, Knoefel WT, Scherbaum WA (2011). "Neuroendocrine neoplasms of the gastrointestinal tract". Dtsch Arztebl Int. 108 (18): 305–12. doi:10.3238/arztebl.2011.0305. PMC 3103981. PMID 21629514.
- ↑ Bosman, F. T. (2010). WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer. ISBN 978-9283224327.
- ↑ 6.0 6.1 Sun J (2017). "Pancreatic neuroendocrine tumors". Intractable Rare Dis Res. 6 (1): 21–28. doi:10.5582/irdr.2017.01007. PMC 5359348. PMID 28357177.
- ↑ Berger M, Bordi C, Cüppers HJ, Berchtold P, Gries FA, Münterfering H; et al. (1983). "Functional and morphologic characterization of human insulinomas". Diabetes. 32 (10): 921–31. PMID 6311653.
- ↑ Bosman, F. T. (2010). WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer. ISBN 978-9283224327.