Neuroendocrine neoplasms of the lung

Primary Pulmonary Carcinoid Tumor: A Long-term Single Institution Experience

OBJECTIVES

Primary carcinoid tumors of the lung are rare tumors which comprise approximately 0.5% to 5% of all lung malignancies in adults and roughly 20% to 30% of all carcinoid tumors. The purpose of this retrospective, descriptive study was to describe the incidence, characteristics, and outcomes of patients treated for primary pulmonary carcinoid tumor at a single institution.

MATERIALS AND METHODS

All patients with a diagnosis of primary pulmonary carcinoid tumor treated from 1989 to 2009 were reviewed. Data collected included demographics, pathology, tobacco use, clinical presentation, tumor location, tumor spread, treatment, and survival.

RESULTS

There were 59 cases of pulmonary carcinoid tumors: 47 typical (80%) and 12 atypical (20%). All but 4 patients underwent surgery, including 54 (92%) lung-sparing resections and 1 pneumonectomy. Five of 55 patients received concurrent adjuvant chemoradiation therapy; 4 patients with atypical and 1 with typical histology. Three additional patients with atypical carcinoid were treated only with adjuvant radiotherapy, palliative radiotherapy, or palliative chemotherapy, respectively. The Kaplan-Meier 5- and 10-year overall survivals were both 80% within the entire population. In the 88% of patients who achieved complete remission, disease-free survival was 98%. A review of a large series from the literature is also presented.

CONCLUSIONS

Surgical resection was primary and adequate therapy for most typical carcinoid tumors with high overall survival and disease-free survival. Adjuvant chemotherapy or radiotherapy might be considered for patients with atypical carcinoid tumors who present with adverse pathologic findings.

Clinico-pathologic study of pulmonary carcinoid tumours--a retrospective analysis and review of literature

OBJECTIVE

To determine the characteristic clinico-pathologic features of pulmonary carcinoid tumours in India.

METHODS

Retrospective analysis of the clinico-pathologic and radiologic data of patients with pulmonary carcinoid tumours from the department of Pulmonary Medicine of the Christian Medical College, a tertiary care teaching hospital in Southern India, over a study period of 3 years (2001-2004).

RESULTS

There were 25 cases of pulmonary carcinoid tumours: typical 22 (88%) and atypical 3 (12%). The ratio of female to male was 0.8:1. There were 3 smokers (all of whom were males) in the typical carcinoid group and none in the atypical carcinoid group. Haemoptysis and cough were the commonest presenting symptoms. The common radiologic findings were post-obstructive pneumonitis or atelectasis, and mass lesion. Carcinoid syndrome was not present in any patient. Most of the tumours were central (n=23; 92%) and in the main bronchi (n=13; 52%). The most common site was the right main bronchus (n=9; 36%). Diagnosis was made by flexible bronchoscopy and bronchial biopsy in 23 patients (92%). The tumour bled significantly following biopsy in most patients; however, there was no mortality, and only 1 patient required blood transfusion. Surgical option was offered to most; 13 patients (52%) had pneumonectomy and 4 patients (16%) had lobectomy. A review of large series from the literature is also presented.

CONCLUSION

The clinico-pathologic and radiologic features of pulmonary carcinoid tumours are presented. We report the first series of pulmonary carcinoid tumours from India.

Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification

BACKGROUND

Pulmonary carcinoid tumors represent a group of malignant neoplasms comprised of neuroendocrine cells. In 1999, the World Health Organization (W.H.O.) proposed the definitive classification of neuroendocrine tumors based on the criteria from Travis and associates. The W.H.O. described two different groups of carcinoid tumors: typical carcinoids (TC) and atypical carcinoids (AC). Few reports have reviewed their data according to the current classification, and therefore, prognosis and standard therapy for TC and AC are still uncertain.

METHODS

From 1980 to 2001, 98 pulmonary resections have been performed for primary bronchial carcinoid tumors in our Thoracic Department of the University of Milan. We reviewed original histology using the current W.H.O. criteria and identified 88 patients with TC and 10 with AC. We reviewed the outcomes in each group.

RESULTS

The 5 year-overall survival rate was 91.9% for TC and 71% for AC. The 10-year overall survival rate was 89.7% for TC and 60% for AC. The 5-year TNM-related survival rates in the TC group were: IA-B, 100%; IIA-B, 75%; and IIIA, 50%. At 10 years, they were: IA-B, 100%; IIA-B, 75%; and IIIA, 0%. The 5-year survival rates in the AC group were: IA-B, 100%; IIA-B, 100%; and IIIA, 0%. At 10 years, they were: IA-B, 100%; IIA-B, 66%; and IIIA, 0%.

CONCLUSIONS

Prognosis is favorable for both subtypes in the early stage. Advanced stages are related to better prognosis in TC. Recurrences rate is worse in the AC subtype. Our data suggest avoiding limited resections when feasible in AC. Parenchyma-sparing resections should be encouraged in TC.

Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature

OBJECTIVE

To determine the characteristic features and outcome of pulmonary carcinoid tumors in Israel.

METHODS

Retrospective analysis of the clinicopathologic data and outcome of patients from four major hospitals in Israel in the last 20 years.

RESULTS

There were 142 cases of pulmonary carcinoid tumors: typical (n = 128) and atypical (n = 14). We calculated an annual incidence of about 2.3 to 2.8 cases per 1 million population. The ratio of female to male patients was 1.6:1. The prevalence of smoking was similar to the general population in patients with typical carcinoids and twice as high in the atypical group. Bronchial obstruction was the cause of most of the presenting symptoms and signs and included obstructive pneumonitis, pleuritic pain, atelectasis, and dyspnea (41%). Carcinoid syndrome was extremely rare and occurred in only one patient with metastatic disease. Most of the tumors (68%) arose in the major bronchi. Diagnosis was made using fiberoptic bronchoscopy in 52% of patients without evidence of endobronchial hemorrhage. Nodal involvement and distant metastases occurred in 57% and 21%, respectively, in the atypical group, and 10% and 3%, respectively, in the typical group. The treatment of choice was surgical: lobectomy (56%) or pneumonectomy (16%). The respective 5-year survival rates for patients with typical and atypical tumors were 89% and 75% (not significant), and the 10-year survival rates were 82% and 56% (p < 0.05). A review of large series from the literature is presented.

CONCLUSION

Pulmonary carcinoid is an uncommon tumor in the Israeli population. With early diagnosis and aggressive surgical therapy, long-term prognosis is excellent.