Endocrine Abstracts

Introduction: Pulmonary neuroendocrine tumours (pulNETs) histologically encompass: small cell, large cell, typical (TC) and atypical carcinoid (AC). Diffuse idiopathic pulmonary neuroendocrine hyperplasia (DIPNECH) is a very rare condition but potentially progress to pulNET and is associated with MEN. Advances in treatment have modified management, and there have been recommendations to use Ki67 for grading. However there is a paucity of randomized studies.

Method: A retrospective analysis in the form of a search using the key words/codes ‘atypical and typical carcinoid’ was performed on the Apex histopathology database for cases between Jan 2009 to Dec 2019. All cases found on the Apex histopathology database were collated. Electronic records, histopathology and biochemistry were reviewed.

Results: 97 cases were found. Of those: 17AC (17%) and 75TC (77%). DIPNECH was found in a further 3 patients. 85 patients had Ki67 analysed to grade the NET. Grading was carried out according to WHO 2015 classification as G1(49), G2(32), G3(7),no data in (9). In terms of imaging and staging, 97patients (100%) had undergone CT TAP, 86 had FDG PET and 11 had SSTR scintigraphy (Gallium 68 PET or Octreoscan). In terms of staging at presentation 64 were PT1, 22 were PT2, (6) PT3 and 5 was PT4. Surgical procedures included: 35 VATS, 48 thoracotomies. As for follow up, 81 had CXR,7 had CT surveillance under respiratory physicians. In terms of biochemistry chromogranin A was performed in 5 patients. 4 received somatostatin analogue therapy, 4 had chemotherapy, 4 had radiotherapy and none had targeted treatment. 2 % were MEN 1 gene positive. The number of deaths were 27 and those under active follow up were 31 and 39 were discharged. 12 patients were listed at the NET MDT after 2016.

Conclusion: According to our analysis, histopathological review carried out in patient was according to the WHO classification, met criteria for gold standard, immunohistochemistry and WHO grading 2015 was done as well. 100% of patients received imaging with CT scan. NET MDT was only performed in limited number of patients as this was set up since STH becoming Centre of excellence in 2016.