Carcinoid tumor
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Carcinoid tumours are a type of neuroendocrine tumour that can occur in a number of locations. Carcinoid tumours arise from endocrine amine precursor uptake and decarboxylation (APUD) cells that can be found throughout the gastrointestinal tract as well as other organs (e.g. lung). In general, they are slow-growing tumours but are nevertheless capable of metastasising.
Clinical presentation
- can be variable, dependent on the location:
- carcinoid tumours involving the jejunum and ileum can be large at presentation but are usually found incidentally
- rectal carcinoids may cause pain
- gastrointestinal tract carcinoid can present as vague abdominal pain
- carcinoid syndrome: in 8% of patients with a carcinoid tumour 9
Pathology
Location
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gastrointestinal tract carcinoid (60-85% of all carcinoids) 11,12
- small bowel: ~40% of gastrointestinal carcinoids, mostly in the terminal ileum
- rectum (~22.5%)
- colon (~15%)
- appendix (~10%)
- stomach (~7.5%)
- pancreas (~7.5%)
- carcinoid tumours of the lung (~25% of all carcinoids)
- primary hepatic carcinoid
- ovarian carcinoid: accounts for 0.5% of carcinoid tumours and 0.3% of ovarian tumours 7
- thymic carcinoid
Markers
- 5-HIAA (5-hydroxyindoleacetic acid): usually suggests a functioning carcinoid tumour
- chromogranin A (CgA): considered a valuable tool in the diagnosis of neuroendocrine neoplasia in general 6
Radiographic features
CT/MRI
Refer to specific articles (above) for imaging characteristics.
Nuclear medicine
- gallium-68 octreotide PET/CT (e.g. Ga-68 DOTATATE) has shown improved accuracy for detection of neuroendocrine tumours relative to indium-111 pentetreotide (Octreoscan) SPECT/CT 13,14
- indium-111 octreotide (e.g. Octreoscan) SPECT/CT 15
- iodine-123 MIBG will also concentrate on carcinoid tumours, including the low percentage (~15%) that are negative with indium-111 octreotide 16
Treatment and prognosis
Complications
History and etymology
It was initially coined by Oberndorfer in 1907 as “karzinoide” to denote its resemblance to carcinoma 4.
-<li><a href="/articles/hepatic-carcinoid">primary hepatic carcinoid</a></li>- +<li><a href="/articles/hepatic-neuroendocrine-tumor">primary hepatic carcinoid</a></li>
-<li>gallium-68 octreotide PET/CT (e.g. <a href="/articles/gallium-68-dotatate">Ga-68 DOTATATE</a>) has shown improved accuracy for detection of neuroendocrine tumours relative to <a title="Octreotide scintigraphy" href="/articles/octreotide-scintigraphy">indium-111 pentetreotide (Octreoscan) SPECT/CT</a> <sup>13,14</sup>- +<li>gallium-68 octreotide PET/CT (e.g. <a href="/articles/gallium-68-dotatate">Ga-68 DOTATATE</a>) has shown improved accuracy for detection of neuroendocrine tumours relative to <a href="/articles/octreotide-scintigraphy">indium-111 pentetreotide (Octreoscan) SPECT/CT</a> <sup>13,14</sup>
Images Changes:
Image 21 CT (lung window) ( create )
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