Bronchial Carcinoid Tumours a Clinicopathologic Study of 82 Cases

Abstract

A clinical and "blind" histologic review of 82 cases of bronchial carcinoid tumour is presented. The malignant potential of the tumours was only partly predictable from their histologic appearance. Histologically 65 of the tumours were typical benign carcinoids. Regional metastases were found at operation in two of these patients. Fatal carcinoid syndrome with regional and distant metastases appeared in two patients about 1 and 3 years postoperatively. One of the patients with regional metastases at operation is clinically free from carcinoid 12 years later. Malignancy was histologically suspected in 17 cases, in ten of which regional metastases were found at operation. Three of these ten patients are alive 6 to 16 years postoperatively, but two without regional metastases at operation died of local recurrence and distant metastases after 3 to 4 years. Carcinoid syndrome was not seen in these 17 patients. There was one peroperative death. Altogether ten patients (12%) died of recurrence. Among the cases judged at the "blind" histologic review to be suspectedly malignant, the corresponding figure was 50%. For typical carcinoids, conservative resection, including lymph-node metastases, is the treatment of choice. Wedge or sleeve resection with or without pulmonary resection were employed in ten cases. Suspectedly malignant carcinoid tumours may require more extensive surgery.

Bronchial and Thymic Carcinoid Tumors: A Review

“…In our experi ence, only 6 cases of 'moderate-to-severe' hemorrhage have occurred, and none of these required double lumen intubation or emergency surgery [24], A major problem with carcinoid tumors is the propor tion of misdiagnoses of endoscopic biopsies. This is low with the larger biopsies taken through the rigid broncho scope [ 16,32], but as many as one third of the patients can have falsely negative or incorrect preoperative biopsy results [15,30,33]. Furthermore, a certain number of 72 Dusmet/Mc Kneally Bronchial and Thymic Carcinoid Tumors: A Review patients will be falsely diagnosed as having small cell car cinoma [7,12,15,16,30,32], The reliability of biopsies in peripheral lesions is considerably lower.…”

“…This is low with the larger biopsies taken through the rigid broncho scope [ 16,32], but as many as one third of the patients can have falsely negative or incorrect preoperative biopsy results [15,30,33]. Furthermore, a certain number of 72 Dusmet/Mc Kneally Bronchial and Thymic Carcinoid Tumors: A Review patients will be falsely diagnosed as having small cell car cinoma [7,12,15,16,30,32], The reliability of biopsies in peripheral lesions is considerably lower. In one series of 29 peripheral carcinoids, the correct diagnosis was made 4 times; in 6 patients an incorrect diagnosis was made, and in 19 no diagnosis could be made [5], In this same series there were 64 central lesions, which were correctly identified preoperatively in 54 cases.…”

“…Some of the tumors can be occult initially, and hormone secretion can be suppressed with high-dose prednisone or with metyrapone in one half of the cases, mimicking pituitary Cushing's syndrome [19], Corticotropin secretion has been seen in typical (9 cases), atypical (3 cases) and metastatic carcinoids (3 cases) [19], Acromegaly due to the release of a growth hormonereleasing factor has also been reported [20,21], Biopsy Biopsy of carcinoid tumors was often considered dan gerous because these tumors can be very vascular [5], Cytology and brushings are often nondiagnostic because the tumors are covered by a normal mucosa [10,36]. This can also impair the yield of biopsies taken through the flexible bronchoscope [10], Furthermore, if hemorrhage does occur hemostasis can be difficult to secure with flexi ble bronchoscopy [5,32], In our review of the literature there were 587 carcinoid tumors which were biopsied with either flexible or rigid bronchoscopes [1,2,4,5,7,15,16,24,30,[32][33][34]38], A total of 15 cases of hemor rhage were reported, 11 of which required neither transfu sion nor intervention. Four cases did, however, bleed so severely that emergency thoracotomy was required [16].…”

“…Warren et al [7] report that the intermediate cell neu roendocrine carcinoma can respond to small cell carcino ma-type chemotherapy. Many chemotherapeutic agents have been tried for atypical or metastatic carcinoids (ta ble 1), but the response rates are generally poor [2,7,10,17], Small cell carcinoma, on the other hand, requires che motherapy to be treated successfully, even in the rare cases seen in an apparently early stage [7,17], Most authors agree that there are three essential com ponents of the surgical treatment of carcinoid tumors: (1) complete removal of the tumor; (2) sparing of as much lung parenchyma as possible, and (3) lymph node dissec tion [2,3,7,9,13,15,30,34], It is often tempting to resect Table 1. Chemotherapy for carcinoid tumors these tumors endoscopically.…”

“…In 8 of the 9 patients there was residual tumor in the specimen [5]. Bertelsen et al [30] resected and cauterized the base of 3 tumors which were attached to the bronchial wall by a slender stalk via bronchotomy -2 of these recurred [30].…”