Serdar Balcı

Gastrointestinal and Pancreas Neuroendocrine Tumors

Serdar BALCI, MD



Dr. Oberndorfer

Learn his life and his contribution to “Istanbul” and “Karzinoide”

Carcinoid vs Neuroendocrine Tumor

Well Differentiated Neuroendocrine Tumor

Neuroendocrine Tumors

Neuroendocrine Neoplasms


Endocr Pathol. 2014 Mar;25(1):65-79

Neuroendocrine Tumor

intramural or submucosal masses

small polypoid lesions

yellow or tan in appearance

form intense desmoplastic reaction that may cause kinking of the bowel and obstruction

Robbins Basic Pathology

Neuroendocrine Tumor

islands, trabeculae, strands, glands, or sheets of uniform cells

Robbins Basic Pathology

Neuroendocrine Tumor

scant, pink granular cytoplasm

round to oval stippled nucleus

salt and pepper chromatin

Robbins Basic Pathology


Endocr Pathol. 2014 Mar;25(1):65-79

Clinical Features of GI NET

Peak incidence in the sixth decade, may appear at any age

Symptoms by the hormones produced

Zollinger-Ellison syndrome

NET produce gastrin

Gastrinomas of small intestine or pancreas

Increase oxyntic mucosa, increased acid production

Ulcer formation in stomach

Carcinoid syndrome

Ileal tumors

Cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right-sided cardiac valvular fibrosis

If confined to intestine, the secretions are metabolised in liver

If large tumor, in nonportal circulation, metastasis to liver → carcinoid syndrome

Location is important for prognosis


Pancreatic Neuroendocrine Tumors

Autopsy Pathology: A Manual and Atlas

Endocr Pathol. 2014 Mar;25(1):65-79

Ankara Atatürk Eğitim ve Araştırma Hastanesi Arşivi

Endocr Pathol. 2014 Mar;25(1):65-79

Endocr Pathol. 2014 Mar;25(1):65-79


Look remarkably like giant islets

Preservation of the regular cords of monotonous cells and their orientation to the vasculature

Not even malignant lesions present much evidence of anaplasia, and they may be deceptively encapsulated

Deposition of amyloid in the extracellular tissue is a characteristic feature of many insulinomas

Robbins Basic Pathology

Under the electron microscope, neoplastic beta cells, like their normal counterparts, display distinctive round granules

Robbins Basic Pathology


Over half of gastrin-producing tumors are locally invasive or have already metastasized at the time of diagnosis

25% of patients, arise in conjunction with other endocrine tumors

MEN-1 associated gastrinomas frequently are multifocal

Sporadic gastrinomas usually are single

Histologically bland and rarely exhibit marked anaplasia

α-cell tumors (glucagonomas)

δ-cell tumors (somatostatinomas)

Associated with diabetes mellitus, cholelithiasis, steatorrhea, and hypochlorhydria

Difficult to localize preoperatively

High plasma somatostatin levels are required for diagnosis


Rare pancreas NET

Serotonin and an atypical carcinoid syndrome are exceedingly rare

Pancreatic polypeptide-secreting endocrine tumors present as mass lesions as even high plasma levels of this hormone fail to cause symptoms

Multihormonal tumors

Endocr Pathol. 2014 Mar;25(1):65-79

Endocr Pathol. 2014 Mar;25(1):65-79

Endocr Pathol. 2014 Mar;25(1):65-79

Endocr Pathol. 2014 Mar;25(1):65-79

Endocr Pathol. 2014 Mar;25(1):65-79