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1.
Anticancer Res ; 39(12): 6835-6842, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810950

RESUMO

BACKGROUND/AIM: Typical carcinoids (TC) and atypical carcinoids (AC) are rare diseases. A paucity of randomized studies and disagreements among various guidelines makes the management challenging. PATIENTS AND METHODS: Using codes for TC (8240) and AC (8249) in the National Cancer Database (NCDB), all surgically resected cases from 2004-2014 were included to evaluate the need for adjuvant chemotherapy. RESULTS: A total of 6,673 cases were included, 88% were TCs and 12% were ACs. From 2004 to 2014, the proportion of TCs went up from 1.3% to 1.8% and ACs from 0.1% to 0.3% of all lung malignancies. TC patients did well with surgery alone in all stages. AC patients with stage I [5-year overall survival (OS) - 84% vs. 52%; S vs. S+CT] and stage II disease (5-year OS - 81% vs. 55%; S vs. S+CT) showed better OS trend with surgery alone, while stage III patients showed some benefit with the use of adjuvant chemotherapy (5-year OS - 46% vs. 54%; S vs. S+CT). These results supported the National Comprehensive Cancer Network (NCCN) guidelines. CONCLUSION: No benefit was seen from adjuvant chemotherapy in TCs. While the adjuvant therapy may add benefit in stage III AC, the numbers are small and did not reach statistical significance.


Assuntos
Tumor Carcinoide/terapia , Quimioterapia Adjuvante/métodos , Neoplasias Pulmonares/terapia , Procedimentos Cirúrgicos Pulmonares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
2.
J Surg Oncol ; 120(7): 1096-1101, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31592538

RESUMO

BACKGROUND: Goblet cell carcinoid (GCC) tumors of the appendix are a rare malignancy. We aim to examine the overall survival per stage and the relationship between different treatment modalities and outcomes for patients with GCC tumors of the appendix. METHODS: We identified patients with GCC tumors of the appendix from the National Cancer Database. The main outcome was overall patient survival and cox proportional hazard models were used to ascertain predictors of survival. RESULTS: There were 2552 patients identified. The median age of diagnosis was 57 (interquartile range: 49-65) and 52.3% of patients were female. The 5-year survival for Stage I disease was 91.1% (95% confidence interval [CI]: 82.2%-95.7%), for Stage II disease was 90.5% (95% CI: 85.8%-93.7%), for Stage III disease was 57.0% (95% CI: 45.0%-67.3%), and for Stage IV disease was 18.9% (95% CI: 9.3%-31.0%). In a Cox proportional hazard model, older age (hazard ratio [HR]: 1.1; 95% CI: 1.03-1.12; P < .001), lymph node metastasis (HR: 6.9; 95% CI: 2.76-17.01; P < .001), and positive surgical margins (HR: 2.9; 95% CI:1.13-7.26; P = .003) were associated with worse overall survival for Stages I to III disease while only older age (HR: 1.03; 95% CI: 1.002-1.06; P = .04) was associated with worse overall survival for Stage IV disease. CONCLUSIONS: Patients with GCC tumors of the appendix who have the nonmetastatic disease have a high 5-year survival. We have identified several prognostic factors for GCC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Apendicectomia/mortalidade , Neoplasias do Apêndice/mortalidade , Tumor Carcinoide/mortalidade , Recidiva Local de Neoplasia/mortalidade , Idoso , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/terapia , Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
3.
Anticancer Res ; 39(9): 5053-5056, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519614

RESUMO

Primary ovarian carcinoids are very rare tumors that belong to the germ cell family of ovarian malignancies. They account for less than 1% of all carcinoid tumors and for less than 0.1% of all ovarian neoplasms. Recurrences are even rarer, with only few cases reported in the literature. Strumal carcinoid has recently been recognized as an extremely rare distinct entity. We report on a patient with bilateral mature cystic teratoma with millimetric foci of ovarian strumal carcinoid who developed lymph node para aortic metastasis after 30 years from primary diagnosis. Our case is thus far the second report of a metastatic strumal carcinoid and the first one in which strumal carcinoid occurred bilaterally and was also metastatic.


Assuntos
Tumor Carcinoide/diagnóstico , Neoplasias Ovarianas/diagnóstico , Estruma Ovariano/diagnóstico , Biópsia , Tumor Carcinoide/terapia , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Ovarianas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estruma Ovariano/terapia , Tomografia Computadorizada por Raios X
4.
Nihon Shokakibyo Gakkai Zasshi ; 116(8): 654-659, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31406070

RESUMO

A 42-year-old female developed type 1 diabetes mellitus at the age of 16 years and received insulin therapy. Esophagogastroduodenoscopy revealed an atrophic change localized in the gastric body and a small, protruding gastric lesion. Biopsy revealed that this lesion was gastric neuroendocrine tumor. Hence, the patient underwent en bloc resection by endoscopic submucosal resection with a ligation device. As the patient presented both autoimmune gastritis and type 1 diabetes mellitus, she was diagnosed with type 4 autoimmune polyendocrine syndrome. We report this case considering that only few cases of gastric neuroendocrine tumor with autoimmune gastritis (type A gastritis) complicated with autoimmune polyendocrine syndrome have been reported till date.


Assuntos
Tumor Carcinoide/diagnóstico , Gastrite Atrófica/diagnóstico , Gastrite , Poliendocrinopatias Autoimunes/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Tumor Carcinoide/terapia , Diabetes Mellitus Tipo 1 , Feminino , Gastrite Atrófica/complicações , Humanos , Poliendocrinopatias Autoimunes/complicações , Neoplasias Gástricas/terapia
5.
Vnitr Lek ; 65(5): 363-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163970

RESUMO

Thymic carcinoid account for cca 0.4 % of all carcinoid tumors in the body [1]. As compared to other neuroendocrinne tumors, high rates of reccurences after surgery, more aggressive behaviour and relatively high rates of paraneoplastic syndromes are characteristic for thymic carcinoid. The mainstay of treatment is radical surgery [2-4]. Therapy of locally advanced and metastatic stages is influenced by other neuroendocrinne tumors´guidelines. We present a case report of patient with locally advanced, atypical thymic carcinoid, treated with different modalities, including newer procedures like peptide radionuclide receptor therapy (PRRT).


Assuntos
Tumor Carcinoide , Neoplasias do Timo , Tumor Carcinoide/terapia , Terapia Combinada , Humanos , Neoplasias do Timo/terapia
6.
World J Gastroenterol ; 25(17): 2133-2143, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31114139

RESUMO

BACKGROUND: Patients with neuroendocrine tumors (NETs) of the gastrointestinal tract suffer frequently from chronic diarrhea. A well characterized medical advice containing zeolite (Detoxsan® powder) was applied to patients suffered from therapy-refractory diarrhea either by its frequency or by watery stool, despite receiving standard pharmacotherapy according to the guidelines for carcinoid syndrome and comorbidities. Detoxsan® powder acts as an adsorbent and might reduce significantly symptoms of diarrhea in patients suffering from NETs. AIM: To overcome the therapy-refractory diarrhea of patients with NETs by the zeolite containing medical advice Detoxsan® powder. METHODS: A total of 20 patients (12 female and 8 male) suffering from diarrhea either by its frequency or from watery stool caused by NETs were included. In each patient, the diagnosis had been confirmed by histology and somatostatin receptors expression proven by positron emission tomography/computed tomography using Ga-68-labeled somatostatin analogs. All patients received standard-of-care pharmacotherapy and were additionally given Detoxsan® powder as an extemporaneous drug containing 90% natural Cuban zeolite and 10% magnesium aspartate. Recommended daily dosage ranges between 3 g once to three times per day. Each day dose and bowel movements were documented by the patients themselves in a pre-defined table. Additionally to the bowel movements quantitative determinations of serotonin, urea, creatinine and single ions were performed within the serum of the patients by commercially available equipment used as a matter of routine in the clinic. RESULTS: All patients enrolled in this pilot study did not only suffer from NETs, but also from comorbidities and treatment-resistant diarrhea. There was insufficient control of diarrhea, most probably due to the secretion of hormones like serotonin produced by the slowly growing and highly differentiated NETs. All patients only took Detoxsan® powder as an antidiarrheal drug. In general, response effects need several days to become perceptible and require an intake of Detoxsan® powder for an extended time period or intermittently, if persisting stabilization of bowel movements could not be achieved. A correlation between NET grade, part and size of bowel resection and functionality of the tumor could not be demonstrated. Therefore, diarrhea seemed to be based on the metabolic activity of the well-differentiated NETs, which eventually led to treatment resistance. In summary, 14 out of the 20 patients (70%) declared to be very content with using Detoxsan® powder and observed a significant reduction of diarrhea, while the effective dose and intake period that resulted in a symptom relief varied individually. CONCLUSION: Detoxsan® powder is able to reduce significantly symptoms of NET-related diarrhea in the majority of patients. The duration of taking Detoxsan® powder and its dosage vary individually.


Assuntos
Diarreia/complicações , Neoplasias Gastrointestinais/complicações , Tumores Neuroendócrinos/complicações , Zeolitas/uso terapêutico , Adsorção , Adulto , Idoso , Idoso de 80 Anos ou mais , Silicatos de Alumínio/química , Tumor Carcinoide/terapia , Comorbidade , Diarreia/terapia , Feminino , Radioisótopos de Gálio/química , Neoplasias Gastrointestinais/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/fisiopatologia , Projetos Piloto , Pós , Somatostatina/química , Resultado do Tratamento , Zeolitas/química
7.
Lung Cancer ; 131: 90-94, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31027704

RESUMO

BACKGROUND: Atypical bronchopulmonary carcinoid tumors are rare but carry high recurrence rates following resection. The role of adjuvant therapy remains unclear owing to a lack of high-volume data. To address this knowledge gap, we examined predictors of adjuvant therapy and effects on outcome. METHODS: We queried the National Cancer Database for patients with resected stage I-III atypical carcinoid. Adjuvant therapy was defined as chest radiation, chemotherapy, or a combination thereof. Multivariable logistic regression identified predictors of adjuvant therapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases. RESULTS: Overall, 533 stage I/II and 129 stage III patients were identified. Predictors for adjuvant therapy in stage I/II disease were stage II, positive margins, lymph node ratio (LNR) of 1-25%, and more remote year of treatment. Predictors for adjuvant therapy in stage III were female gender and LNR of 26-50%. Median overall survival in stage I/II and III was 116 months and 61 months, respectively. Predictors for survival in stage I/II were age, margins, comorbidity score, and LNR; factors for stage III disease were LNR and more remote year of treatment. Delivery of adjuvant therapy was not independently associated with survival in either stage I/II or III patients. Furthermore, propensity matched analysis did not reveal a benefit to adjuvant therapy. CONCLUSIONS: This study shows no clear survival benefit with adjuvant radiotherapy and/or chemotherapy, even in stage III disease. Although this implies that adjuvant therapy should not be routinely delivered, individualized judgment is still recommended.


Assuntos
Tumor Carcinoide/terapia , Quimiorradioterapia Adjuvante , Quimioterapia Adjuvante , Neoplasias Pulmonares/terapia , Radioterapia Adjuvante , Adulto , Fatores Etários , Idoso , Tumor Carcinoide/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Fatores Sexuais , Análise de Sobrevida , Resultado do Tratamento
8.
J Pak Med Assoc ; 69(4): 533-540, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000859

RESUMO

Neuroendocrine tumours are a rare tumour type involving neuroectodermal cells. They are also termed carcinoids. Gastroenteropancreatic system is most commonly involved. They are classified as low, intermediate or high grade depending upon mitotic index and Ki-67 index. Their diagnosis involves measurement of chromogranin A levels. Ultrasound is the initial imaging modality for their evaluation. Endoscopic ultrasound allows close evaluation of the tumour. Staging is commonly undertaken by computed tomography scan. These tumours typically show hyper-enhancement on arterial phase. Their metastasis to the liver also shows arterial enhancement. Small bowel carcinoids tend to have hepatic and mesenteric spread. Mesenteric spread of disease gives a characteristic spoke wheel appearance. On magnetic resonance imaging, these tumours typically appear as hypointense on T1 weighted image, hyperintense on T2 weighted image and show avid enhancement on postcontrast scan. Surgical resection is appropriate treatment with follow-up at 6-month intervals during the first year. The current review was planned to cover the aetiology, diagnosis, staging, imaging techniques, imaging features and treatment of these rare tumours that need prompt diagnosis.


Assuntos
Tumor Carcinoide/diagnóstico por imagem , Carcinoma Neuroendócrino/diagnóstico por imagem , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/terapia , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Tomografia por Emissão de Pósitrons , Cintilografia , Ultrassonografia
9.
Tumori ; 105(6): NP20-NP23, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30799770

RESUMO

BACKGROUND: Primary carcinoid tumors are rare and constitute 0.23% of all testicular tumors. We report a case of primary carcinoid tumor of testicular localization, with a review of the literature. CASE PRESENTATION: A 29-year-old man, without specific ascendants, consulted the urology department for progressive scrotal swelling of 6 months, associated with pain. After surgery, histology showed diffuse tumor proliferation composed of small round monotone cells with hyperchromatic nuclei evoking undifferentiated carcinoma. Immunohistochemistry showed that tumor cells were positive for chromogranin A and negative for placental alkaline phosphatase and α-fetoprotein. CONCLUSION: Primary neuroendocrine carcinoma of the testis is a very rare malignant tumor. Immunohistochemistry contributes to its diagnosis in relation to other metastatic neuroendocrine carcinomas, carcinoid tumor teratomas, seminoma, and Sertoli cells.


Assuntos
Tumor Carcinoide/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Biomarcadores Tumorais , Biópsia , Tumor Carcinoide/metabolismo , Tumor Carcinoide/terapia , Carcinoma Neuroendócrino/diagnóstico , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Masculino , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/terapia , Testículo/metabolismo , Testículo/patologia , Ultrassonografia
10.
Cardiovasc Intervent Radiol ; 42(4): 569-576, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30627774

RESUMO

PURPOSE: To evaluate initial response and overall survival of neuroendocrine tumor (NET) liver metastases initially treated with transarterial embolization (TAE) using spherical particles of different sizes. METHODS: A single-institution retrospective review was performed of 160 patients with NET liver metastases initially treated with TAE using < 100 µm (n = 77) or only ≥ 100 µm (n = 83) spherical particles. For each patient, we evaluated: initial response by mRECIST, time to progression, overall survival, complications, primary site, tumor grade and degree of differentiation, volume of liver disease, extrahepatic disease, NET-related symptoms, comorbidities, Child-Pugh score, performance status, lobar versus selective embolization, and arteriovenous shunting. RESULTS: Initial response was higher for TAE using particles < 100 versus TAE using only particles ≥ 100 µm (64 vs 42%, p = 0.007). Multivariate logistic regression showed that use of particles < 100 µm and liver < 50% replaced with tumor were independent predictors of a better initial response rate. There was no difference in major or minor complications between the two particle size groups. Median overall survival after TAE was 55 months for well- to moderately differentiated NET and 13 months for poorly differentiated or undifferentiated NET. There was no significant difference in survival between TAE patients treated with < 100 versus only ≥ 100-µm particles. CONCLUSION: NET patients treated with TAE using particles < 100 µm had better initial response, but the same overall survival, compared to TAE using only particles ≥ 100 µm.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Hepáticas/secundário , Microesferas , Tumores Neuroendócrinos/secundário , Tamanho da Partícula , Adulto , Idoso , Tumor Carcinoide/mortalidade , Tumor Carcinoide/secundário , Tumor Carcinoide/terapia , Progressão da Doença , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/terapia , Estudos Retrospectivos , Resultado do Tratamento
11.
Adv Anat Pathol ; 26(2): 75-83, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30601149

RESUMO

Goblet cell carcinoid (GCC) or goblet cell carcinoma is a unique mixed endocrine-exocrine neoplasm that is almost exclusively seen in the appendix. The hallmark of GCC is the concentric infiltration of the appendiceal wall by small tight clusters, nests or cords of tumor cells that exhibit a goblet cell morphology with a small compressed nucleus and conspicuous intracytoplasmic mucin. The coexistence of high-grade adenocarcinoma with GCC has been increasingly recognized as a common finding, which has been called adenocarcinoma ex GCC or mixed GCC-adenocarcinoma. A number of studies have shown that it is the high-grade adenocarcinomatous component that dictates the prognosis. Several histologic classification/grading systems have been proposed, which correlate with overall patient survival. Treatment options are primarily based on tumor stage and the presence or absence of a high-grade adenocarcinomatous component.


Assuntos
Adenocarcinoma/patologia , Neoplasias do Apêndice/patologia , Tumor Carcinoide/patologia , Células Caliciformes/patologia , Neoplasias Complexas Mistas/patologia , Adenocarcinoma/química , Adenocarcinoma/mortalidade , Adenocarcinoma/terapia , Neoplasias do Apêndice/química , Neoplasias do Apêndice/mortalidade , Neoplasias do Apêndice/terapia , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Biópsia , Tumor Carcinoide/química , Tumor Carcinoide/mortalidade , Tumor Carcinoide/terapia , Células Caliciformes/química , Humanos , Imuno-Histoquímica , Técnicas de Diagnóstico Molecular , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Complexas Mistas/química , Neoplasias Complexas Mistas/mortalidade , Neoplasias Complexas Mistas/terapia , Resultado do Tratamento
12.
Gastroenterol Hepatol ; 42(6): 386-387, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30029926
13.
Medicine (Baltimore) ; 97(47): e13286, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30461637

RESUMO

RATIONALE: Thymic carcinoids are a rare type of malignant neuroendocrine tumors which have a poor prognosis due to their distant metastasis, invasive behaviour, and postoperative recurrence. Surgical resection is still the fundamental mode for treating thymic carcinoids. Here, we report the rapid shrinkage of an atypical thymic carcinoid with multiple metastases following chemoradiation plus octreotide as a first-line therapy PATIENT CONCERNS:: A 39-year-old Chinese man presented with chest tightness, dyspnea with a history of lumbago and untreated malignant thymoma. DIAGNOSIS: Thoracic computed tomography (CT) scan revealed an anterior mediastinal mass with pulmonary and multiple bone metastases as well as bilateral pleural and pericardial effusions. Percutaneous needle biopsy was performed on the mediastinal mass and the pathological diagnosis was neuroendocrine carcinoma of moderately differentiation (atypical carcinoid) INTERVENTIONS:: The tumor was considered unresectable because of extensive invasion into the lung and various bones. The patient was started on paclitaxel and oxaliplatin per 21 days for 4 cycles, and on 20 mg of depot formulation of octreotide once per 21 days. After 2 cycles of chemotherapy, the patient received concurrently mediastinal radiotherapy (39.6 Gy × 22 fractions). OUTCOMES: A follow-up CT of the chest at the completion of his fourth chemotherapy regimen demonstrated, approximately 22% of tumor shrinkage. There were no signs of disease progression but the patient refused further chemoradiation treatment. The patient received monthly treatment of octreotide and zoledronate and his progression-free survival reached 18 months. Due to uncontrollable disease progression, the patient expired. LESSONS: Early diagnosis and radical surgery of thymic carcinoid are very important. However, radiotherapy (combined/noncombined chemotherapy) must be considered if radical resection is not performed. We believe that further study of chemoradiation and octreotide with the palliative intent of preparing tumors for shrinkage is warranted as a strategy to improve curative management of neuroendocrine tumors.


Assuntos
Neoplasias Ósseas , Tumor Carcinoide , Neoplasias Pulmonares , Mediastino/diagnóstico por imagem , Octreotida/administração & dosagem , Neoplasias do Timo , Adulto , Antineoplásicos Hormonais/administração & dosagem , Biópsia/métodos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Quimiorradioterapia/métodos , Terapia Combinada/métodos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Estadiamento de Neoplasias , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Endocrinol Metab Clin North Am ; 47(3): 645-660, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30098721

RESUMO

Gastric carcinoids, formally named gastric neuroendocrine neoplasms (NENs), are derived from enterochromaffin-like cells of the stomach and are increasingly diagnosed. A majority are designated as type I (related to autoimmune gastritis) and type II (related to gastrinoma) neoplasms that develop secondary to gastrin hypersecretion. Types I and II gastric carcinoids are mostly small-sized (1-2 cm), multiple, low-malignancy potential lesions mainly confined to the gastric mucosa/submucosa. These lesions have an indolent course and low metastatic potential. In contrast, type III gastric carcinoids are single, larger-sized (>2 cm), non-gastrin-related lesions that infiltrate the muscular layers associated with local and distant metastases.


Assuntos
Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Tumor Carcinoide/tratamento farmacológico , Neoplasias Gastrointestinais/tratamento farmacológico , Humanos , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico
15.
Endocrinol Metab Clin North Am ; 47(3): 699-709, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30098725

RESUMO

Carcinoids of the lung and thymus are rare thoracic cancers. In general, lung carcinoid tumors have a favorable prognosis, particularly when diagnosed at an early stage and treated with surgical resection. Thymic neuroendocrine tumors may be associated with multiple endocrine neoplasia-1 syndrome, tend to have a more aggressive natural history, and relatively frequently secrete ectopic adrenocorticotropic hormone.


Assuntos
Tumor Carcinoide/terapia , Neoplasias Pulmonares/terapia , Tumores Neuroendócrinos/terapia , Neoplasias do Timo/terapia , Antineoplásicos/uso terapêutico , Tumor Carcinoide/tratamento farmacológico , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Tumores Neuroendócrinos/tratamento farmacológico , Tumores Neuroendócrinos/parasitologia , Tumores Neuroendócrinos/cirurgia , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
16.
J Clin Pathol ; 71(11): 1030, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30154130

RESUMO

CLINICAL QUESTION: A 45-year-old woman presented with painless vaginal bleeding for 2 months. A biopsy was taken from the uterine cervix, and poorly differentiated adenocarcinoma was suspected. After three cycles of neoadjuvant chemotherapy treatment, the patient underwent radical hysterectomy with bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy.Review the high quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2018-205081-1/ and consider your diagnosis. WHAT IS YOUR DIAGNOSIS?: Typical carcinoid.Poorly differentiated adenocarcinoma.Atypical carcinoid.Small cell neuroendocrine carcinoma.Sex cord-stromal tumours of the uterine cervix.-The correct answer is after the discussion. DISCUSSION: Neuroendocrine tumours of the uterine cervix are a rare cancer of the female reproductive system, accounting for approximately 1% of all female cervical malignancies.1 2 In 1997, a consensus workshop suggested four types of neuroendocrine tumours of the uterine cervix: typical and atypical carcinoid tumours, small cell neuroendocrine carcinomas, and large cell carcinomas.1 Among all the categories, small cell neuroendocrine carcinomas are of the highest incidence. A PubMed search revealed that only 15 cases of atypical carcinoid tumours of the uterine cervix have been reported.3 4 Because of infrequency, the clinical and pathological features of atypical carcinoid tumours of the uterine cervix remain unknown.Atypical carcinoids are characterised by great cytological atypia, which means abundant or scanty cytoplasm and visible nucleoli with granular chromatin. Tumour cells lined up in insular, trabecular, columnar and nested organoid patterns; they are epithelioid in appearance, but can be spindled (figure 1A). Necrosis could be observed in some areas and mitotic activity is up to 10 mitotic figures/10 high-power field (figure 1B). On immunohistochemistry, atypical carcinoids are diffuse and positive for Syn, CgA and CD56 (figure 2). An electron microscopic test was done, and several neuroendocrine granules were distributed in the tumour cell plasma (figure 3).jclinpath;71/11/1030/F1F1F1Figure 1(A) Insular, trabecular and columnar patterns of tumour cells were focally observed in the deep stroma of the cervix (H&E ×200). (B) Tumour cells showed small-sized, scanty cytoplasm, enlarged and deeply stained nuclei with condensed chromatin, obvious atypia, and increased mitotic activity (H&E ×400). (C) The cervical gland has shown atypical hyperplasia and adenocarcinoma in situ (H&E ×200).jclinpath;71/11/1030/F2F2F2Figure 2Immunohistochemical study findings: (A-C) The neuroendocrine markers Syn, CgA and CD56 were diffuse with strong expression in the tumour cell plasma. (D-E) P63 and CK5/6 for the squamous cell carcinomas showed no expression. (F-G) P16 for atypical carcinoid and adenocarcinoma in situ, respectively, had strong diffuse expression. (H-I) Ki67 had low expression in both atypical carcinoid and adenocarcinoma in situ (×200).jclinpath;71/11/1030/F3F3F3Figure 3Several neuroendocrine granules were distributed in the tumour cell plasma.Neuroendocrine tumours of the uterine cervix are sometimes combined with adenocarcinoma (figure 1C); their cytological and immunohistochemical features showed the neuroendocrine and adenomatous components shared the same origin.


Assuntos
Adenocarcinoma in Situ/patologia , Tumor Carcinoide/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma in Situ/química , Adenocarcinoma in Situ/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Biópsia , Tumor Carcinoide/química , Tumor Carcinoide/terapia , Quimioterapia Adjuvante , Feminino , Humanos , Histerectomia , Imuno-Histoquímica , Excisão de Linfonodo , Microscopia Eletrônica , Pessoa de Meia-Idade , Terapia Neoadjuvante , Salpingo-Ooforectomia , Neoplasias do Colo do Útero/química , Neoplasias do Colo do Útero/terapia
17.
Magy Onkol ; 62(2): 113-118, 2018 Jul 20.
Artigo em Húngaro | MEDLINE | ID: mdl-30027939

RESUMO

Lung neuroendocrine tumors comprise 20% of all pulmonary tumors. Their appearance and behavior are very heterogeneous. Histologically they are divided into four groups, well-differentiated and low-malignant typical carcinoid, poorly differentiated and worse prognosis atypical carcinoid, and highly malignant small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma. Of these, the most common is small cell lung cancer with an incidence of 15%, while those of large cell neuroendocrine tumors and lung carcinoids are 3% and 2%, respectively. The treatment and prognosis of carcinoids are very different from those of highly malignant small cell and large cell neuroendocrine carcinomas. The paper summarizes the characteristics of lung neuroendocrine tumors.


Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/terapia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Carcinoma de Células Grandes/diagnóstico , Carcinoma de Células Grandes/epidemiologia , Carcinoma de Células Grandes/patologia , Carcinoma de Células Grandes/terapia , Carcinoma de Células Pequenas/diagnóstico , Carcinoma de Células Pequenas/epidemiologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/terapia , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/patologia , Prognóstico
18.
Arch Pathol Lab Med ; 142(8): 947-951, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29869902

RESUMO

CONTEXT: - Air space invasion or aerogenous spread of lung adenocarcinoma is a relatively new concept and has been implicated as a potential prognostic factor as well as has been added as an exclusion point in the diagnosis of minimally invasive adenocarcinoma. Potential role for Ki-67 immunostaining as a diagnostic and prognostic marker in pulmonary carcinoid tumors has been suggested in the literature, given the significant interobserver variability and the difficulty in predicting their clinical behavior. OBJECTIVE: - To review the concept of air space invasion in lung adenocarcinoma and the current controversies regarding the role of Ki-67 immunostaining on pulmonary carcinoid tumors Data Sources.- PubMed search of English literature. CONCLUSIONS: - Pathologists need to recognize air space invasion with a critical evaluation to differentiate it from artifacts that are commonly seen in sections. Currently, Ki-67 immunostaining is not recommended for routine use in the diagnosis of pulmonary carcinoid tumors or for predicting their prognosis, except for the differential diagnosis from small cell carcinomas or large cell neuroendocrine carcinomas in small biopsy specimens with crush artifacts.


Assuntos
Adenocarcinoma/patologia , Tumor Carcinoide/patologia , Antígeno Ki-67/metabolismo , Neoplasias Pulmonares/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/metabolismo , Adenocarcinoma/terapia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/metabolismo , Tumor Carcinoide/terapia , Tomada de Decisão Clínica , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/terapia , Invasividade Neoplásica
19.
J Laryngol Otol ; 132(7): 568-574, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29909787

RESUMO

OBJECTIVE: This review aimed to critically analyse data pertaining to the clinical presentation and treatment of neuroendocrine carcinomas of the larynx. METHOD: A PubMed search was performed using the term 'neuroendocrine carcinoma'. English-language articles on neuroendocrine carcinoma of the larynx were reviewed in detail.Results and conclusionWhile many historical classifications have been proposed, in contemporary practice these tumours are sub-classified into four subtypes: carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma. These tumours exhibit a wide range of biological behaviour, ranging from the extremely aggressive nature of small and large cell neuroendocrine carcinomas, which usually have a fatal prognosis, to the less aggressive course of carcinoid tumours. In small and large cell neuroendocrine carcinomas, a combination of irradiation and chemotherapy is indicated, while carcinoid and atypical carcinoid tumour management entails conservation surgery.


Assuntos
Carcinoma Neuroendócrino/genética , Carcinoma Neuroendócrino/terapia , Neoplasias Laríngeas/genética , Neoplasias Laríngeas/terapia , Fenótipo , Protocolos Antineoplásicos , Tumor Carcinoide/genética , Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Carcinoma Neuroendócrino/patologia , Carcinoma de Células Pequenas/genética , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/terapia , Tratamento Conservador/métodos , Humanos , Neoplasias Laríngeas/patologia , Laringe/patologia , Laringe/cirurgia , Prognóstico
20.
Curr Oncol ; 25(Suppl 1): S86-S93, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29910651

RESUMO

Background: Neuroendocrine tumours (nets) are classified by site of origin, with lung being the second most common primary site after the gastrointestinal tract. Lung nets are rare and heterogeneous, with varied pathologic and clinical features. Typical and atypical carcinoid tumours are low-grade lung nets which, compared with the more common high-grade nets, are associated with a more favourable prognosis. Still, optimal treatment strategies are lacking. Methods: This review concentrates on classification and treatment strategies for metastatic low-grade lung nets, considering both typical and atypical carcinoids. The terminology can be confusing, and an attempt is made to simplify it. Promising results from recent trials that included lung nets are presented and discussed. Finally, guidelines from Europe and North America are discussed, and differences are noted. Results: Even within the group of patients with low-grade nets, the presentation, the locations of metastasis, and the speed of progression can be very different. The initial work-up and an understanding of the tumour's biology are key in making management decisions. Various treatment options-including somatostatin analogs, peptide receptor radioligand therapy, and biologic systemic therapy, specifically with the mtor (mechanistic target of rapamycin) inhibitor everolimus-are now available and are presented in a treatment algorithm. Summary: Although lung nets are rare and evidence supporting optimal treatment strategies is lacking, the recent publication of trials that have included patients with lung nets advances evidence-based therapy for these tumours. Many variables have to be considered in managing these tumours that have received little attention. Education for treating physicians is needed.


Assuntos
Tumor Carcinoide/patologia , Tumor Carcinoide/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Oncologia , Guias de Prática Clínica como Assunto , Progressão da Doença , Humanos , Oncologia/métodos , Oncologia/normas , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/normas
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