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Neuroendocrine Tumors and Carcinoid

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Capecitabine
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Fluorouracil
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Octreotide
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Doxorubicin
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doxorubicin hydrochloride
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Lanreotide
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Streptozocin
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Temozolomide
James Buxbaum, MD, MS Associate Professor or Medicine (Clinical Scholar), Keck Medicine of University of Southern California

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Neuroendocrine Tumors and Carcinoid - Case 1

Case Study thumbnail 232

Neuroendocrine Tumors and Carcinoid - Case 2

1. A 45-year-old woman presents with flushing, diarrhea, and abdominal cramping. A CT scan reveals a mass in the small intestine with liver metastases. Which of the following is the most appropriate initial diagnostic test to confirm carcinoid syndrome?

Select only 1 answer.

  1. A. Serum chromogranin A
  2. B. 24-hour urinary 5-HIAA
  3. C. Plasma serotonin level
  4. D. Endoscopic ultrasound (EUS) with biopsy

2. Which of the following is the most appropriate treatment for a patient with a well-differentiated neuroendocrine tumor (NET) of the midgut and carcinoid syndrome?

Select only 1 answer.

  1. A. Surgical resection of the primary tumor
  2. B. Everolimus
  3. C. Octreotide
  4. D. Chemotherapy with capecitabine and temozolomide

3. A 50-year-old man with a history of Zollinger-Ellison syndrome undergoes endoscopy, revealing multiple small nodules in the stomach. Biopsy confirms type 2 gastric carcinoids. What is the underlying cause of these lesions?

Select only 1 answer.

  1. A. H. pylori infection
  2. B. Autoimmune gastritis
  3. C. Ectopic gastrin production
  4. D. Chronic use of proton pump inhibitors

4. Which of the following imaging techniques is most sensitive for detecting small, localized pancreatic neuroendocrine tumors (PNETs)?

Select only 1 answer.

  1. A. MRI
  2. B. CT scan
  3. C. DOTATATE PET imaging
  4. D. Endoscopic ultrasound (EUS)

5. A patient with a known neuroendocrine tumor presents with new symptoms of hypoglycemia. Which type of tumor is most likely responsible for these symptoms?

Select only 1 answer.

  1. A. Gastrinoma
  2. B. Insulinoma
  3. C. VIPoma
  4. D. Somatostatinoma

6. Which of the following statements is true regarding the management of type 3 gastric carcinoids?

Select only 1 answer.

  1. A. They can be managed conservatively with surveillance.
  2. B. They have a high risk of metastasis and often require surgical resection.
  3. C. They are associated with autoimmune gastritis and have a benign course.
  4. D. They are typically small and non-neoplastic, requiring no intervention.

7. A 60-year-old man with a history of small bowel obstruction undergoes surgery, and a neuroendocrine tumor is found in the ileum. What is the most likely reason for his obstruction?

Select only 1 answer.

  1. A. Tumor-related fibrosis
  2. B. Hormone secretion by the tumor
  3. C. Direct invasion by the tumor
  4. D. Vascular compromise

8. Which of the following best describes the typical presentation of a midgut carcinoid tumor?

Select only 1 answer.

  1. A. Early symptoms of bowel obstruction
  2. B. Painless jaundice and weight loss
  3. C. Diarrhea, flushing, and abdominal pain
  4. D. Epigastric pain relieved by food

9. In a patient with a known pancreatic neuroendocrine tumor (PNET), which of the following genetic syndromes should be considered?

Select only 1 answer.

  1. A. Lynch syndrome
  2. B. Multiple endocrine neoplasia type 1 (MEN-1)
  3. C. BRCA2 mutation
  4. D. Peutz-Jeghers syndrome

10. A 58-year-old man presents with weight loss, abdominal pain, and a newly diagnosed pancreatic mass. His serum chromogranin A is elevated. Which imaging modality is most appropriate to assess the extent of disease?

Select only 1 answer.

  1. A. MRI
  2. B. Abdominal ultrasound
  3. C. DOTATATE PET imaging
  4. D. Contrast-enhanced CT scan

11. Which of the following laboratory tests is most useful in the follow-up of a patient with a known metastatic neuroendocrine tumor being treated with octreotide?

Select only 1 answer.

  1. A. Serum gastrin
  2. B. Plasma 5-HIAA
  3. C. Serum chromogranin A
  4. D. Plasma somatostatin

12. A patient with a pancreatic neuroendocrine tumor presents with recurrent hypoglycemic episodes. Which of the following is the best management strategy?

Select only 1 answer.

  1. A. Surgical resection of the tumor
  2. B. Chemotherapy with streptozocin
  3. C. Initiate treatment with lanreotide
  4. D. Dietary management and observation

13. In a patient with a small intestinal neuroendocrine tumor, which of the following is the most important factor in determining the risk of metastasis?

Select only 1 answer.

  1. A. Tumor size
  2. B. Serum chromogranin A level
  3. C. Presence of carcinoid syndrome
  4. D. Location within the small intestine