SPLEEN VOLUME EVOLUTION IN COURSE OF ACTH-ECTOPIC SYNDROME DUE TO PANCREATIC NEUROENDOCRINE TUMOR LIVER METASTASES. A CASE REPORT AND LITERATURE REVIEW

Shorikov M.A., Sergeeva O.N., Virshke E.R., Panov V.O., Dolgushin B.I.

N.N. Blokhin Russian Cancer Research Center, Research Institute of Clinical and Experimental Radiology. Moscow, Russia.

 

Purpose. The paper is based on a seven-year surveillance of the patient showing ectopic adrenocorticotropic hormone (ACTH) syndrome.

Materials and methods. A female 49-year old patient underwent pancreaticoduodenectomy for pancreatic head neuroendocrine tumor (NET) with synchronous liver metastases in 2009. Over time the metastatic lesions were gradually enlarging and conventional transarterial chemoembolization (cTACE) was performed twice: on December 2012 and on March 2014 in “on demand” regimen. Since 2013 the patient developed clinical signs suspicious for hypercortisolism but the elevated serum cortisol and ACTH levels were registered only on May 2015. ACTH production was proven to be ectopic by dexamethasone suppression test and it was a quite rare finding in a pancreatic NET. At the same time the spleen volume on MRI was evaluated as 126 cm3 which was almost two times lower than in 2009 (231 cm3).

Results. With regard to occasional papers which mentioned cTACE as a method for hypercortisolism abatement the third cTACE was performed on June 2015. It resulted in tumor destruction, normalization of cortisol and ACTH levels and restoration of the spleen size, ongoing up to the date (12 months after the procedure). The retrospective MRI-based spleen volumetry demonstrated reduction of the spleen volume overall, and its increase in a period 1.5-12.0 months after each cTACE (r2=0.5, p<0.006). The spleen volume also correlated with ACTH levels (p<0.0001). Thought a remarkable spleen weight decrease after prolonged dexamethasone treatment has been shown on rodent models, PubMed search revealed no previous clinical reports focusing on splenic volume evolution depending on glucocorticoid levels.

Conclusions. The presented case makes us hypothesize that the consistent pattern similar to that in the animal studies is also present in humans and, thus, microsplenia in cancer patients may serve as an indirect visualization sign of the ectopic ACTH production.

 

Keywords: spleen, neuroendocrine tumors, chemoembolization, ACTH-ectopic syndrome, MRI, volumetry.

 

Corresponding author:  Shorikov M.A., Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Shorikov M.A., Sergeeva O.N., Virshke E.R., Panov V.O., Dolgushin B.I. Spleen volume evolution in course of ACTH-ectopic syndrome due to pancreatic neuroendocrine tumor liver metastases. A case report and literature review. REJR. 2016; 6 (3):108-116. DOI:10.21569/2222-7415-2016-6-3-108-116.

 

Received: 29.06.2016 Accepted: 13.07.2016