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Pancreas-Neuroendocrine-Tumors-An-Introduction.Pdf JOP. J Pancreas (Online) 2018 Dec 31; S(3):321-327. REVIEW ARTICLE PANCREATIC NEUROENDOCRINE TUMORS Pancreas Neuroendocrine Tumors: An Introduction Yasunaru Sakuma, Naohiro Sata, Alan Kawarai Lefor Department of Gastroenterological Surgery, Jichi Medical University, Tochigi, Japan ABSTRACT Neuroendocrine tumors are rare, however their incidence is increasing. Details of the clinical aspects of these unusual tumors are gradually being revealed all over the world. Pancreas neuroendocrine tumors are a heterogeneous group of tumors with diverse morphologies and behaviors. However, as their character is being revealed, new treatment options have been developed in recent years. This introduction presents an overview of Pancreas Neuroendocrine Tumors, with a focus on their origin, character, epidemiology and biology. Origin of Neuroendocrine Tumors of the Pancreas also throughout the body as if supporting the DNES concept, and are thought to originate in the embryologic “Neuroendocrine tumors (NET)” are considered to neural crest [4]. This APUD cell concept cleverly arise from "neuroendocrine cells" located in various explains the origin of Multiple Endocrine Neoplasms parts of the body. Since neuroendocrine cells are located (MEN) which produce multiple peptide hormone, and throughout the body, these tumors can originate in many synchronous and/or metachronous tumors which occur organs of the body including the pancreas, gastrointestinal also in multiple organs. While the pituitary and adrenal tract, lung, etc. [1]. The origin of the cells from which glands, target organs for MEN, are known to be derived neuroendocrine tumor cells arise is not well understood. from ectodermal tissue, the pancreas is originally from However, neuroendocrine cells can be divided into two endoderm. The APUD cell concept overcomes this systems, namely aggregations of cells that constitute embryological antinomy. glands (pituitary, thyroid, parathyroid, ganglia, thymus and adrenal medulla) and diffusely distributed dispersed However, to add to the confusion, it is still believed that cells that constitute a disseminated system which is now pancreas neuroendocrine cells arise not from the neural referred to as the diffuse neuroendocrine system (DNES) crest but from the endoderm, meaning that these cells [2]. Embryologically, these systems are different, because should come from the epithelial cells of the pancreas itself the former is derived from ectodermal tissue and the latter or the proximal small intestine. Histologically, pancreas is from endodermal tissue. NET (PNET) seems to arise in tissues adjacent to the pancreas, as well as within the pancreas itself [5]. PNETs Compensating for these embryological differences, thus originate from islet cells or the islets of Langerhans, Pearse et al hence they were previously known as islet cell tumors. using Grimelius staining which applies a redox reaction Islet cells are the endocrine cells of the pancreas and of silver, and. identified described these a diversepeptide cells hormone more reliably secreting by distinct from the exocrine cells, from which pancreatic cells in the body which have a common morphological ductal adenocarcinomas arise. characteristic, a new Amine and Precursor Uptake and Decarboxylation (APUD) cell concept [3]. APUD cells are When focusing on PNET, there are still other probable recognized by the presence of neurosecretory granules and origins as well as these anatomical aspects. In addition have autocrine, paracrine and neuromodulatory functions, to mature endocrine cells in the pancreas, there are in accordance with their endocrine function. These cells also multipotent stem cells that can differentiate into are also found not only in the gland they constitute, but endocrine cells in the pancreas and malignant cells such as adenocarcinomas or squamous cell carcinomas which have the potential to be trans-differentiated into Received August 12th, 2017 - Accepted October 10th, 2017 neuroendocrine cells. Furthermore, intraductal papillary Keywords Biology; Embryology; Epidemiology; Neuroendocrine Cells; neoplasm also considered having a common neoplastic neuroendocrine tumor; Pancreas progenitor or they may be transdifferentiation into Abbreviations APUD Amine and Precursor Uptake and Decarboxylation; DNES diffuse neuroendocrine system; NET neuroendocrine tumors PNET. Isolated endocrine cell which exist in acinar Correspondence Yasunaru Sakuma cells may also serve as the origin of these tumors [6, 7, Department of Surgery 8, 9]. Finally, when considering the origin of PNET, the Jichi Medical University APUD cell concept is still reasonable, however there is 3311-1 Yakushiji Shimotsuke; Tochigi, Japan 3290427 Tel +81(285) 58-7371 other evidence to support the origin of these cells from Fax +81 (285) 44-3234 endoderm and/or the trans-differentiation from stem E-mail [email protected] cells in the pancreas [10, 11]. JOP. Journal of the Pancreas - http://pancreas.imedpub.com/ - Special Issue No. 3 – Dec 2018. [ISSN 1590-8577] 321 JOP. J Pancreas (Online) 2018 Dec 31; S(3):321-327. ording to their site of origin in pituitary gland from its neuroendocrine cells [14]. The the embryological gut, and divided into foregut, midgut phenotype sometimes does not relate to their histogenesis NETs are classified acc and hormones at each site. With more “neural-like” which only include cells of endodermal origins. Foregut differentiation, there are neuroendocrine cells in the tumorsand hindgut develop tumors. in the These thymus, are reasonable esophagus, classifications respiratory larynx, lung, thymus, and thyroid. With a more “epithelial- tract, stomach, duodenum, and pancreas. Midgut tumors like” differentiation, there are neuroendocrine cells in develop in the appendix, small bowel, cecum and ascending the gastroenteropancreatic NET (GEP-NET) system, and colon. Hindgut tumors develop in the transverse colon, interplay seems to exist between these neuroendocrine descending colon, sigmoid colon and rectum. PNET were cells and neural crest-derived nerve endings [15]. Not only neuroendocrine cells, but also NETs, expressing general markers of neuroendocrine differentiation such as (Figurepreviously 1) . classified within foregut tumors, with at least five functional and other non-functional tumors [12] These are peptide hormones, and can be employed in the To investigate the origin of these tumors, the genesis clinicalchromogranin, and morphological synaptophysin diagnosis and neuron-specific of GEP-NET, enolase.because of the cells is important to understand their nature. However in the clinical setting, the ideal situation is to These peptide hormones share a neural-endocrine phenotypethey are independent [16]. Synaptophysin of cell-specific is a small hormone synaptic production. vesicle, and Chromogranin A (CgA) is a membrane protein of morphology.detect these tumorsAt the present before stage,they grow wherever significantly, from and which how neurosecretory granules. These molecules can serve as themay neuroendocrine make it difficult cells to fully arise, evaluate there remains their pathology a difference and tumor markers, including serum tumor markers and between the clinical importance and the many theories to immunohistochemical tumor markers [17]. These peptide explain their origin. hormones are useful for establishing the diagnosis of Characteristics of Neuroendocrine Cells NET. Furthermore, serum CgA levels, a widely used serum marker and member of the chromogranin family, are often ects the fact that these elevated in the serum of patients with PNET especially cells exhibit both the morphological and physiological The term “neuroendocrine” refl those with non-functioning tumors [18]. Serum CgA is attributes of the neural and endocrine regulatory systems, now considered to be the best available biomarker for the and the “neuroendocrine cell” means the type of cell which diagnosis of NET, and an elevated CgA level may correlate synthesizes hormones in the cytoplasm with transport to with tumor progression. In neuroendocrine cells, CgA is usually secreted into the serum with the hormones inside, the nerve endings [13]. As an example, the hypothalamus however the real reason for the elevation of CgA in patients the axon, and finally secreting into the blood vessels from is connecting the nervous system to the endocrine system with NET and its relation to tumor growth are unknown. via the pituitary gland, thus vasopressin and oxytocin are released into the capillaries of the posterior lobe of the two types are expressed in neuroendocrine cells, called Enolase is a glycolytic enzyme with five subtypes, and Figure 1. at least 5 different types of functional tumors. Neuroendocrine tumors are generally classified as foregut, midgut, or hindgut depending on their embryonic origin, and the pancreas are having JOP. Journal of the Pancreas - http://pancreas.imedpub.com/ - Special Issue No. 3 – Dec 2018. [ISSN 1590-8577] 322 JOP. J Pancreas (Online) 2018 Dec 31; S(3):321-327. At least 17 different entities are described arising are lysed due to rapid proliferation and/or treatment of in different organs only in GEP-NET, and different theneuron tumor, specific the serum enolase level (NSE). of NSE If cellsis elevated containing [19]. NSENot terminologies have increased the level of confusion. only neuroendocrine cells but also NET cells express at Moreover, NETs are generally characterized by their ability least two subtypes of somatostatin receptors (SSTRs) to produce peptides that lead
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