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Carcinoid Tumors

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intestine, appedix, proximal colon, and hindgut distal colon, rectum, GU) ... Gastric carcinoid variant: histamine mediated, results in hives; also PUD ... – PowerPoint PPT presentation

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Title: Carcinoid Tumors


1
Carcinoid Tumors
  • Arise from enterochromaffin cells of the GI tract
    (including foregutlungs, bronchi and stomach,
    midgutsm. intestine, appedix, proximal colon,
    and hindgutdistal colon, rectum, GU)
  • Histologic characteristics are based on special
    stains, typical vs. atypical features
  • Benign vs. Malignant metastatic pattern of
    spread (as opposed to histology alone)

2
Carcinoid
  • Appendix most common neoplasm found at path,
    usually younger pt, asymptomatic, can cause
    obstruction? appy. Less than 2 cm unlikely to
    have mets.
  • Small intestine located terminal ileum, age
    60s-70s, abd pain due to mechanical obstruction
    or mesenteric ischemia
  • Colon age 70s, abd pain or weight loss,
    usually right colon/cecum
  • Rectum age 60s-70s, rectal bleeding or pain

3
Carcinoid
  • Stomach type 1assoc. with atrophic gastritis
    and pernicious anemia. High levels of gastrin
    stimulate the enterochromaffin cells to transform
    into carcinoid.
  • Stomach type 2in association with gastrinomas
    or MEN I.
  • Both of these are indolent, rarely metastasize.

4
Carcinoid of the Lung
  • A neuroendocrine tumor, arises from Kulchitskys
    cells within the bronchial mucosa usually
    perihilar
  • Age 50s, cough, hemoptysis, recurrent
    pneumonia, chest pain.
  • Paraneoplastic syndromes cushings, acromegaly,
    carcinoid (less than 5 of pts)
  • Usu. indolent in lt15 of cases can met to nodes,
    liver, bone, skin

5
Carcinoid Syndrome
  • Rare manifestation 10
  • Tumors produce histamine, serotonin, kallikrein,
    and prostaglandins
  • Symptoms abdominal pain, diarrhea, flushing,
    edema (increased vascular permeability),
    wheezing, tryptophan deficiency (dermatitis,
    glossitis, mental confusion)
  • With intestinal carcinoiddoes not occur without
    mets to liver bronchial can cause the syndrome
    in absence of mets

6
Other manifestations
  • Cardiac right sided valvular lesions (fibrous
    deposits)
  • Fibrosis in the retroperitoneum or other sites
  • Gastric carcinoid variant histamine mediated,
    results in hives also PUD
  • Bronchial carcinoid variant prolonged flushing
    (days) with wheezing, periorbital edema,
    lacrimation, salivation, hypotension, tachycardia
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