Clinicopathological characteristics of rectal carcinoids
ABSTRACT Carcinoids are heterogeneous neuroendocrine tumors with malignant potential. The rectum is the third most common location for gastrointestinal carcinoids. We assessed the clinicopathological characteristics of rectal carcinoids.
A retrospective study of 203 patients treated for rectal carcinoids at the Asan Medical Center, Seoul, Republic of Korea from 1991 to 2007.
The patients were on average 51 (18-83) years old. The male-to-female ratio was 1.48:1. Over half (62.1%) of the patients were asymptomatic. The most frequent symptoms in the symptomatic patients were abdominal pain (11.1%) and hematochezia (10.7%). Local excision was applied to 92.1%, low anterior resection to 4.9%, and biopsy only to 3.0% of total patients. Initially, 4.4% presented with distant metastasis. Distant metastasis rates for tumors < or =1 cm, >1 to < or =2 cm, and >2 cm were 1.7% (3/177), 15.0% (3/20), and 50.0% (3/6), respectively. In the follow-up period, three patients showed recurrences. The size, lymphovascular invasion, perineural invasion, and T and N stages were associated with distant metastasis. The overall 5-year survival rate was 94.0%. The TNM stage and presence of lymphovascular invasion were associated with lower survival.
The chance that a rectal carcinoid will develop distant metastases increases as the tumor increases in size, lymphovascular invasion or perineural invasion is present, and T and N stages increase. The TNM stage and presence of lymphovascular invasion were associated with lower survival. Treatment plan should be chosen carefully considering above factors.
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ABSTRACT: Rectal carcinoids are an uncommon entity comprising only 1%-2% of all rectal tumors. Rectal carcinoids are frequently diagnosed during colonoscopy, but management after polypectomy is still controversial. The aims of this study were to review the surgical procedures for rectal carcinoids and to compare the outcomes of patients after different treatment modalities in a university hospital in Hong Kong. All rectal carcinoids diagnosed between January 2003 and September 2012 were reviewed retrospectively, including clinicopathological characteristics, their management, and surgical outcomes. There were 54 patients with a median age of 60 years, and 32 were males (59.3%). All patients underwent colonoscopy, and the most had rectal bleeding (53.7%). Two patients were diagnosed incidentally in the surgical specimens of rectal tissues. Eighteen patients were diagnosed to have rectal carcinoids after snaring polypectomy, and no further intervention was required. Twenty-five patients had local resection either by means of transanal resection or transanal endoscopic operation. Radical resection was performed in seven patients in which one had T3N1 disease and the others did not have any lymph node metastasis. In the median follow-up of 30 months (10-108 months), there was no recurrence in the "incidental" or post-polypectomy group. However, two patients with transanal resection and two patients with radical resection developed hepatic metastases after 13-24 months post-treatment. The 5-year overall survival was 100% in patients having snaring polypectomy only, 83% for those with local resection, and 63% in patients who underwent radical surgery (p = 0.04). Our data suggested that that local resection was an effective treatment for small rectal carcinoids and generally brought about good oncological and surgical outcomes. For larger tumors, radical resection seemed to provide acceptable oncological outcomes. Regular surveillance with colonoscopy and endorectal ultrasound is highly recommended for high-risk patients for long-term management. By sharing our experience, we hope to provide more evidence on the management on rectal carcinoids which, together with evidence from further studies, may guide us in the long-term management of these patients in the future.World Journal of Surgical Oncology 12/2015; 13(1). DOI:10.1186/s12957-015-0463-3 · 1.20 Impact Factor
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ABSTRACT: Background Paraneoplastic neurological syndromes (PNS) have frequently been described in patients with lung or breast cancer. However, some reports also described a correlation to carcinoid tumors, probably triggered via the excessive release of hormones. Case presentation We report the case of a 40-year-old woman that was diagnosed with a neuroendocrine neoplasm (NEN) of the rectum and multiple synchronous liver metastases ten years ago. She initially responded well to transarterial chemoembolization (TACE), resulting in prolonged disease stabilization. However, ten years after initial diagnosis the patient developed unspecific neurological symptoms that could not be classified by standard neurological diagnostic work-up. Special laboratory analysis revealed a high titer of anti-Ri (ANNA-2), a well-characterized antibody that is associated with paraneoplastic neurologic syndromes. The patient’s symptoms improved markedly after a 5-day-course of high-dose glucocorticoid therapy. To our knowledge, this is the first report of a Ri-positive PNS in a patient with hormone-negative rectal NEN. Conclusion PNS can complicate the patient’s clinical course, response to treatment, impact prognosis and even be interpreted as metastatic spread. However, owing to their rarity, the knowledge of these syndromes is very helpful in order to be able to provide evidence-based diagnostic and therapeutic approaches.BMC Cancer 09/2014; 14(1):691. DOI:10.1186/1471-2407-14-691 · 3.32 Impact Factor
Article: Neuroendokrine kolorektale Tumoren[Show abstract] [Hide abstract]
ABSTRACT: Die Inzidenz der kolorektalen neuroendokrinen Tumoren (NETs) ist in den letzten Jahrzehnten in den entwickelten Ländern deutlich angestiegen. Dies ist in erster Linie der zunehmenden Verbreitung der (Vorsorge-)Endoskopie geschuldet, die immer häufiger klinisch asymptomatische Tumoren entdeckt, möglicherweise aber auch einer häufigeren Diagnosestellung entsprechend der WHO-Klassifikation. Weniger als 1% der kolorektalen NETs produzieren Serotonin, sodass diese Tumoren fast nie mit einem „Karzinoidsyndrom“ auffallen. Zur Festlegung der adäquaten Therapiestrategie ist ein exaktes und standardisiertes klinisch-pathologisches Staging unerlässlich, das den Tumortyp (gut – schlecht differenziert) und prognostische Risikofaktoren (Größe, Infiltrationstiefe, Angioinvasion, Lymphknotenbefall, Fernmetastasierung) umfasst. Schlecht differenzierte kolorektale NETs sind bei Diagnosestellung häufig bereits metastasiert, sodass der chirurgischen Therapie häufig nur eine palliative Rolle zukommt. Gut differenzierte Tumoren von mehr als 2cm Größe haben ein hohes Risiko für eine (Lymphknoten-)Metastasierung; sie werden dementsprechend onkologisch radikal wie Adenokarzinome operiert. Die Mehrzahl der Kolon-NETs fällt in diese Gruppe. Tumoren kleiner 1cm – hauptsächlich im Rektum lokalisiert – metastasieren sehr selten und können in der Regel endoskopisch oder transanal lokal-chirurgisch abgetragen werden. Der Größenbereich zwischen 1 und 2cm stellt eine prognostische Grauzone dar: Hier muss unter Berücksichtigung der tumorspezifischen Risikofaktoren und der Komorbiditäten des Patienten eine individuelle und am besten gemeinsame interdisziplinäre Therapieentscheidung von Chirurg und Endoskopiker getroffen werden. The incidence of colorectal neuroendocrine tumors (NETs) is rising in developed countries primarily as a result of increased incidental detection by endoscopy and probably also due to a more adequate diagnosis according to the WHO classification. Less than 1% of colorectal NETs produce serotonin so that such tumors are practically never associated with a hormonal carcinoid syndrome. An exact clinico-pathological staging is of paramount importance for the therapeutic strategy and comprises the classification of the tumor type (well or poorly differentiated) and the assessment of established prognostic risk factors (depth of infiltration, vascular invasion, lymph node and distant metastases). Poorly differentiated colorectal NETs often present in an advanced, metastatic state, where surgical therapy is basically palliative. Well-differentiated tumors larger than 2cm have a high risk of metastatic spread and should be treated as adenocarcinomas by radical oncological surgical resection. This applies to the majority of colon NETs. Tumors smaller than 1cm, mainly locacted in the rectum, only rarely metastasize and are usually accessible for endoscopic treatment or transanal local surgery. Tumors between 1 and 2cm in size have an uncertain prognosis and additional risk factors and co-morbidities of the patient have to be considered for a suitable, multidisciplinary therapeutic decision. SchlüsselwörterNeuroendokrine Tumoren–Kolon–Rektum–Chirurgische Resektion–Endoskopie KeywordsNeuroendocrine tumors–Colon–Rectum–Resection–EndoscopyDer Chirurg 07/2011; 82(7):607-611. DOI:10.1007/s00104-011-2072-1 · 0.52 Impact Factor