Pancreatic neuroendocrine tumor code in the ICD 10 & ndash; C25. It is this combination in the international classifier that denotes malignant neoplasms localized in the specified organ. What are these diseases? Let's try to consider in more detail.
general information
Without the normal functioning of the nervous system, the secreting glands, the human body cannot function and be in order. Modern medicine considers these elements as a whole, classifying them into the neuroendocrine system. Specific cells localized in endocrine glandular structures are responsible for the production of active compounds. One of the important elements of the pancreas is the islets of Langerhans. Coding of the case when a neoplasm is detected in this area is C25.4 according to the ICD. A pancreatic neuroendocrine tumor of this format can form if cells of the indicated type begin to divide, function, and die in an incorrect, incorrect way.
The specified variety of pathologies is not accidentally allocated in a separate group. The manifestations characteristic of it, the nuances of clarifying the diagnosis, the treatment methodology are very different from those applicable to neoplasms formed by epithelial cells.
Anatomy and medicine
The nervous system, hormonal substances generated by endocrine structures function mutually. Signals of the nervous system enter the hypothalamus, where they stimulate the production of hormonal substances. Those, in turn, affect the pituitary gland, activating or slowing down the activity of the pathways. Substances with blood flow spread throughout the body, stimulating the secretory function of glandular structures.
The generation of hormones is determined not only by impulses of the nervous system. Important factors are the processes occurring in the body, the condition of the person as a whole and of individual organs and structures. The central nervous system and the secretory system are mutually connected: due to hormones through the adrenal glands, the work of nerves is regulated. This is realized through the release of adrenaline into the bloodstream.
Pancreas: how it works
Under the code of a neuroendocrine tumor of the pancreas C25 refers to a pathological condition associated with the malfunctioning of the gastroenteropancreatic NES. In the human body, it dominates other NES in size. It is this system that scientists have studied especially well. It was possible to establish that the NES is formed by neurons, apudocytes, generating hormonal compounds. These cells are scattered throughout the gastrointestinal tract, are present in all organs.
The most important area of the pancreas from this point of view is the islets of Langerhans, that is, the tail zone. Relative to the entire organ, these islets account for only about 2% of the mass, that is, about 1.5 g. The number of islands is much more impressive - it has been established that their number is close to a million.
Neoplasms: the nuances of formation
A pancreatic neuroendocrine tumor (G2, G1) can form from any cell of this type localized in this organ. The mechanism of the onset of the disease is the process of uncontrolled cell division. Currently, the nuances of the formation of neoplasms have not been adequately studied. It was clarified that a significant percentage of patients showed a mutation in the eleventh chromosome pair. NEO belongs to the category of rare diseases, which significantly complicates the specification of the condition: only a highly qualified doctor can determine its symptoms.
In a predominant percentage of cases, a neuroendocrine tumor of the pancreas forms as a bubble or plate. The official name of such forms (respectively): alveoli, trabeculae. In some patients, the progress of the disease is quite slow, while others are characterized by a fulminant course. In general, as the information accumulated by medicine shows, the pathology is extremely unpredictable. A small neoplasm is far from always malignant. A conclusion about his character is made by determining the speed of development. In some cases, the tumor is localized in one organ; in more severe cases, it spreads to neighboring structures.
The nuances of manifestation
Symptoms of a pancreatic neuroendocrine tumor in the early stages of the development of the disease are absent or extremely lubricated. A rather large percentage of cases can be detected only at an advanced stage, when a pathological condition has been developing for 5-8 years. Specific manifestations in the first stages of most tumors are not characteristic. Certain health problems of patients are disturbed, but they cannot be connected with the neuroendocrine system, and treatment for completely different diseases is prescribed.
It is possible to assume that there is a neuroendocrine tumor of the pancreas (with or without metastases, it is determined after a full examination) if the pain in the abdomen is disturbing. Sensations can come periodically or be constant. The patient loses weight, feels constantly tired. There is an upset stool, nausea and vomiting. Against the background of the neoplasm, blood sugar decreases, the pulse becomes more frequent, tides worry.
Categories and types
In many ways, the prognosis of a neuroendocrine pancreatic tumor depends on the type of case. A system has been developed for dividing them into several groups. The main evaluation criterion is the ability to generate hormonal compounds, the activity of this process. There are four varieties: active, inactive, non-functional and working.
The first type is a pancreatic neuroendocrine tumor, whose cells produce biological substances that regulate the body. Among the total number of neoplasms, active account for about 80%. A much less common species is inactive. Diagnosing such a pathology is the most difficult. Non-functioning NEOs can secrete hormonal compounds. The case is not characterized by specific symptoms. Finally, the last category is the NSO, which generates more than the norm, the amount of hormones. This usually can be determined quite early. Increased hormone production is often observed under the influence of a stress factor. This may be the answer to anesthesia, biopsy.
Status Update
Diagnosis of a neuroendocrine pancreatic tumor is not an easy task for a modern doctor. It is more likely to suspect that the patient’s health problems are due to just such a reason, a highly qualified and experienced doctor who has already encountered similar cases. If an assumption arises about the possibility of the existence of NEO, it is necessary to conduct a series of studies to confirm or refute the assumption. Begin by studying the medical history of a person and his immediate family. Clarification of hereditary pathologies is important information for analyzing the causes of symptoms. Also, at the initial appointment, the patient is carefully examined, all complaints are clarified and this information is systematized.
The next step in determining a pancreatic neuroendocrine tumor is collecting samples of fluids and tissues for laboratory research. It is necessary for the patient to obtain cells containing hormonal substances, presumably generated by the neoplasm. The doctor also determines a list of other active substances, the analysis of which will help to obtain more useful information about the case. Select tissue sites to obtain biopsy samples, prescribe scintigraphy with somatostatin. The next stage is CT, ultrasound, MRI, X-ray. An ultrasound can be prescribed using an endoscope.
The diagnosis is confirmed: what next?
The treatment of a pancreatic neuroendocrine tumor is selected based on the case being of a specific type. There are several basic methods and approaches: targeted therapy, radiation, chemotherapy, surgery, radio transmission, biological method. There are currently no measures to prevent neoplasms of this type. This is due to the rarity of such cases and the lack of sufficient knowledge about the process of their formation. The mechanism of occurrence has not yet been identified accurately, which excludes the possibility of effective prevention.
In a predominant percentage of cases, the therapeutic course involves surgery. The described category of neoplasms allows minimally invasive measures. It is possible to use a laparoscope. This removes the minimum area of the diseased organ, which minimizes complications and accelerates the rehabilitation of the patient. If metastases are detected, they must be removed.
A good approach for a neuroendocrine pancreatic tumor is nuclear therapy. This approach activates destructive intracellular processes. You can resort to these methods yourself or combine them with the operation. In the general case, the prognosis for a neuroendocrine pancreatic tumor is more favorable than many other forms of malignant neoplasms in the gastrointestinal tract. The best prospects are for people suffering from active forms established at an early stage, if it is possible to begin adequate treatment without wasting time.
Active types: insulinoma
Such a neoplasm consists of insulin-producing beta cells. Among other cases of NEO, this type accounts for up to 75%. There is a higher probability of the formation of a tumor process in women; age group of risk - 40-60 years. In the main percentage of cases, a single tumor is detected, the location in the organ is unpredictable. A small percentage of cases occur in localization outside the pancreas. The size of the neoplasm is rarely more than 1.5 cm. Color - resembling cherry, yellowish gray or brown. Up to 15% of cases are malignant.
This form of the tumor generates large volumes of insulin, which determines the main symptom: glucose is significantly reduced in the circulatory system. Hypoglycemia is especially pronounced after exercise or with a long time interval between meals. Reduced glucose concentration leads to improper energy metabolism, which causes the body and brain subcortex to suffer. The patient feels weak, hungry. Sweat glands are more active than normal, the frequency and speed of the heartbeat are disturbed, tremors and disorientation in space, sometimes in time, disturb. Gradually, memory becomes worse, consciousness gets confused, the patient becomes apathetic and suffers from convulsions. The most serious complication of a pancreatic neuroendocrine tumor of this type is hypoglycemic coma.
Case Nuances
Identifying insulin is not easy. This is a relatively small neoplasm, whose symptoms are characteristic of a wide range of other pathologies. The most accurate studies are scintigraphy, endoscopic ultrasound, CT. Up to 50% of cases are detected through radiation diagnostics. If the location is not clear, positron emission tomography is indicated to clarify the case. It is possible to suggest the nuances of localization by conducting an angiographic analysis.
The treatment of a neuroendocrine pancreatic tumor of this class is most effective. With small dimensions, the tumor is immediately completely removed. With a diameter of 3 cm or more, a resection of an organ element is shown. This is especially important if NEO is malignant. A properly held event is the key to absolute recovery.
Gastrinoma
Among all NEOs, this species is the second most common. It accounts for up to 30% of all cases. The higher the likelihood of neoplasm formation in representatives of the stronger sex; age group of risk - 30-50 years. Approximately one in three cases allows the determination of NEO in external structures relative to an organ. Dimensions are usually not more than 3 cm. NEOs larger than the specified diameter are considered malignant. A distinctive feature of this form is a tendency to early formation of metastases. The disease manifests itself by excessive generation of gastrin, activating the production of juice in the stomach. This causes ulcers to form in the intestines. Such a process often becomes the first manifestation of a tumor.
Gastrin can be suspected by loose stools and pain attacks that resemble colic. Peptic ulcer disease shows increased resistance to treatment. Higher probability of NEO if such a diagnosis was made to parents.
Case Nuances
Clarification of gastrinoma is complicated by the small size of the neoplasm and the manifestations characteristic of a widespread peptic ulcer. To determine the tumor, it is necessary to check the circulatory system for gastrin content. The optimal approach is radioimmunological. Clarification of localization is possible with the help of ultrasound, endoscopic examination, CT, MRI. Up to 90% of all NEOs of this type are located between the neck of the gland, the descending intestinal part and the general pathway for eliminating bile.
The therapeutic course involves radical intervention. The patient is shown an operation. If there is a high probability of malignancy of the site, if the neoplasm has the ability to spread to nearby organs and tissues, it is necessary to remove not only the gastrin, but also the element of the gland in which it was formed. Removing only NEO from the patient’s body is practiced if the dimensions of the formation are small. According to the results of treatment, the prognosis for a neuroendocrine tumor of the pancreas is positive, you can expect a full recovery.
Glucagon
This form is very rare. It can appear during the degeneration of glucagon-producing cellular alpha structures. There is a higher probability of detecting such a disease in young and mature women. On average, among the female half, pathology occurs three times more often than in men. A greater percentage of cases occur in the location of the formation in the caudal or main part of the gland. Typically, NEO is single, with dimensions of 5 cm or more. Up to 70% of all cases are malignant. The active production of glucagon stimulates the generation of insulin, and glycogen breaks down in the liver structures.
The disease can be suspected by migratory erythema, accompanied by necrotic areas. Blood clots appear in the deep venous system, the patient's condition becomes depressed. Secondary diabetes is possible. In a blood test, glucagon indices exceed the standards tenfold. To clarify the localization, ultrasound, CT are shown.
The future after the tumor
Women with such a diagnosis are traditionally most concerned with: is pregnancy possible after neuroendocrine pancreatic tumors? As clinical practice has shown, this is not only possible, but also took place in real life. Moreover, successful cases of bearing and giving birth to a child are known even against the background of pancreatic removal due to malignant NEO identified earlier. Of course, first you have to go the full course of treatment and recovery, wait until the condition stabilizes, and only then think about the continuation of the genus. Nevertheless, the fact remains: pregnancy after neuroendocrine pancreatic tumors is possible, practiced, successful, and children can be born completely healthy.
According to doctors, the main aspect of the prognosis is the correct operation in an adequate time period. An accurately held event involving qualified doctors helps to ensure a person a long and full life.