52 years old asymptomatic woman presented seven neuroendocrine tumors localized in head, neck, body and tail of the pancreas that were observed at Gallium 68 Dotatate. These lesions were no observed neither CT nor RNM. This lesions ranged between 1,5 and 3,5 cm. The larger ones are localized in the body and tail (total of five lesions). Two lesions present 1,5 cm and are localized in the head and neck. All of these lesions shine at Gallium 68 Dotatate evaluation. Echoendoscopy and biopsy confirmed grade 1 nonfunctionanting neuroendocrine tumor ( 2% of KI 67 expression) in three lesions that presented between 1,5 and 3,0 cm of the diameter (head, neck and tail). She presents no comorbidities. What is the best management?
Cannot exclude splenic involvement in which case it is metastatic disease needing systemic or locoregional therapy. Otherwise since these are non functioning tumors and Ki 67 expression is low, patient may be followed up closely with frequent monitoring by clinical signs, serum chromogranin A, Dotatoc Scan, serum hormone levels as deemed necessary.
PNETs are a heterogenous group and data is constantly changing the way we manage these leaions.
Numerous factors to take into account (some of them you cover), but these are best run through a MDT. Guidelines from NCCN feoup and ENET’s group helpful but still need to individualise
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