{"id":4231,"date":"2015-04-22T10:00:56","date_gmt":"2015-04-22T10:00:56","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/tumor-neuroendocrino-gastrico\/"},"modified":"2022-10-26T20:35:42","modified_gmt":"2022-10-26T20:35:42","slug":"tumor-neuroendocrino-gastrico","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/tumor-neuroendocrino-gastrico\/","title":{"rendered":"Tumor Neuroend\u00f3crino G\u00e1strico"},"content":{"rendered":"

Os tumores neuroend\u00f3crinos g\u00e1stricos s\u00e3o les\u00f5es compostas por hiperplasia das c\u00e9lulas enterocromafin-like. Os padr\u00f5es histol\u00f3gicos s\u00e3o variados e confirmam-se pela imunohistoqu\u00edmica, tendo positividade para marcadores como cromogranina A.<\/p>\n

Os tumores neuroend\u00f3crinos (TNE) g\u00e1stricos s\u00e3o divididos clinicamente em tr\u00eas tipos:
\nTipo 1<\/strong>: mais comum (80%), ocorre num contexto de gastrite atr\u00f3fica associado a hipergastrinemia, geralmente m\u00faltiplos. Apresentam-se como pequenos n\u00f3dulos no corpo e limitados \u00e0 submucosa e mucosa. Geralmente benignos, podendo regredir. As met\u00e1stases linfonodais s\u00e3o raras, podendo ocorrer em les\u00f5es maiores de 2 cm.
\nTipo 2<\/strong>: s\u00e3o raros (5%), geralmente menores que 1,5 cm, multifocais no corpo e associado a s\u00edndrome neuroend\u00f3crina m\u00faltipla (MEN tipo 1) e s\u00edndrome de Zollinger Ellison. H\u00e1 met\u00e1stase em 30% dos casos, preferencialmente quando les\u00f5es maiores de 2 cm e com invas\u00e3o da muscular pr\u00f3pria.
\nTipo 3<\/strong>: segundo mais comum (15%), \u00e9 espor\u00e1dico, solit\u00e1rio e sem associa\u00e7\u00e3o com gastrite atr\u00f3fica e sem hipergastrinemia. Ocorrem em qualquer local do est\u00f4mago e, como os demais, as met\u00e1stases est\u00e3o relacionadas com o tamanho, presen\u00e7a de invas\u00e3o angiolinf\u00e1tica e invas\u00e3o da muscular pr\u00f3pria.<\/p>\n

\"tabela<\/a><\/p>\n

A nova classifica\u00e7\u00e3o histol\u00f3gica dos TNE g\u00e1stricos, da Organiza\u00e7\u00e3o Mundial de Sa\u00fade, \u00e9 feita atrav\u00e9s da contagem mit\u00f3tica em campos de grande aumento (10 HPF) e pelo \u00edndice de Ki67, sendo assim divididos em:
\nGrau I<\/strong> (bem diferenciado, cerca de 90%): Ki67 \u2264 2% e < 2 mitoses\/10 campos de maior aumento;
\nGrau II<\/strong> (bem diferenciado): Ki67 de 3 a 20% e 2 a 20 mitoses\/10 cma;
\nGrau III<\/strong> (pouco diferenciado): Ki67 > 20% e mitose > 20\/10 cma.<\/p>\n

Quanto a conduta, deve-se considerar a classifica\u00e7\u00e3o cl\u00ednica, o grau histol\u00f3gico, o grau de invas\u00e3o, o n\u00famero de les\u00f5es, o tamanho do tumor e a presen\u00e7a de invas\u00e3o angiolinf\u00e1tica ou de met\u00e1stases.<\/p>\n

Nos tumores do tipo 1 e 2, nos casos em que h\u00e1 menos de 5 p\u00f3lipos e o maior deles for inferior a 1 cm \u00e9 recomendado ressec\u00e7\u00e3o endosc\u00f3pica, se n\u00e3o houver invas\u00e3o da camada muscular pr\u00f3pria (quando diagnosticado por ecoendoscopia antes da ressec\u00e7\u00e3o). O acompanhamento \u00e9 feito com endoscopia digestiva alta anualmente. Quando houver margens comprometidas da ressec\u00e7\u00e3o endosc\u00f3pica, a ressec\u00e7\u00e3o cir\u00fargica local est\u00e1 indicada (gastrectomia subtotal).<\/p>\n

Fatores de risco para doen\u00e7a metast\u00e1tica:
\n– Invas\u00e3o da muscular pr\u00f3pria
\n– Invas\u00e3o angiolinf\u00e1tica
\n– Classifica\u00e7\u00e3o histol\u00f3gica grau III (pouco diferenciado)<\/p>\n

Tumores neuroend\u00f3crinos que apresentam qualquer fator de risco para met\u00e1stase ou classificados clinicamente como tipo 3, est\u00e1 indicada a gastrectomia com linfadenectomia.<\/p>\n

Nos casos de met\u00e1stases, h\u00e1 op\u00e7\u00f5es como t\u00e9cnicas de radiologia intervencionista, radioterapia para dissemina\u00e7\u00e3o \u00f3ssea sintom\u00e1tica e quimioterapia em doen\u00e7a metast\u00e1tica irressec\u00e1vel.<\/p>\n

CASOS CL\u00cdNICOS<\/strong>
\nCaso 1<\/strong>: feminina, 32 anos, com hipotireoidismo e depress\u00e3o, refere pirose e epigastralgia diariamente, sem sinais de alarme. Na EDA, evidenciaram-se p\u00f3lipos em corpo g\u00e1strico e gastrite antral erosiva plana moderada, foram feitas polipectomias. \u00c0 bi\u00f3psia e imunohistoqu\u00edmica, constatou-se tumor neuroend\u00f3crino (cromogranina positivo) , Grau I (Ki67 < 2%) , apresentando tamb\u00e9m atrofia, metaplasia intestinal e padr\u00e3o morfol\u00f3gico sugerindo gastrite autoimune. Exame laboratorial demonstrou hipergastrinemia, anti- c\u00e9lula parietal positivo e defici\u00eancia de vitamina B12. A conduta feita foi reposi\u00e7\u00e3o de vitamina B12 e orienta\u00e7\u00f5es quanto ao quadro e seguimento endosc\u00f3pico.<\/p>\n

\"IMAGEM<\/a>
\nCLASSIFICA\u00c7\u00c3O CL\u00cdNICA: Tipo 1 CLASSIFICA\u00c7\u00c3O HISTOL\u00d3GICA: Grau I<\/p>\n

Caso 2<\/strong>: masculino, 33 anos, com queixa de dispepsia intermitente h\u00e1 10 meses, tem hipotireoidismo. \u00c9 irm\u00e3o da paciente do caso 1. EDA evidenciou pangastrite enantematosa<\/a><\/strong> leve e p\u00f3lipos g\u00e1stricos. \u00c0 bi\u00f3psia e imunohistoqu\u00edmica, constatou-se tumor neuroend\u00f3crino (cromogranina positivo), Grau II (Ki67 7 %) , invadindo submucosa e com margem profunda comprometida. Apresentando tamb\u00e9m atrofia, metaplasia intestinal e padr\u00e3o morfol\u00f3gico sugerindo gastrite autoimune. Devido as margens de ressec\u00e7\u00e3o comprometidas e grau histol\u00f3gico um pouco mais agressivo foi indicado o tratamento cir\u00fargico do qual o paciente se recusou em fazer e perdeu o acompanhamento.<\/p>\n

\"tabela<\/a>
\nCLASSIFICA\u00c7\u00c3O CL\u00cdNICA: Tipo 1 CLASSIFICA\u00c7\u00c3O HISTOL\u00d3GICA: Grau II<\/p>\n

Caso 3<\/strong>: feminina, 37 anos., com queixa de epigastralgia,. Endoscopia evidenciando p\u00f3lipos em corpo g\u00e1strico sendo um com cerda de 10mm, sendo este ressecado por mucosectomia. Diagn\u00f3stico histol\u00f3gico e imunohistoqu\u00edmico compat\u00edvel com tumor neuroend\u00f3crino, invasor da submucosa e margens cir\u00fargicas comprometidas, associado a gastrite atr\u00f3fica. Laborat\u00f3rio com hipergastrimenia e investiga\u00e7\u00e3o de met\u00e1stase a dist\u00e2ncia negativa. Paciente submetida a gastrectomia parcial devido margens cir\u00fargicas comprometidas.<\/p>\n

\"IMAGEM<\/a>
\nCLASSIFICA\u00c7\u00c3O CL\u00cdNICA: Tipo 1 CLASSIFICA\u00c7\u00c3O HISTOL\u00d3GICA: Grau I<\/p>\n

Caso 4<\/strong>: feminina, 60 anos, HAS pr\u00e9via, tendo como queixa principal pirose. EDA apresentando 2 p\u00f3lipos g\u00e1stricos na grande curvatura sendo o maior com cerca de 8mm. \u00c0 bi\u00f3psia e imunohistoqu\u00edmica, constatou-se p\u00f3lipo hiperpl\u00e1sico e o outro como tumor neuroend\u00f3crino (cromogranina positivo), Grau I (Ki67 <2%), sem invas\u00e3o angiolinf\u00e1tica, com margem profunda comprometida, sem atrofia associada. Solicitado tomografia de abdome e gastrina s\u00e9rica. Paciente n\u00e3o retornou e o seguimento do caso foi perdido.<\/p>\n

\"IMAGEM<\/a>
\nCLASSIFICA\u00c7\u00c3O CL\u00cdNICA: Tipo 3 \u00a0CLASSIFICA\u00c7\u00c3O HISTOL\u00d3GICA: Grau I<\/p>\n

Discuss\u00e3o<\/strong>
\nOs pacientes dos casos 1 e 2 possuem hipotireoidismo e atrofia g\u00e1strica, sendo por um com gastrite autoimune confirmada, mostrando a rela\u00e7\u00e3o que pode existir entre as doen\u00e7as autominues<\/p>\n

Os pacientes dos casos 1 e 2 s\u00e3o irm\u00e3os sugerindo a associados do tumor neuroend\u00f3crino com fatores gen\u00e9ticos ou com doen\u00e7as autoimunes que levam a atrofia da mucosa g\u00e1strica<\/p>\n

Os pacientes dos caso 2 e 3 apresentaram margem cir\u00fargica comprometida ap\u00f3s a ressec\u00e7\u00e3o endosc\u00f3pica tendo sido indicada complementa\u00e7\u00e3o cir\u00fargica das les\u00f5es.<\/p>\n

O paciente do caso 4 apresentava les\u00e3o \u00fanica n\u00e3o associada a gastrite atr\u00f3fica o que poderia sugerir a classifica\u00e7\u00e3o clinica como tipo 3. Fala contra este hip\u00f3tese o pequeno tamanho da les\u00e3o.<\/p>\n

Conclus\u00e3o<\/strong>
\nApesar de ser uma neoplasia rara, tem-se demonstrado um aumento progressivo da incid\u00eancia dos tumores neuroend\u00f3crinos g\u00e1stricos e representam atualmente cerca de 10% de todos os TNE gastrointestinais<\/p>\n

Constituem um espectro de neoplasias com caracter\u00edsticas cl\u00ednico-patol\u00f3gicas, mecanismo patog\u00eanico e progn\u00f3stico diferentes do adenocarcinoma<\/p>\n

O conhecimento deste complexo tema com suas classifica\u00e7\u00f5es e apresenta\u00e7\u00f5es \u00e9 de fundamental import\u00e2ncia para a condu\u00e7\u00e3o adequada de tumores desta linhagem<\/p>\n

Bibliografia<\/strong>
\nDal Pizzol AC, Linhares E, Gon\u00e7alves R, Ramos C. Tumores Neuroend\u00f3crinos do Est\u00f4mago: S\u00e9rie de Casos. Revista Brasileira de Cancerologia 2010; 56(4):453-461, Outubro 2010.<\/p>\n

Pathology and Genetics of Tumours of the Digestive System. World Health Organization Classification of Tumours 2010. p. 53-57.<\/p>\n

College of American Pathologists .Protocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach. Based on AJCC\/UICC TNM, 7th Edition.<\/p>\n

Ruszniewski P, Delle Fave G, Cadiot G, et al. Frascati Consensus Conference; European neuroendocrine Tumor Society. Well-differentiated gastric tumors\/ carcinomas. Neuroendocrinology 2006;84:158\u201364.<\/p>\n","protected":false},"excerpt":{"rendered":"

Os tumores neuroend\u00f3crinos g\u00e1stricos s\u00e3o les\u00f5es compostas por hiperplasia das c\u00e9lulas enterocromafin-like. Os padr\u00f5es…<\/p>\n","protected":false},"author":1772,"featured_media":9465,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[282],"tipo":[153],"volume":[263],"class_list":["post-4231","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-282","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"\nTumor Neuroend\u00f3crino G\u00e1strico • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/tumor-neuroendocrino-gastrico\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tumor Neuroend\u00f3crino G\u00e1strico\" \/>\n<meta property=\"og:description\" content=\"Os tumores neuroend\u00f3crinos g\u00e1stricos s\u00e3o les\u00f5es compostas por hiperplasia das c\u00e9lulas enterocromafin-like. 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