Carcinoid tumors originate from the neuroendocrine cells throughout the body and occur most frequently (74%) in the gastrointestinal tract. The clinical course is often indolent but can also be aggressive and resistant to therapy. Clinical manifestations are often vague or absent. Nevertheless, in approximately 10% of patients, the tumors secrete bioactive mediators which may engender various elements of characteristic carcinoid syndrome. In many instances, the neoplasms are detected incidentally at the time of surgery for other gastrointestinal disorders. The tendency for metastatic spread correlates with tumor size, and is substantially higher in lesions larger than 2.0 cm. Management of patients with carcinoid tumors requires an understanding of the disease process and a multimodality approach. Treatment consists of radical surgical excision of the tumor, although gastric (type I and II) and rectal carcinoids may be managed with local excision. However, advanced carcinoid tumor remains incurable.
*Carcinoid Tumor/diagnosis/therapy ; English Abstract ; *Gastrointestinal Neoplasms/diagnosis/therapy ; Humans

Aged ; Carcinoid Tumor ; diagnosis ; therapy ; Humans ; Laryngeal Neoplasms ; diagnosis ; therapy ; Male

This report dscribes the thymic carcinoid tumor behaved in a highly aggressive fashion metastasis. Anti-cancer chemotherapy was not effective, the patient died of progressive disease after three months of diagnosis.
Bone Marrow* ; Carcinoid Tumor* ; Diagnosis ; Drug Therapy ; Humans ; Neoplasm Metastasis* ; Pleural Effusion ; Thymus Gland

Ectopic ACTH syndrome is frequently caused by lung cancer and uncommonly by other tumors such as thymic carcinoid. For its treatment, early diagnosis and complete resection is irresponsible, but some cases are remained unlocalized in spite of all diagnostic modalities. Here we report a case of ectopic ACTH syndrome which was localized by PET but could not be localized by conventional technique. A tumor at thymic area was ACTH secreting thymic carcinoid which was operated but couldnt resect completly. Glucocorticoid hypersecretion was persisted with chemotherapy, radiotherapy, and ketoconazole treatment. Patient died of sepsis after 12 months of diagnosis.
ACTH Syndrome, Ectopic* ; Adrenocorticotropic Hormone ; Carcinoid Tumor* ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Humans ; Ketoconazole ; Lung Neoplasms ; Radiotherapy ; Sepsis

Thymic carcinoid tumor is a rare mediastinal tumor, which was firstly described by Rosai and Higa in 1972. A carcinoid tumor of the thymus has recently been regarded as a distinct tumor from thymoma, and is probably Kultschizky cell origin. The pathologic diagnosis of thymic carcinoid is made from findings from light microscopy, immunohistochemical studies and electron microscopy. About 50% of thymic carcinoids were seen with endocrinopathies. Recurrences and extrathoracic metastasis are characteristics of thymic carcinoids. Surgical removal of the intial and tumor recurred are considered to be the most effective treatment today. However, the role of the adjuvant radiotherapy and the chemotherapy is still uncertain. Herein we report a case of thymic carcinoid tumor, which was confirmed by operation and pathologic study.
Carcinoid Tumor* ; Diagnosis ; Drug Therapy ; Mediastinal Neoplasms ; Microscopy ; Microscopy, Electron ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Thymoma ; Thymus Gland ; Thymus Neoplasms

OBJECTIVETo discuss the diagnosis and treatment of primary hepatic carcinoid tumor (PHCT).

METHODSReport one case of huge PHCT treated in February 2004, and search the other 19 cases which were published from January 1994 to December 2006 in the Chinese biological and medical literature database. The clinical manifestation, pathological findings, diagnosis and treatment of these 20 PHCT patients were analyzed retrospectively.

RESULTSThe main symptoms were abdominal pain or discomfort (8 cases) and abdominal mass (7 cases), cases with typical carcinoid syndrome were rare (3 cases). Immunohistochemical staining was positive for neuron-specific enolase, chromogranin A and synaptophysin in most cases. Sixteen cases received operation, among which there were 13 removed completely, other 4 cases were treated by transcatheter arterial chemoembolization (TACE).

CONCLUSIONSThe definite diagnosis of PHCT depends on pathological and histochemical findings. Complete surgical resection is the best treatment for PHCT with favourable prognosis. TACE is also effective for nonoperative cases.

Antigens, CD34 ; analysis ; Carcinoid Tumor ; diagnosis ; metabolism ; therapy ; Chromogranin A ; analysis ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Liver Neoplasms ; diagnosis ; metabolism ; therapy ; Male ; Middle Aged

OBJECTIVETo investigate the clinicopathological features, treatment, and prognosis of gastric neuroendocrine carcinoma and gastric carcinoma with neuroendocrine cell differentiation.

METHODSA total of 19 patients were treated for gastric neuroendocrine cancer or gastric cancer with neuroendocrine differentiation in the Beijing Cancer Hospital from January 1997 to December 2008. Clinical data were retrospectively analyzed.

RESULTSFourteen patients had neuroendocrine carcinoma in the gastric cardia (n=9) or gastric body(n=5), and 5 patients had gastric cancer with neuroendocrine differentiation in the gastric cardia(n=2), the antrum(n=2), and the entire stomach(n=1). According to the International Classification of Disease for Oncology(2000), patients were divided into gastric carcinoid type I((n=2, 10.5%), type III( sporadic gastric carcinoid (n=9, 47.4%), small cell carcinoma of the stomach(n=3,15.8%), and gastric cancer with neuroendocrine cell differentiation(n=5, 26.3%). Clinical manifestations were mostly non-specific. Diagnosis was based on pathological and immunohistochemical examination. Eighteen patients underwent surgery including radical subtotal gastrectomy and total gastrectomy, of whom 3 underwent simultaneous resection of the liver metastasis. The remaining one patient with small cell carcinoma of the gastric body received chemotherapy alone because of unresectable liver metastasis. The survival rate was 73.7% at 1 year and 38.6% at 3 years.

CONCLUSIONSGastric neuroendocrine carcinoma usually develops in the cardia and body of the stomach. Gastric carcinoma with neuroendocrine cell differentiation can occur in any locations of the stomach. Immunohistochemistry is important to the diagnosis. Radical resection is the main treatment.

Aged ; Carcinoid Tumor ; diagnosis ; pathology ; therapy ; Carcinoma, Neuroendocrine ; diagnosis ; pathology ; therapy ; Carcinoma, Small Cell ; diagnosis ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; therapy

We report a case of a goblet-cell carcinoid tumor of the appendix which metastasized to the peritoneum and was treated by using cytoreductive surgery (CRS) with intraperitoneal chemotherapy. A 47-year-old male presented with chronic constipation and was diagnosed as having a rectal adenocarcinoma with a signet-ring-cell component under colonoscopy. Computed tomography suggested peritoneal metastases with diffuse nodular parietal peritoneal thickening of the entire abdomen and focal invasion of the upper rectum by a seeding mass. CRS with intraperitoneal chemotherapy was done under the diagnosis of a rectal adenocarcinoma with peritoneal metastases. The pathologic diagnosis was a goblet-cell carcinoid tumor of the appendix with peritoneal metastasis. The histological discrepancy between a peritoneal metastatic mass and a rectal mass was due to the mixed histological pattern of a goblet-cell carcinoid tumor. A metastatic mass may not share identical immunohistochemical characteristics from its origin. This histologic discrepancy necessitates caution in diagnosing a distant metastasis of a goblet-cell carcinoid tumor.
Abdomen ; Adenocarcinoma ; Appendix ; Carcinoid Tumor* ; Colonoscopy ; Constipation ; Diagnosis ; Drug Therapy* ; Goblet Cells ; Humans ; Infusions, Parenteral ; Male ; Middle Aged ; Neoplasm Metastasis ; Peritoneal Neoplasms ; Peritoneum ; Rabeprazole ; Rectum

PURPOSE: To report the first case of pigmented choroidal metastases without enucleation diagnosed with fine-needle aspiration biopsy. CASE SUMMARY: A 47-year-old male was referred to our clinic with a suspected diagnosis of choroidal melanoma in his left eye. Positron emission tomography-computer tomography used to evaluate systemic metastases revealed lung cancer. Pathology of the detected lung mass was primary lung neuroendocrine tumor. To differentiate choroidal metastasis and primary choroidal melanoma, we performed a fine-needle aspiration biopsy for choroidal tumors. The cytology showed results favoring metastatic atypical carcinoid and the patient was started on systemic chemotherapy. CONCLUSIONS: All pigmented choroidal tumors are not choroidal melanomas and choroidal metastases may be pigmented. The present case suggests that proper systemic evaluation and biopsy for suspected choroidal tumor could be helpful in diagnosis.
Biopsy ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Choroid* ; Diagnosis ; Drug Therapy ; Electrons ; Humans ; Lung ; Lung Neoplasms ; Male ; Melanoma* ; Middle Aged ; Neoplasm Metastasis* ; Neuroendocrine Tumors ; Pathology

BACKGROUND: Metastases to the pancreas are uncommon, and are usually a part of widespread disease. However, isolated metastatic lesions can be resected, which can lead to prolonged survival of the patient. The aim of this study was to evaluate the characteristics of metastatic tumors of the pancreas in a Korean poulation. METHODS: We evaluated clinical features and treatment results in patients with a pathological confirmation of metastasis to the pancreas from January 1997 to June 2005. RESULTS: Twenty-five patients were included in the study. Nineteen patients were male. The mean age at the diagnosis of the metastasis was 58.2 years. Renal cell carcinoma was the most frequent primary malignancy (n=8), followed by gastric carcinoma (n=5), colorectal carcinoma (n=2), hepatocellular carcinoma (n=1), lymphoma (n=1), thymic carcinoid (n=1), gastrointestinal stromal tumor (n=1), liposarcoma (n=1), cholangiocarcinoma (n=1), osteosarcoma (n=1), small cell lung cancer (n=1), and non-small cell lung cancer (n=1). Eleven patients were asymptomatic upon diagnosis. The mean interval between the primary diagnosis and diagnosis of the metastases was 4.9 years. Fourteen patients underwent surgery with or without chemotherapy, five patients received chemotherapy, one patient received radiation therapy, and five received palliative care. The mean survival after the diagnosis of metastasis was 44.3 months. Renal cell carcinoma as the primary tumor, asymptomatic upon diagnosis of the metastasis, the interval between primary diagnosis and diagnosis of the metastases of more than 43 months, and surgery with or without chemotherapy were associated with a prolonged survival. CONCLUSIONS: Metastasis to the pancreas can occur after a prolonged period from an initial diagnosis. In selected patients (e.g., renal cell carcinoma), aggressive treatment can prolong survival.
Carcinoid Tumor ; Carcinoma, Hepatocellular ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Renal Cell ; Cholangiocarcinoma ; Colorectal Neoplasms ; Diagnosis ; Drug Therapy ; Gastrointestinal Stromal Tumors ; Humans ; Liposarcoma ; Lymphoma ; Male ; Neoplasm Metastasis ; Osteosarcoma ; Palliative Care ; Pancreas* ; Small Cell Lung Carcinoma