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Dec 05, 20232 min read

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Metastatic neuroendocrine tumor of liver, M1, G1 (Ki-67:1%, tissue from liver), primary to be determined, dx on 2018/5/21

  • 2018/5/29 check for functioning tumor or not: ask s/s such as hypoglycemia (insulinoma), diarrhea or hypokalemia (VIPoma), hot flush, diarrhea or hyperglycemia (glucagonoma), recurrent gastric ulcers (gastrinoma), or bronchoconstrition, cardiac valvular fibrosis.
  • 2018/5/29 Check for primary site with whole body CT scan or CXR, panendoscope, colonscopy
  • 2018/5/29 survey for MEN-1 (pituitary tumor and/or hyperparathyroidism)
  • 2018/5/29 Offer referal to CGMH Dr Shieh for pre treatment or post treatment gallium 68 scan clinical trial to find primary or follow up treatment response later
  • 2018/5/29 Send pathology for IHC stain (SSTR-2a or SSTR-5; VIP, Glucagon, Gastrin, Insulin), spnsored by Ipsen, SIGN INFORM CONSENT AND PERMIT @ need to arrange brain MRI to rule out pituitary tumor @ need to arrange EGD (patient has GERD s/s) and colonscopy for primary site survey @ need to check CGA, Calcitonin, PTH-rp, GHRH, gastrin, urine 5-HIAA, serum VIP, serum glucagon, serum insulin, pro-insulin, c-peptide @ 請開立重大傷病

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