Open Journal of Obstetrics and Gynecology, 2013, 3, 739-742 OJOG Published Online December 2013 (
Neuroendocrine tumors of the ovary: What support?
H. Al Moubaker1, S. Errarhay1, S. Mahmoud1, Amal Bennani2, C. Bouchikhi1,
Affaf Amarti2, A. Banani1
1Service Gynecology Obstetricsi Chuhassan Iifes, Fez, Morocco
2Service Pathological Anatomy Chuhassan Iifes, Fez, Morocco
Received 20 November 2013; revised 12 December 2013; accepted 20 December 2013
Copyright © 2013 H. Al Moubaker et al. This is an open access article distributed under the Creative Commons Attribution License,
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Neuroendocrine tumors of the ovary tumors are little
known and infrequent. They are made up of cells ap-
pearing in the endocrine and nervous systems. These
tumors are rare, but most of them are very aggressive,
especially when they are diagnosed beyond FIGO Sta-
ge I. The distinction among the different subtypes is
difficult and requires efficient techniques. Symptoms
of neuroendocrine tumors are often nonspecific (red-
ness in the face, diarrhea, asthma, abdominal pain
and etc.,) and confused with more common diseases.
Misdiagnosis is often asked: menopause or irritable
bowel syndrome. Often the correct diagnosis is not
made until years after the onset of symptoms. The
relative rarity of these diseases and the lack of speci-
ficity of the symptoms make them often be diagnosed
several years after onset. Fortunately, science has
made significant advances in the diagnosis and
treatment of neuroendocrine tumors. We report the
case of a woman of 54 years, with abdominopelvic
mass, in whom abdominal ultrasound revealed a mass
avascular tissue Doppler taking the screen. The abdo-
minopelvic CT showed a large cystic mass solido—
abdominopelvic whose origin is difficult to determine.
The patient underwent an exploratory laparotomy.
Anapath the results of the right ovary were in favor
of a well-differentiated neuroendocrine lesion.
Keywords: Tumor
Neuroendocrine tumors are tumors that develop from
hormone-producing cells located in the endocrine (hor-
monal) system and the nervous system [1].
During their growth, these tumors, in some cases,
produce more hormones. Others are called non-secreting:
although formed from neuroendocrine cells, they do not
produce hormones.
Carcinoid tumors represent 0.1 % of organic lesions of
the ovary. This type of tumor, resulting in germ cells, is
considered in the WHO classification as a highly spe-
cialized teratoma. A mature teratoma is associated in
75% of cases [ 2,3].
These particular tumors can metastasize easily. Most
are formed in the gut and the lung, but are found else-
where in the body. The members have functions of
glands. Althoug h ther e ar e man y type s of neu roen doc rine
tumor, they are treated as a separate group because the
cells of these tumors have several common features: they
are physically quite similar neoplasms and produce a
secretory granule often with a production biogenic ami-
nes and hormones (polypeptides). We can distinguish
four groups of carcinoid tumors of the ovary: the insular
carcinoid, trabecular, and mucinous stroma .
54-years-old patient, single, no significant pathological
history, which has pelvic pain associated with a progres-
sive increase in abdominal volume, in which the clinical
examination is a farm abdomino-pelvic mass, fixed, two
finger breadths above the umbilicus, the rest of the ex-
aminati on was no rmal.
Abdominal ultrasound revealed a mass non-vascula-
rized tissue Doppler taking the screen, the uterus and an-
nexes seen.
The abdomino-pelvic CT objectified an important so-
lido—abdominopelvic cystic mass whose origin is diffi-
cult to determine. (Figure 1)
The patient underwent an exploratory laparotomy
showing an increased uterus size by 20 weeks of gesta-
H. Al Moubaker et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 739-742
Figure 1. Clearlydifferentiat edneuroendocrine tumor (×10).
tion seat multiple myomas, the largest landlocked is ear-
lier in the right broad ligament, the 2 annexes were unre-
markable .
A total hysterectomy with bilateral salpingo-oopho-
rectomy were performed and the cell proliferation and
histological immunohistochemical analysis was in favor
of a well-differentiated neuroendocrine lesion on the right
ovary (Figure 2). The patient underwent clinical moni-
toring was unremarkable for a year.
The neuroendocrine tumors are classified according to
several criteria: location of the tumor; type of secretion
of tumor (or lack of secretion); level of proliferation:
speed cell division; level of differentiation of cells: can-
cer cells are they close to normal cell or have they lost
their basic characteristics; size of the tumor and the
presence or absence of metastases; etc.
The diagnosis is difficult and of ten delayed [4]. Sev-
eral factors are responsible for the late diagnosis of neu-
roendocrine tumors: slow evolution, primary tumor of
ten small and little talking symptoms.
The symptoms of neuroendocrine tumors are nonspe-
cific. These slow-growing tumors are often confused
with more common diseases. This feature, as well as
their relative rarity, they are often diagnosed several
years after onset. Fortunately, research evolves impress-
Figure 2. AbdominopelvicCT: A massive mass abdomin-
opelvic solido-cystic.
sive in the diagnosis and management of these tumors
Some of these tumors secrete substances such as sero-
tonin and may be responsible for: episodes of redness in
the face and neck (flushing); episodes of infectious diar-
rhea without cause; asthma attacks; abdominal pain ; red
digestive after meals ; chest pain etc.
However, there are some symptoms that typical and
often attributed to other illnesses such as irritable bowel
syndrome or Crohn’s disease [6], for example. Further-
more 50% of neuroendocrine tumors are not accompa-
nied by these symptoms and are therefore diagnosed only
when their size becomes too large or by chance during
Copyright © 2013 SciRes. OPEN ACCESS
H. Al Moubaker et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 739-742 741
gastrointestinal or pulmonary examinations.
In recent years, specific blood tests have been devel-
oped and proved to be very useful in the diagnosis and
monitoring of neuroendocrine tumors [8-10]. Various
hormones can be secreted by type of neuroendocrine
tumor. In addition, it is very difficult to dose dozens of
hormones that may be secreted by a neuroendocrine tu-
mor. Special substance called chromogranin A seems to
be commonly found in the blood sample, regardless of
the location and type of neuroendocrine tumor. In case of
increased blood levels of the chromogranin, dosages of
specific hormones can be considered to specify what
type of tumor neuroencocrine it is.
The majority of neuroendocrine tumors secretes a sub-
stance called serotonin. As blood serotonin level varies
during the day, its measurement is unreliable. For cons,
the measurement in urine collected for 24 hours a sub-
stance derived from serotonin, acid-5-hydroxyindole (5
HIAA), may be useful in diagnosis.
Colonoscopies are more frequently used in screening
for colon cancer. A neuroendocrine tumor can therefore
be discovered by chance during an examination of this
type [11,12].
Colonoscopy also allows, in case of discovery of a
tumor, to take to make microscopic analysis a piece of it
by biopsy. This deduction can confirm the diagnosis.
CT and magnetic resonance canlocate the neuro-endo-
crine tumor; determine the size of the tumor; whether
there are metastases in other organs such as the liver.
Both tests, however, are limited by the size of the tumor
Isotopic consideration (scintigraphy) is injected into
the circulation of the patient and the radioactive octreo-
tide measuring cell activity [14].
In the context of neuroendocrine tumors, the injected
product is called somatostatin. This product binds to the
majority of cancer cells neuroendocrine tumors. We can
in this way determine if treatment with octreotid e is pos-
Many parameters will influence the choice of treat-
ment. We must first keep in mind that more than half of
neuroendocrine tumors have metastasized at diagnosis.
This is partly due to the fact that it often takes several
years before the diagnosis.
The treatment therefore concerns not only the primary
tumor but also any metastases and symptoms often pre-
sent for some time.
If the tumor is diagnosed early enough, and therefore
localized and small, a cure can sometimes be considered.
This treatment will be achieved by surgical removal of
the tumor. In other cases, if the primary tumor is larger or
if there are metastases, the goal is to stabilize the tumor
progression and improve quality of life of the patient.
The patient’s age, background, his general health, are
parameters that will influence the choice of treatment.
Surgery plays an important role in the treatment of
neuroendocrine tumors. It has three objectives:
healing when possible; When neuroendocrine tumor
is localized and small, curative surgery may be con-
sidered. It is to remove the entire tumor.
improving the quality of life of the patient; Some-
neuroendocrine tumors are large, for example, block
the digestive tract and prevent the passage of stool.
An operation is then performed to relieve the patient.
support some metastases: liver metastases (liver) are
common. Surgery can help remove one or more liver
metastases. Unlike some tumors very rapidly chang-
ing the surgical treatment of metastatic neuroendo-
crine tumors is one of the mainstays of treatment
In the case of ovarian tumor, Standard surgical princi-
ples apply for neuroendocrine tumors.
However, for young patients with an ovarian tumor
isolated, conservative surgery of fertility may be consid-
ered in combination with adjuvant chemotherapy. This
chemotherapy is generally based on platinum derivatives
and drugs etoposide.
Availability since 1988 (16,18) Octreotide has signifi-
cantly changed the management of patients with neuro-
endocrine tumors (NET). Octreotide is a somatostatin
analog. After octreotide, other somatostatin analogs such
as lanreotide, have appeared.
Scientists recent studies have shown that ocrétotide
allow stabilization of the tumor. It is reserved for patients
in whom the tumor can not be treated by simple surgical
resection. The drug slows the growth of cancer cells and
reduces the risk of tumor progression by 66% compared
to placebo.
Octreotide and lanreotide also seem to have an effect
on certain symptoms such as episodes of flushes (sudden
redness in the face and neck) and diarrhea.
Many other treatments are sometimes offered to pa-
tients with neuroendocrine tumors: radiotherapy, chemo-
therapy, liver transplant, etc.
Prognosis: well-differentiated neuroendocrine tumors
have a slow evolution, long time locally contrast to un-
differentiated tumors. The risk of lymph node metastasis
and visceral extension is important when the tumor is
large and when the mitotic activity is greater. The vis-
ceral metastases are usually hepatic. Survival is related
with the degree of differentiation.
The discovery of a neuroendocrine tumor is difficult to
live, with regard to the rarity of this tumor and the lack
of information available. However, many patients are
relieved to finally have found the cause of the symptoms
they suffer for se ve ra l ye ars.
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H. Al Moubaker et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 739-742
Copyright © 2013 SciRes.
Neuroen docrine tumors are often growing slowly. Pa-
radoxically, this slow evolution is often responsible for
late diagnosis. Upon detection of neuroendocrine tumor
is often add that the existence of metastases.
Fortunately, research evolves impressive in the diag-
nosis and management of these tumors. Moreover, their
relatively good prognosis for some of them can hope.
[1] Capella, C., Heitz, P.U., Höffler, H., Solcia, E. and Klöp-
pel, G. (1995) Revised classification of neuroendocrine
tumours of the lung, pancreas and gut. Virchows Archiv,
425, 547-560.
[2] Pearse, A.G.E. (1969) The cytochemistry and ultrastruc-
ture of polypeptide hormone-producing cells of the
APUD series, and the embryologic, physiologic and pa-
thologic implications of the concept. Journal of Histoche-
mistry & Cytochemistry, 17, 303-313.
[3] Le Douarin, N.M., Teillet, M.A. and Couly, G. (1990)
Chimères embryonnaireset développement du système
nerveux. Medecine Sciences, 6, 228-244.
[4] Andrew, A., Kramer, B. and Rawdon, B. (1998) The ori-
gin of gut and pancreatic neuroendocrine (APUD) cells-
the last word? The Journal of Pathology, 186, 117-118.
[5] Lechago, J. and Gould, V.E. (1997) Blood worth’s endo-
crine pathology, 3rd Edition, Williams & Wilkins, Balti-
[6] Saint-André, J.P., Valo, I. and Guyétant, S. (2000) Im-
munohistochimie des tumeurs neuro-endocrines. Annales
de Pathologie, 20, S129-31.
[7] Oda, Y., Tanaka, Y., Naruse, T., Sasanabe, R., Tsubamo-
to, M. and Funahashi, H. (2002) Expression of somatos-
tatin receptor and effects of somatostatin analog on pan-
creatic endocrine tumors. Surgery Today, 32, 690-694.
[8] Hauser, H., Wolf, G., Uranus, S. and Klimpfinger, M.
(1995) Neuroendocrine tumours in various organ systems
in a ten-year period. European Journal of Surgical On-
cology, 21, 297-300.
[9] Modlin, I.M. and Sandor, A. (1997) An analysis of 8305
cases of carcinoid tumors. Cancer, 79, 813-829.
[10] Williams, E.D. and Sandler, M. (1963) The classification
of carcinoid tumours. Lancet, 281, 238-239.
[11] Travis, W.D., Colby, T.V., Corrin, B., et al. (1999) His-
tological typing of lungand pleural tumours. WHO Inter-
national Histological Classificationof Tumours, Springer,
[12] Solcia, E., Klöppel, G. and Sobin, L.H. (2000) Histologi-
cal typing of endocrine tumours. WHO International His-
tological Classification of Tumours. Springer, Berlin.
[13] Capella, C., Sessa, F., Cornaggia, M., La Rosa, S. and
Uccella, S. (1999) Mixedexocrine-endocrine tumors of
the gastro-intestinal tract. Revista española de Patología,
32, 466-467.
[14] Heymann, M.F., Joubert, M., Nemeth, J., Franc, B., Vis-
set, J., Hamy, A., le Borgne, J., le Neel, J.C., Murat, A.,
Cordel, S. and le Bodic, M.F. (2000) Prognostic and im-
munohistochemical validation of the Capella classifica-
tion of pancreatic neuroendocrine tumours: An analysis
of 82 sporadic cases. Histopathology. 36, 421-432.
[15] Gumbs, A.A., Moore, P.S., Falconi, M. Bassi, C., Be-
ghelli, S., Modlin, I. and Scarpa, A. (2002) Review of the
clinical, histological and molecular aspects of pancreatic
endocrine neoplasms. Journal of Surgical Oncology, 81,
[16] Le Bodic, M.F., Heymann, M.F., Lecomte, M., Berger,
N., Berger, F., Louvel, A., De Micco, C., Patey, M., De
Mascarel, A., Burtin, F. and Saint-Andre, J.P. (1995) Im-
muno-histochemical study of 100 pancreatic tumors in 28
patients with Multiple Endocrine Neoplasia type 1. The
American Journal of Surgical Pathology, 20, 1378-1384.
[17] Komminoth, P. (1999) Review: Multiple endocrine ne-
oplasia type 1, sporadic n eur oendocrine tumors, and MENIN.
Diagnostic Molecular Pathology, 8, 107-112.
[18] Matias-Guiu, X. (1998) RET protooncogene analysis in
the diagnosis ofmedullary thyroid carcinoma and muliple
endocrine neoplasiatype II. Advances in Anatomic Patho-
logy, 5, 196-201.