Code for a neuroendocrine tumor of the pancreas in ICD 10 - C25. It is this combination in the international classifier that denotes malignant neoplasms localized in the indicated organ. What are these diseases? Let's try to consider in more detail.
General information
Without the normal functioning of the nervous system, 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 the endocrine glandular structures are responsible for the production of active compounds. One of the important elements of the pancreas is the islets of Langerhans. The case coding for neoplasms in this area is C25.4 according to the ICD. A neuroendocrine tumor of the pancreas of this format can form if cells of the specified type begin to divide, function, die in an incorrect, incorrect way.
Indicateda variety of pathologies is not accidentally singled out in a separate group. Its manifestations, the nuances of clarifying the diagnosis, and treatment methodologies are very different from those applicable to neoplasms formed by epithelial cells.
Anatomy and medicine
Nervous system, hormonal substances generated by endocrine structures function mutually. Signals from the nervous system come to the hypothalamus, where they stimulate the production of hormonal substances. Those, in turn, affect the pituitary gland, activating or slowing down the activity of tropins. Substances with blood flow spread throughout the body, stimulating the secretory function of glandular structures.
Generation of hormones is determined not only by the impulses of the nervous system. Important factors are the processes occurring in the body, the state of the person as a whole and individual organs and structures. The central nervous system and the secretory system are interconnected: due to hormones, the work of nerves is regulated through the adrenal glands. This is done through the release of adrenaline into the bloodstream.
Pancreas: how it all works
Under the code of neuroendocrine tumor of the pancreas C25 refers to a pathological condition associated with improper functioning of the gastroenteropancreatic NES. In the human body, it dominates over 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 that generate hormonal compounds. These cells are scattered throughout the gastrointestinal tract,present in all organs.
The most important part 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 islets is much more impressive - it has been established that their number is close to a million.
Neoplasms: the nuances of formation
Neuroendocrine tumor of the pancreas (G2, G1) can form from any cell of this type localized in the specified organ. The mechanism of the appearance of the disease is the process of uncontrolled cell division. Currently, the nuances of the formation of neoplasms have not been studied deeply enough. It has been clarified that a significant percentage of patients have a mutation in the eleventh chromosome pair. NET 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 the predominant percentage of cases, a neuroendocrine tumor of the pancreas is formed as a bubble or a plate. The official name of such forms (respectively): alveoli, trabeculae. In some patients, the progression of the disease is quite slow, while others are characterized by a fulminant course. In general, as evidence accumulated by medicine shows, pathology is extremely unpredictable. A neoplasm of small dimensions is far from always malignant. The conclusion about his character is made by determining the speeddevelopment. 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 neuroendocrine tumor of the pancreas at the first stages of the development of the disease are absent or extremely blurred. A rather large percentage of cases can be detected only at an advanced stage, when the pathological condition has been developing for 5-8 years. Specific manifestations in the first stages of most tumors are not typical. Certain problems with the he alth of patients are disturbing, but they cannot be connected with the neuroendocrine system, and treatment of 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 you are worried about pain in the abdomen. Feelings can come intermittently or be permanent. The patient loses weight, feels constantly tired. There is a disorder of the stool, nausea and vomiting. Against the background of the neoplasm, blood sugar decreases, the pulse becomes more frequent, hot flashes are disturbing.
Categories and types
In many ways, the prognosis for a neuroendocrine tumor of the pancreas 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-functioning and working.
The first type is a neuroendocrine tumor of the pancreas, whose cells produce biological substances that regulate the functioning of the body. Among the total number of neoplasms, active ones account for about 80%. A much less common variety is inactive. Diagnosing such a pathology is the most difficult. Non-functioning NETs can secrete hormonal compounds. The case is not characterized by specific symptoms. Finally, the last category is HSO, which generates more than the norm, the amount of hormones. This usually can be determined quite early. Increased production of hormones is often observed under the influence of a stress factor. This may be the answer to anesthesia, biopsy.
Status update
Diagnosing a neuroendocrine tumor of the pancreas is not an easy task for a modern doctor. It is more likely to suspect that the patient's he alth problems are due to just such a reason, in a highly qualified and experienced doctor who has already encountered similar cases. If there is an assumption about the possibility of the existence of NET, it is necessary to conduct a series of studies to confirm or refute the assumption. They begin with a study of the medical history of the 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 neuroendocrine tumor of the pancreas is to collect samples of fluids, tissues forlaboratory research. The patient needs 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. Tissue areas are selected to obtain samples for biopsy, scintigraphy with somatostatin is prescribed. The next stage is CT, ultrasound, MRI, x-ray. An ultrasound examination may be ordered using an endoscope.
Diagnosis confirmed: what next?
Treatment of a neuroendocrine tumor of the pancreas is chosen based on the type of case. There are several main methods and approaches: targeted therapy, radiation, chemotherapy, surgery, radioablation, 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 exactly, which excludes the possibility of effective prevention.
In the predominant percentage of cases, the therapeutic course involves surgical intervention. The described category of neoplasms allows minimally invasive measures. It is possible to use a laparoscope. At the same time, the minimum portion of the diseased organ is removed, which minimizes complications and speeds up the patient's rehabilitation. If metastases are detected, they must be removed without fail.
Good approachwith a neuroendocrine tumor of the pancreas, nuclear drug therapy is considered. This approach activates destructive intracellular processes. You can resort to these methods on their own or combine them with surgery. In general, the prognosis for a neuroendocrine tumor of the pancreas is more favorable than many other forms of malignant neoplasms in the gastrointestinal tract. The best prospects are those with active forms diagnosed at an early stage, if it is possible to begin adequate treatment without wasting time.
Active types: insulinoma
This neoplasm consists of insulin-producing beta cells. Among other cases of NET, this type accounts for up to 75%. Higher probability of 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 outside the pancreas. The dimensions of the neoplasm are rarely more than 1.5 cm. The color is cherry-like, yellowish gray or brown. Up to 15% of cases are malignant.
This form of tumor generates large amounts of insulin, which determines the main symptom: the glucose content in the circulatory system is significantly reduced. Hypoglycemia is especially pronounced after exercise or with a long time interval between meals. Reduced glucose concentration causes improper energy metabolism, which affects the body and subcortex of the brain. The patient feels weak and hungry. Sweat glands are more activethe norms, frequency and speed of the heart beat are disturbed, tremors and disorientations in space, sometimes in time, are disturbing. Memory gradually becomes worse, consciousness is confused, the patient becomes apathetic and suffers from convulsions. The most severe complication of this type of pancreatic neuroendocrine tumor is hypoglycemic coma.
Nuances of the case
Detecting an insulinoma 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 by radiodiagnosis. When the location is unclear, positron emission tomography is shown to clarify the case. You can guess the nuances of localization by conducting an angiographic analysis.
Treatment of a neuroendocrine tumor of the pancreas of this class is most effectively surgical. With small dimensions, the tumor is immediately completely removed. With a diameter of 3 cm or more, a resection of an organ element is indicated. This is especially important if the NET is malignant. A properly conducted event is the key to absolute recovery.
Gastrinoma
Among all NETs, this species is the second most common. It accounts for up to 30% of all cases. The probability of formation of a neoplasm in the representatives of the stronger sex is higher; age group of risk - 30-50 years. Approximately every third case allows you to determine the NET duringexternal structures relative to the organ. Dimensions are usually no more than 3 cm. NETs larger than the specified diameter are considered malignant. A distinctive feature of this form is the tendency to early formation of metastases. The disease manifests itself by excessive generation of gastrin, which activates the production of juice in the stomach. This causes the formation of ulcers in the intestines. Such a process is often the first manifestation of a tumor.
You can suspect gastrinoma by loose stools and pain attacks resembling colic. Peptic ulcer shows increased resistance to treatment. There is a higher chance of NET if parents were diagnosed with it.
Nuances of the case
Clarification of gastrinoma is complicated by the small dimensions of the neoplasm and manifestations characteristic of a widespread peptic ulcer. To determine the tumor, it is necessary to check the circulatory system for the content of gastrin. The optimal approach is radioimmunoassay. Clarification of localization is possible with the help of ultrasound, endoscopic examination, CT, MRI. Up to 90% of all NETs of this type are localized between the neck of the gland, the descending intestinal part and the common bile pathway.
Therapeutic course involves a radical intervention. The patient is shown an operation. If there is a high probability of malignancy of the site, if the neoplasm is characterized by the ability to spread to nearby organs and tissues, it is necessary to remove not only the gastrinoma, but also the gland element in which it was formed. Withdrawal from the body of the patient only NET is practiced ifformation dimensions are small. Based on the results of treatment, the prognosis for a neuroendocrine tumor of the pancreas is positive, you can count on a complete recovery.
Glucagonoma
This form is very rare. It can appear during the degeneration of glucagon-producing cellular alpha structures. The probability of detecting such a disease in young and mature women is higher. 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 tail or main part of the gland. Usually NET is single, dimensions are from 5 cm and more. Up to 70% of all cases are malignant. Active production of glucagon stimulates the generation of insulin, and in the liver structures glycogen breaks down faster.
You can suspect the disease by migrating erythema, accompanied by necrotic areas. Thrombi appear in the deep venous system, the patient's condition becomes depressed. Possible secondary diabetes. In the study of blood, glucagon indicators exceed the standards by dozens of times. To clarify the localization, ultrasound, CT are indicated.
The future after the tumor
Women with this diagnosis are traditionally most concerned about: is pregnancy possible after neuroendocrine tumors of the pancreas? 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 ofremoval of the pancreas due to previously diagnosed malignant NET. Of course, first you will have to go through a full course of treatment and recovery, wait for the stabilization of the condition, and only after that think about procreation. And yet the fact remains: pregnancy after neuroendocrine tumors of the pancreas is possible, practiced, successful, and children can be born absolutely he althy.
As the doctors say, the main aspect of the prognosis is the correct operation in an adequate time period. An accurately conducted event with the involvement of qualified doctors helps to ensure a long and fulfilling life for a person.
