• [Carcinoid tumors]

• Acromegaly caused by a growth hormone-releasing hormone-secreting carcinoid tumor: case report.

• Diagnostic, surgical and medical aspect of the midgut carcinoids.

• Carcinoid of the ileocaecal valve: a case report.

1
UI - 12063867
AU - Toth M; Pronai L; Nemeth AM; Tulassay Z
TI - [Carcinoid tumors]
SO - Orv Hetil 2002 May 12;143(19 Suppl):1087-92
Carcinoids are characteristically indolent, but heterogeneous tumors with respect to their site of origin, endocrine features, clinical manifestations and biologic behaviour. The authors summarize the current laboratory, endoscopic and radiologic methods used for the diagnosis of carcinoid tumors. Treatment modalities should be directed against the tumor and the hormonal excess state. The authors review the outcome of most frequently used therapies, including somatostatin-analogue and interferon treatment, chemotherapy, embolization, receptor-targeted radiotherapy and surgical intervention). Patients with carcinoid tumors, with or without carcinoid syndrome, are best managed by a multidisciplinary approach.

2
UI - 12015856
AU - Altstadt TJ; Azzarelli B; Bevering C; Edmondson J; Nelson PB
TI - Acromegaly caused by a growth hormone-releasing hormone-secreting carcinoid tumor: case report.
SO - Neurosurgery 2002 Jun;50(6):1356-9; discussion 1360
AD - Department of Surgery, Section of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5124, USA, talstad@iupui.edu
OBJECTIVE AND IMPORTANCE: We describe a patient with acromegaly and pituitary hyperplasia secondary to a growth hormone-releasing hormone-secreting gastrointestinal carcinoid tumor. This case report illustrates the importance of including this rare clinical syndrome in the differential diagnosis of acromegaly for patients with suspected or known neuroendocrine tumors. CLINICAL PRESENTATION: A 19-year-old, Asian-American, male patient with a 2-year history of a nonresectable, metastatic, intestinal carcinoid tumor presented with complaints of headaches, arthralgias, sweats, and changing features. The examination revealed a young subject with acromegalic features, without visual field deficits. Magnetic resonance imaging revealed a diffuse sellar mass that extended suprasellarly to compress the optic chiasm. Endocrinological studies demonstrated a growth hormone level of more than 100 ng/ml and an inappropriately elevated growth hormone-releasing hormone level. INTERVENTION: The patient underwent transsphenoidal resection of the pituitary mass for diagnostic and decompressive purposes. The pathological examination revealed pituitary hyperplasia, without evidence of an adenoma. Therapy with long-acting repeatable octreotide (Sandostatin LAR; Novartis AG, Basel, Switzerland) was initiated postoperatively, to further control the acromegaly and carcinoid tumor. The soft-tissue swelling resolved, and the patient remained free of headaches, arthralgias, and sweats at the 6-month follow-up examination. CONCLUSION: Ectopic acromegaly is a rare syndrome that must be recognized by neurosurgeons because its treatment differs from that of classic pituitary acromegaly. We describe a patient for whom this syndrome was documented with magnetic resonance imaging, endocrinological testing, and pathological examinations.

3
UI - 12027412
AU - de Vries H; Verschueren RC; Willemse PH; Kema IP; de Vries EG
TI - Diagnostic, surgical and medical aspect of the midgut carcinoids.
SO - Cancer Treat Rev 2002 Feb;28(1):11-25
AD - Department of Surgery, University Hospital Groningen, The Netherlands. vriesdeh@dz.nl
This review covers the incidence, prognosis, diagnosis and treatment of midgut carcinoids with emphasis on the surgical and peri-operative aspects. Midgut carcinoids are rare neuro-endocrine tumours which become manifest once they have metastasized to the liver. Treatment of metastatic disease may include radical resection but is usually palliative. The tumour grows relatively slow. Besides the biochemical effects resulting in the carcinoid syndrome, patients may suffer from mechanical mass effects of the tumour. Medical treatment can alleviate the biochemical effects of the tumour, but has a limited effect on tumour growth. The introduction of octreotide was a milestone in palliation of these symptoms and has led to more aggressive treatment protocols. Treatment aimed at cytoreduction of hepatic metastasis and diminished secretion of bioactive amines may achieve good palliation. Cytoreduction may be performed by means of surgery, hepatic arterial ligation, (chemo)embolization, cryosurgery, radio-frequency ablation, internal radiation or even liver transplantation. The role of these options will be discussed in this review. Copyright 2002 Published by Elsevier Science Ltd.

4
UI - 11824067
AU - Di Cataldo A; Greco S; Caldarella P; Lanteri R; Li Destri G; Licata A
TI - Carcinoid of the ileocaecal valve: a case report.
SO - Chir Ital 2001 Nov-Dec;53(6):879-82
AD - Cattedra di Chirurgia dell'Apparato Digerente, Policlinico Universitario, Universita degli Studi di Catania.
The authors present a case of carcinoid of the ileocaecal valve. The patient complained for over one year of mild pain in the right lower quadrant of the abdomen. Colonoscopy had shown hyperaemia on the colic side of the ileocaecal valve which appeared substenotic and biopsy revealed micronodules formed by chromogranin-A-positive neuroendocrine cells. Roentgenography of the small bowel and barium enema revealed a specular filling defect in the caecum and in the terminal ileum near the ileocaecal valve. Right hemicolectomy was performed and the definitive diagnosis was carcinoid of the ileocaecal valve. The tumour had spread to all layers of the intestinal wall and 4/19 lymph nodes were metastatic. The patient refused an oncological examination; however, three years after surgery there are no signs of recurrence. Carcinoids have been included in the APUD system and usually present endocrine activity. The 5-year survival of patients with gastrointestinal carcinoids is 80% when located in the appendix and rectum as against 50% in the stomach, jejunum and colon, because the localisation in the appendix and rectum is marked by clinical signs of appendicitis and rectal bleeding, which suggest diagnostic examinations useful for an early diagnosis. Radical operations according to the rules of oncologically correct surgery are the treatment of choice, while complementary treatments have yet to be codified.

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