RESUMO
A 38-year-old Japanese man who had been diagnosed with appendiceal carcinoid and undergone ileocecal resection 8 years before presented with duodenal obstruction caused by a submucosal tumor-like appearance. He was diagnosed with long-term recurrence of appendiceal goblet cell carcinoid (GCC) with a multi-morphological pattern based on the histological assessment of a duodenal biopsy and his previously resected appendix. He underwent subtotal stomach-preserving pancreaticoduodenectomy combined with resection of an ileo-colic anastomotic lesion. The GCC recurred at the nearby ileo-colic anastomosis and invaded the duodenum. This late recurrence might have resulted from the unique features of his GCC, which contained cells with different degrees of malignancy.
Assuntos
Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/cirurgia , Cisplatino/uso terapêutico , Obstrução Duodenal/cirurgia , Etoposídeo/uso terapêutico , Neoplasias Intestinais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Antineoplásicos/uso terapêutico , Apendicectomia/métodos , Neoplasias do Apêndice/tratamento farmacológico , Tumor Carcinoide/tratamento farmacológico , Tumor Carcinoide/fisiopatologia , Colectomia/métodos , Obstrução Duodenal/etiologia , Humanos , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/fisiopatologia , Japão , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Sudden massive release of serotonin, histamine, kallikrein, and bradykinin is postulated to cause an intraoperative carcinoid crisis. The exact roles of each of these possible agents, however, remain unknown. Optimal treatment will require an improved understanding of the pathophysiology of the carcinoid crisis. METHODS: Carcinoid patients with liver metastases undergoing elective abdominal operations were studied prospectively, using intraoperative, transesophageal echocardiography, pulmonary artery catheterization, and intraoperative blood collection. Serotonin, histamine, kallikrein, and bradykinin levels were analyzed by enzyme-linked immunosorbent assay. RESULTS: Of 46 patients studied, 16 had intraoperative hypotensive crises. Preincision serotonin levels were greater in patients who had crises (1,064 vs 453 ng/mL, Pâ¯=â¯.0064). Preincision hormone profiles were otherwise diverse. Cardiac function on transesophageal echocardiography during the crisis was normal, but intracardiac hypovolemia was observed consistently. Pulmonary artery pressure decreased during crises (Pâ¯=â¯.025). Linear regression of preincision serotonin levels showed a positive relationship with mid-crisis cardiac index (râ¯=â¯0.73, Pâ¯=â¯.017) and a negative relationship with systemic vascular resistance (r=-0.61, Pâ¯=â¯.015). There were no statistically significant increases of serotonin, histamine, kallikrein, or bradykinin levels during the crises. CONCLUSION: The pathophysiology of carcinoid crisis appears consistent with distributive shock. Hormonal secretion from carcinoid tumors varies widely, but increased preincision serotonin levels correlate with crises and with hemodynamic parameters during the crises. Statistically significant increases of serotonin, histamine, kallikrein, or bradykinin during the crises were not observed.
Assuntos
Hipotensão/fisiopatologia , Hipovolemia/fisiopatologia , Síndrome do Carcinoide Maligno/fisiopatologia , Artéria Pulmonar/fisiopatologia , Serotonina/sangue , Bradicinina/sangue , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/cirurgia , Ecocardiografia Transesofagiana , Feminino , Histamina/sangue , Humanos , Neoplasias Intestinais/fisiopatologia , Neoplasias Intestinais/cirurgia , Complicações Intraoperatórias , Calicreínas/sangue , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Masculino , Síndrome do Carcinoide Maligno/sangue , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
A 64-year-old male former smoker with a history of prostate cancer presented to our pulmonary clinic, complaining of nonproductive cough for 10 years. Prior evaluation included treatment for upper airway cough syndrome and gastroesophageal reflux, stopping angiotensin-converting enzyme inhibitor, and initiation of inhaled ß-agonists. Esophageal pH monitoring indicated silent reflux, and proton pump inhibitor therapy was started. He continued to cough and complain of dyspnea. Physical examination produced unremarkable results, with no evidence of lymphadenopathy. Pulmonary function tests showed a pseudo-restrictive pattern with air trapping, hyperreactivity, and incomplete bronchodilator responsiveness: FEV1, 2.48 L (69% of predicted); FVC, 3.57 L (75% of predicted); FEV1/FVC, 92%; total lung capacity, 7.00 L (100% of predicted); and residual volume, 3.05 L (136% of predicted). Laboratory studies, including a complete metabolic panel, prostate-specific antigen test, and complete blood count, yielded normal results.
Assuntos
Tumor Carcinoide/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Tumor Carcinoide/complicações , Tumor Carcinoide/patologia , Tumor Carcinoide/fisiopatologia , Doença Crônica , Tosse/etiologia , Dispneia/etiologia , Fluordesoxiglucose F18 , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/complicações , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/fisiopatologia , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Volume Residual , Fatores de Tempo , Tomografia Computadorizada por Raios X , Capacidade Pulmonar Total , Capacidade VitalRESUMO
Central sensitization defines a state of amplified sensory input within the nervous system across many organ systems; it overlaps syndromes as fibromyalgia, chronic fatigue, irritable bowel, and interstitial cystitis. Commonly, individuals will experience multiple syndromes during the course of their lifetime. A 62-year-old patient presented for evaluation of multiple medically unexplained symptoms postsurgically including chronic left chest wall and flank pain with concomitant diarrhea, abdominal pain, and facial flushing. After extensive multidisciplinary evaluations, he was diagnosed as having central sensitization in which the initial presentation mimicked carcinoid syndrome. He was subsequently treated with extensive multidisciplinary pain rehabilitation, and it did well.
Assuntos
Tumor Carcinoide/diagnóstico , Tumor Carcinoide/fisiopatologia , Sensibilização do Sistema Nervoso Central , Tumor Carcinoide/complicações , Sensibilização do Sistema Nervoso Central/fisiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The term diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) may be used to describe a clinico-pathological syndrome, as well as an incidental finding on histological examination, although there are obvious differences between these two scenarios. According to the World Health Organization, the definition of DIPNECH is purely histological. However, DIPNECH encompasses symptomatic patients with airway disease, as well as asymptomatic patients with neuroendocrine cell hyperplasia associated with multiple tumourlets/carcinoid tumours. DIPNECH is also considered a pre-neoplastic lesion in the spectrum of pulmonary neuroendocrine tumours, because it is commonly found in patients with peripheral carcinoid tumours.In this review, we summarise clinical, physiological, radiological and histological features of DIPNECH and critically discuss recently proposed diagnostic criteria. In addition, we propose that the term "DIPNECH syndrome" be used to indicate a sufficiently distinct patient subgroup characterised by respiratory symptoms, airflow obstruction, mosaic attenuation with air trapping on chest imaging and constrictive obliterative bronchiolitis, often with nodular proliferation of neuroendocrine cells with/without tumourlets/carcinoid tumours on histology. Surgical lung biopsy is the diagnostic gold standard. However, in the appropriate clinical and radiological setting, transbronchial lung biopsy may also allow a confident diagnosis of DIPNECH syndrome.
Assuntos
Hiperplasia/fisiopatologia , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/fisiopatologia , Células Neuroendócrinas/patologia , Biópsia , Tumor Carcinoide/fisiopatologia , Proliferação de Células , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Pulmão/fisiopatologia , Neoplasias Pulmonares/patologia , Lesões Pré-Cancerosas/fisiopatologia , Fibrose Pulmonar/fisiopatologia , Respiração , SíndromeAssuntos
Tumor Carcinoide , Colonoscopia , Dissecação , Neoplasias Intestinais , Neoplasias Retais , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/patologia , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/cirurgia , Colonoscopia/instrumentação , Colonoscopia/métodos , Dissecação/instrumentação , Dissecação/métodos , Desenho de Equipamento , Feminino , Humanos , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/patologia , Neoplasias Intestinais/fisiopatologia , Neoplasias Intestinais/cirurgia , Pessoa de Meia-Idade , Neoplasias Retais/diagnóstico , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Resultado do TratamentoRESUMO
A case study of 35-year-old woman with persistent breathlessness and wheezing that had been unsuccessfully treated with inhaled beta 2-agonists and steroids for about two years. Patient developed dry cough and haemoptysis, so investigated further. Spirometry demonstrated a restrictive pattern. Chest CT demonstrated well defined hyperdense lesion in right middle lobe. Biopsy taken from the mass during bronchoscopy demonstrated the picture of atypical bronchial carcinoid. In this case, due to the lack of awareness, diagnosis of carcinoid was delayed by two years.
Assuntos
Asma/diagnóstico , Neoplasias Brônquicas , Tumor Carcinoide , Pneumonectomia/métodos , Adulto , Biópsia/métodos , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/fisiopatologia , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/patologia , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/cirurgia , Feminino , Humanos , Espirometria/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoAssuntos
Antituberculosos/administração & dosagem , Tumor Carcinoide , Pulmão , Fotoquimioterapia/métodos , Pneumonectomia/métodos , Tuberculose Pulmonar , Broncoscopia/métodos , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/cirurgia , Esquema de Medicação , Monitoramento de Medicamentos , Humanos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Planejamento de Assistência ao Paciente , Tomografia por Emissão de Pósitrons , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/fisiopatologia , Tuberculose Pulmonar/radioterapia , Tuberculose Pulmonar/cirurgia , Adulto JovemRESUMO
A 46-year-old woman with Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) secretion caused by primary ovarian mature teratoma with carcinoid components was presented in our case. The patient manifested sustained hypercortisolemia without circadian rhythm and a lack of suppression of either low-dose dexamethasone suppression test (LDDST) or high-dose dexamethasone suppression test (HDDST). There was no evidence of a pituitary mass or secretion of other hormones. After careful clinical evaluation, no other tumor masses were found. Resection of the ovarian tumors led to sharp reduction of serum ACTH and cortisol concentrations. Immunohistochemistry showed positivity in CgA, Syn, CK, NSE. To the best of our knowledge, there are rare reports of an ACTH-secreting carcinoid components located in an ovarian mature teratoma, and bilateral ovarian mature teratoma makes it rarer.
Assuntos
Síndrome de ACTH Ectópico/fisiopatologia , Tumor Carcinoide/fisiopatologia , Síndrome de Cushing/etiologia , Neoplasias Ovarianas/fisiopatologia , Teratoma/fisiopatologia , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/metabolismo , Tumor Carcinoide/cirurgia , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/prevenção & controle , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/cirurgia , Teratoma/diagnóstico , Teratoma/metabolismo , Teratoma/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Carcinoid tumors are uncommon neuroendocrine tumors that account for less than 1% of gastrointestinal tract malignancies. They have a reported incidence of 1.3 per 100,000. Small bowel carcinoids are the commonest and have the highest incidence of associated second primary malignancies, followed by appendiceal and colorectal carcinoids. The most common second primary malignancy is colorectal adenocarcinoma. CASE SERIES: We report a series of 11 patients observed in the period 2006-2011 with primary gastrointestinal tract cancers and synchronous carcinoids discovered incidentally by the histopathologist in the resected primary cancer specimen. RESULTS: In all patients with synchronous carcinoids and colorectal adenocarcinoma there was a pattern of similar embryonic visceral origin. Is this a paracrine effect from biological peptides produced by the carcinoids?
Assuntos
Adenocarcinoma/diagnóstico , Tumor Carcinoide/diagnóstico , Neoplasias Gastrointestinais/diagnóstico , Achados Incidentais , Neoplasias Primárias Múltiplas/diagnóstico , Comunicação Parácrina , Adenocarcinoma/fisiopatologia , Adulto , Idoso , Tumor Carcinoide/fisiopatologia , Neoplasias Colorretais/diagnóstico , Feminino , Neoplasias Gastrointestinais/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/fisiopatologia , Estudos RetrospectivosAssuntos
Hormônio Adrenocorticotrópico/metabolismo , Tumor Carcinoide/fisiopatologia , Síndrome de Cushing/etiologia , Gastrinas/metabolismo , Neoplasias do Timo/fisiopatologia , Síndrome de Zollinger-Ellison/etiologia , Adulto , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/metabolismo , Tumor Carcinoide/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Radiografia , Timectomia , Timo/diagnóstico por imagem , Timo/metabolismo , Timo/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/metabolismo , Neoplasias do Timo/cirurgia , Resultado do TratamentoAssuntos
Tumor Carcinoide/complicações , Doença Celíaca/complicações , Colite Microscópica/complicações , Neoplasias do Íleo/complicações , Neoplasias Intestinais/complicações , Síndrome do Carcinoide Maligno/etiologia , Idoso , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/patologia , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/cirurgia , Doença Crônica , Diarreia/etiologia , Fármacos Gastrointestinais , Humanos , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/patologia , Neoplasias Intestinais/fisiopatologia , Neoplasias Intestinais/cirurgia , Masculino , Síndrome do Carcinoide Maligno/fisiopatologia , Octreotida , CintilografiaRESUMO
PURPOSE: Carcinoid crises are rare life-threatening events involving cardiac instability when carcinoid tumours release vasoactive peptides. Such events can occur in the perioperative setting. Octreotide, a somatostatin analogue, is administered as a bolus dose of 100-500 µg iv or by infusion to treat carcinoid crises. Due to the apparent low risk-to-benefit profile, a much higher dose is sometimes used in urgent situations. The purpose of this study was to assess the evidence for administering doses or hourly infusions of octreotide that exceeded 1,500 µg iv to treat carcinoid crises. We also sought to identify which patients may require large doses and to describe the adverse effects of such doses. SOURCE: We systematically searched Medline, EMBASE, and Cochrane databases and hand-searched reference lists of relevant articles in 2006 and again in 2010 and 2011. All study designs were included in our search. Resolution of crisis symptoms was the primary outcome. PRINCIPAL FINDINGS: Eighteen articles were included. No patient died during a carcinoid crisis. A retrospective chart review of 89 patients with carcinoid heart disease reported octreotide doses of 25-54,000 µg to treat carcinoid crises, although neither crisis symptoms nor outcomes were described. CONCLUSION: In the included case reports, carcinoid crises were managed effectively using octreotide 25-500 µg iv. Previous exposure to octreotide and carcinoid heart disease may warrant the need for higher doses. In addition to the low quality of the articles and the small sample size, inconsistent use of the term "carcinoid crisis" and paucity of reported outcomes were also limitations of this systematic review. These findings highlight the need for further investigation into dose-response relationships of octreotide for the treatment of carcinoid crisis.
Assuntos
Tumor Carcinoide/tratamento farmacológico , Síndrome do Carcinoide Maligno/tratamento farmacológico , Octreotida/uso terapêutico , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/uso terapêutico , Tumor Carcinoide/fisiopatologia , Relação Dose-Resposta a Droga , Humanos , Infusões Intravenosas , Injeções Intravenosas , Síndrome do Carcinoide Maligno/fisiopatologia , Octreotida/administração & dosagem , Octreotida/efeitos adversos , Resultado do TratamentoRESUMO
Type I gastric carcinoids are indolent lesions that only rarely metastasize. Until now, lymph node metastasis had only being observed in large (≥10 mm) and usually invasive lesions (deep submucosa or beyond). This study reports a diminutive (8 mm) gastric carcinoid, limited to the superficial layer of the submucosa (sm1), with no angiovascular invasion, but with a high Ki-67 index (7%) and an involved perigastric lymph node. The aggressive behavior of this lesion ends the previous believe that small and superficial type I gastric carcinoids do not metastasize. This case also indicates that better parameters are necessary to evaluate the malignant potential of these lesions and presents a further support to the value of 2010 World Health Organization classification of gastrointestinal neuroendocrine tumors.
Assuntos
Tumor Carcinoide/secundário , Neoplasias Gástricas/patologia , Tumor Carcinoide/metabolismo , Tumor Carcinoide/fisiopatologia , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/fisiopatologiaRESUMO
Ovarian carcinoid is a rare tumor accounting for approximately 0.1% of all ovarian malignancies. We describe a case of peptide-YY-producing strumal carcinoid of the ovary associated with severe constipation. A 48-year-old woman was found to have a pelvic mass on ultrasonography when she visited her primary doctor for a health check-up. She was thus referred to our department. Magnetic resonance imaging revealed a solid right ovarian tumor 60 × 50 mm in size. The patient underwent a right adnexectomy and was histopathologically diagnosed as having strumal carcinoid of the ovary. On immunohistochemical examination, the tumor cells were positive for peptide YY. The patient's constipation resolved rapidly after surgery. Based on her clinical course, her constipation was considered to have been caused by the strumal carcinoid of the ovary. The clinical course of this case supports the previously recognized correlation between peptide-YY-producing ovarian carcinoid and constipation.
Assuntos
Tumor Carcinoide/fisiopatologia , Constipação Intestinal/etiologia , Proteínas de Neoplasias/metabolismo , Neoplasias Ovarianas/fisiopatologia , Peptídeo YY/metabolismo , Estruma Ovariano/fisiopatologia , Tumor Carcinoide/metabolismo , Tumor Carcinoide/cirurgia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/prevenção & controle , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/cirurgia , Ovário/metabolismo , Ovário/cirurgia , Índice de Gravidade de Doença , Estruma Ovariano/metabolismo , Estruma Ovariano/cirurgiaRESUMO
Ectopic ACTH production causes 10% of Cushing's syndromes. The diagnostic workup is difficult, can last more than 6 months (> 50% of cases), and the underlying tumour is still frequently not located (12%). Carcinoid tumours of the appendix are frequent and are revealed in 0.3% of patients undergoing routine appendectomy. However, neuroendocrine tumours of the appendix with ACTH production are an extremely rare entity. Here we report the case of a female patient with clinically overt Cushing's syndrome due to ectopic ACTH-production from a carcinoid tumour of the appendix. During the diagnostic workup, repeated endocrine tests, multiple different imaging modalities and frequent and lengthy hospitalisations were necessary. Wrongly, even a neurosurgical pituitary exploration was performed. After 12 months from the initial admission, the tumour was finally detected by an ¹8F-fluoro-L-dihydroxyphenylalanine (¹8FDOPA PET) and an appendectomy followed by right hemicolectomy were performed. The patient recovered rapidly and the symptoms from the hypercortisolism were no more present.In this case, we discuss the multitude of problems, which may delay the diagnosis and the pitfalls, that should be avoided in order to locate the tumour and to initiate adequate therapy as early as possible. Furthermore, our case demonstrates the complexity of diagnostic procedures, which demand most of the times a multidisciplinary approach. In this setting, regular follow-ups in short time intervals and the use of novel imaging techniques can finally cut the diagnostic "Gordian knot".
Assuntos
Síndrome de ACTH Ectópico/diagnóstico , Neoplasias do Apêndice/diagnóstico , Tumor Carcinoide/diagnóstico , Síndrome de ACTH Ectópico/fisiopatologia , Síndrome de ACTH Ectópico/cirurgia , Adulto , Neoplasias do Apêndice/metabolismo , Neoplasias do Apêndice/fisiopatologia , Neoplasias do Apêndice/terapia , Tumor Carcinoide/metabolismo , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/terapia , Terapia Combinada , Síndrome de Cushing/etiologia , Diagnóstico Tardio , Feminino , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Resultado do TratamentoRESUMO
Gastric carcinoid tumors comprise 7% of all gastrointestinal carcinoids and have significantly increased in incidence over the past few decades. Seventy to 80% of gastric carcinoids are type I, which usually are clinically asymptomatic and found incidentally at endoscopic evaluation for abdominal pain or anemia. In this review, advances in understanding the pathophysiology of type I gastric carcinoid are highlighted. In addition, various current diagnostic and treatment options are discussed. Although type I carcinoids generally hold a benign course, rigorous investigation is needed to ensure accurate diagnosis and optimal treatment. This includes appropriate diagnostic procedures and imaging and accurate staging of tumor. Tumor size, depth of invasion, presence of metastasis, and the tumor's gastrin dependency dictate treatment options. Appropriate treatments can consist of endoscopic resection, antrectomy, medical management, or frequent follow-up. This article provides a systematic method of evaluating and treating type I gastric carcinoid.
Assuntos
Tumor Carcinoide/diagnóstico , Tumor Carcinoide/fisiopatologia , Gastrectomia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/fisiopatologia , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Células Enterocromafins/patologia , Células Enterocromafins/fisiologia , Determinação da Acidez Gástrica , Fundo Gástrico/patologia , Fundo Gástrico/fisiopatologia , Fundo Gástrico/cirurgia , Mucosa Gástrica/patologia , Mucosa Gástrica/fisiopatologia , Gastrinas/sangue , Gastrite Atrófica/complicações , Gastrite Atrófica/patologia , Gastrite Atrófica/fisiopatologia , Gastrite Atrófica/cirurgia , Gastroscopia , Humanos , Estadiamento de Neoplasias , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/fisiopatologia , Pólipos/cirurgia , Prognóstico , Antro Pilórico/patologia , Antro Pilórico/fisiopatologia , Antro Pilórico/cirurgia , Cintilografia , Fatores de Risco , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
Proton pump inhibitors have an excellent safety profile and have become one of the most commonly prescribed class of drugs in primary and specialty care. Long-term, sometimes lifetime, use is becoming increasingly common, often without appropriate indications. This paper is a detailed review of the current evidence on this important topic, focusing on the potential adverse effects of long-term proton pump inhibitor use that have generated the greatest concern: B12 deficiency; iron deficiency; hypomagnesemia; increased susceptibility to pneumonia, enteric infections, and fractures; hypergastrinemia and cancer; drug interactions; and birth defects. We explain the pathophysiological mechanisms that may underlie each of these relationships, review the existing evidence, and discuss implications for clinical management. The benefits of proton pump inhibitor use outweigh its risks in most patients. Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from long-term therapy.
Assuntos
Inibidores da Bomba de Prótons/efeitos adversos , Animais , Antiulcerosos/efeitos adversos , Antiulcerosos/uso terapêutico , Tumor Carcinoide/induzido quimicamente , Tumor Carcinoide/fisiopatologia , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/fisiopatologia , Diarreia/induzido quimicamente , Diarreia/fisiopatologia , Interações Medicamentosas , Feminino , Fraturas Ósseas/induzido quimicamente , Fraturas Ósseas/fisiopatologia , Humanos , Deficiências de Ferro , Magnésio/sangue , Masculino , Pneumonia/etiologia , Pneumonia/fisiopatologia , Inibidores da Bomba de Prótons/uso terapêutico , Ratos , Gastropatias/induzido quimicamente , Gastropatias/fisiopatologia , Neoplasias Gástricas/induzido quimicamente , Neoplasias Gástricas/fisiopatologia , Resultado do Tratamento , Deficiência de Vitamina B 12/induzido quimicamente , Deficiência de Vitamina B 12/fisiopatologiaRESUMO
Gastric carcinoid tumors are rare, but are increasing in incidence. This article reviews what is known about the classification, epidemiology, tumor pathogenesis and management of patients. Additionally we present the results of our own 10-years observation after endoscopic and surgery treatment of this tumors.