Carcinoid Tumours in Auckland, New Zealand

Abstract

Merkel cell tumour: clinical behaviour and treatmentW e have reviewed 30 reports of Merkel cell tumour and described a further five cases in order to establish a database and from this more clearly dejine the biology of this tumour, prognostic factors that govern outcome, and optimal management. After excision alone of the primary lesion, local recurrence occurred in 39 per cent of patients and regional failure occurred in 46per cent. In contrast, inpatients treated bji excision plus prophylactic treatment (adjuvant node dissection andlor adjuvant radiation), local recurrence occurred in 26per cent and regional failure in 22 per cent. Locoregional recurrence carried an ominous signijkance with 67 per cent of patients subsequently dying of the disease. For patients who either presented with regional disease or later developed regional disease, the best outcome (44 per cent survival with mean follow-up of 40 mont}is~ was obtained following treatment by therapeutic node dissection with or without radiation. In contrast, treatment of' regional disease with radiation alone was associated with only a 20 per cent survival rate. Unfavourable prognostic factors included young age, lesions sited in the head and neck or trunk, male sex, and the presence of locoregional failure andlor systemic disease. W e conclude that Merkel cell tumours behave in a similar manner to the aggressive variants of melanoma and that minimal treatment consists of wide surgical resection of the primar-y lesion (with a margin of 2.5-3 cm) coupled with resection and probably also radiation of regional disease iJ' present. In addition, consideration should be given to prophylactic node dissection in node negative patients, especially in those patients with unfavourable prognostic factors. 138 0007-1323/91/020138-05 ic) 199 1 Butterworth-Helnemann Ltd

Thyroid Surgery in the Tropics

“…Papillary is the commonest thyroid cancer in iodine‐replete south‐east (SE) Asian countries such as Malaysia 43 and Hong Kong 45,46 . A study of thyroid cancer in Auckland (1969–1987) reported that thyroid cancer is more common in Polynesians born in the Pacific than in Caucasians or Maoris born in New Zealand 47 . The incidence is also high in the Pacific Island state of New Caledonia.…”

Sonographic appearance of primary small bowel carcinoid tumor

“…To our knowledge, US demonstration of SBCT has not been precisely described previously. In most studies, the diagnosis was done only at laparotomy for nonspecific abdominal symptoms or was an incidental finding during surgery or autopsy [1,2,10,13,14].…”

A systematic review of diagnostic procedures to detect midgut neuroendocrine tumors

“…In accordance with Lauffer et al's 79 observation, the mean/median onset age reported by numerous investigators occurs more frequently in patients during their sixth and seventh decades. At least four studies have, nonetheless, reported a mean/median onset age during the fourth and fifth decades 64, 66, 67, 75. Almost a fourth of the affected patients included in our review presented with liver or nodal metastasis at diagnosis.…”

“…Fifteen studies presented clear descriptions of the diagnostic procedures and provided adequate information about diagnostic yields 59–63, 65–76, calculated for each study and as a pooled value. The diagnostic yield of an endoscopy was described in five studies 60, 65, 71–73, that of intestinal contrast radiology in four 62, 67, 70, 73, and that of video capsule endoscopy in one 72. The pooled diagnostic yields of these three procedures were similar as they were, respectively, 56.0% (range 0–100%), 51.6% (range 5–100%), and 60% (range NA) ( P = 0.702).…”

“…These patients could undergo directly to Octreoscan if 5‐HIAA or serum Chromogranin A is positive or if they have associated symptoms such as dyspepsia, nausea, vomiting, and chronic abdominal pain 70, 72, 74. On the other hand, upper GI endoscopy can be considered a first‐line procedure for patients with upper GI symptoms or overt gastrointestinal bleeding 60, 65, 71–73 while double contrast intestinal radiography is advisable if small bowel obstruction is suspected 62, 67, 70, 73. Video capsule endoscopy is a priority exam when there is occult gastrointestinal bleeding 72.…”