Pathology/Pancreatic neuroendocrine cancer
I was hoping you could help me make sense of my husbands test results. He was diagnosed in January 2015 with pancreatic neuroendocrine cancer. He has a 7.5 X 7.6 CM pancreatic head mass that abuts >50% of the SMA/SMV and completely encases the gastroduodenal artery.There was a large focus of intense irregular uptake within the head of the pancreas, but no focal uptake in the liver. (Small liver lesion)
he has mild duodenitis and focal gastric metaplasia-peptic duodenitis.
He was positive for pancytokeratin and synaptophysin.
Chromogranin A results were 300 in Jan., 420 in Feb, and 690 in March. Ki-67 is <1%.
Can you please give me your impressions on this? He is on CAPTEM chemo but our insurance company denied treatment with lanreotide.
I am sorry to hear about the diagnosis of PNET for your husband. This is a tumor located in the head (Broadest region) of pancreas, which is an endocrine organ. This means it secretes hormones directly into the blood stream.
Pancreatic neuroendocrine cancer is a tumor which arises from cells of endocrine and nervous systems (nerves, etc). This tumor is close to one of the major blood vessels in the abdomen, the superior mesenteric and is encasing another vessel which supplies blood to stomach and intestine.
In addition he has inflammation of intestine, due to acid secretion and presence of cells usually found in the stomach which secrete acid. (mild duodenitis and gastric metaplasia)
Tumor markers were evaluated , these help in characterizing the origin of tumor, help diagnose and for follow up of treatment.
Synaptophysin indicates the neural origin and chromogranin positivity indicates endocrine nature of the tumor. Ki-67 is <1% which indicates the tumor cells are not aggressively dividing.
Ideally the chromogranin levels should decrease, I am not sure what the elevated levels mean, an oncologist can better address this issue
I hope this helps.