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Montminy EM, Zhou M, Maniscalco L, Abualkhair W, Kim MK, Siegel RL, Wu XC, Itzkowitz SH, Karlitz JJ. Contributions of Adenocarcinoma and Carcinoid Tumors to Early-Onset Colorectal Cancer Incidence Rates in the United States. Ann Intern Med 2021; 174:157-166. [PMID: 33315473 DOI: 10.7326/m20-0068] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early-onset colorectal cancer (EOCRC) incidence rates (IRs) are rising, according to previous cancer registry analyses. However, analysis of histologic subtypes, including adenocarcinoma (the focus of CRC screening and diagnostic testing) and carcinoid tumors (which are classified as "colorectal cancer" in SEER [Surveillance, Epidemiology, and End Results] databases but have a distinct pathogenesis and are managed differently from adenocarcinoma), has not been reported. OBJECTIVE To assess EOCRC IRs and changes in IRs over time, stratified by histology. DESIGN Retrospective analysis. SETTING Yearly IRs according to SEER 18 data from 2000 to 2016 on age-specific colon-only, rectal-only, and combined-site CRC cases, stratified by histology ("overall" CRC [all histologic subtypes], adenocarcinoma, and carcinoid tumors) and age. PATIENTS 119 624 patients with CRC. MEASUREMENTS IRs per 100 000 population, changes in 3-year average annual IRs (pooled IRs from 2000 to 2002 vs. those from 2014 to 2016), and annual percentage change (APC) in persons aged 20 to 29, 30 to 39, 40 to 49, and 50 to 54 years. RESULTS The steepest changes in adenocarcinoma 3-year average annual IRs were for rectal-only cases in persons aged 20 to 29 years (+39% [0.33 to 0.46 per 100 000]; P < 0.050) and 30 to 39 years (+39% [1.92 to 2.66 per 100 000]; P < 0.050) and colon-only cases in those aged 30 to 39 years (+20% [3.30 to 3.97 per 100 000]; P < 0.050). Corresponding APCs were 1.6% (P < 0.050), 2.2% (P < 0.050), and 1.2% (P < 0.050), respectively. In persons aged 40 to 49 years, 3-year average annual IRs increased in both colon-only (+13% [12.21 to 13.85 per 100 000]; P < 0.050) and rectal-only (+16% [7.50 to 8.72 per 100 000]; P < 0.050) subsites. Carcinoid tumors were common, representing approximately 4% to 20% of all colorectal and 8% to 34% of all rectal cancer cases, depending on age group and calendar year. Colon-only carcinoid tumors were rare. Colorectal carcinoid tumor IRs increased more steeply than adenocarcinoma in all age groups, thus affecting the contribution of carcinoid tumors to overall cancer cases over time. These changes were driven by rectal subsites and were most pronounced in persons aged 50 to 54 years, in whom rectal carcinoid tumors increased by 159% (2.36 to 6.10 per 100 000) between 2000 to 2002 and 2014 to 2016, compared with 10% for adenocarcinoma (18.07 to 19.84 per 100 000), ultimately accounting for 22.6% of all rectal cancer cases. LIMITATION Population-based data. CONCLUSION These findings underscore the importance of assessing histologic CRC subtypes independently. Doing so may lead to a better understanding of the drivers of temporal changes in overall CRC incidence and a more accurate measurement of outcomes from efforts to reduce adenocarcinoma risk, and can guide future research. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Eric M Montminy
- Tulane University School of Medicine, New Orleans, Louisiana (E.M.M., W.A.)
| | - Meijiao Zhou
- Louisiana State University Health Sciences Center, New Orleans, Louisiana (M.Z., L.M., X.W.)
| | - Lauren Maniscalco
- Louisiana State University Health Sciences Center, New Orleans, Louisiana (M.Z., L.M., X.W.)
| | - Wesal Abualkhair
- Tulane University School of Medicine, New Orleans, Louisiana (E.M.M., W.A.)
| | - Michelle Kang Kim
- Icahn School of Medicine at Mount Sinai, New York, New York (M.K.K., S.H.I.)
| | | | - Xiao-Cheng Wu
- Louisiana State University Health Sciences Center, New Orleans, Louisiana (M.Z., L.M., X.W.)
| | - Steven H Itzkowitz
- Icahn School of Medicine at Mount Sinai, New York, New York (M.K.K., S.H.I.)
| | - Jordan J Karlitz
- Southeastern Louisiana Veterans Healthcare System and Tulane University School of Medicine, New Orleans, Louisiana (J.J.K.)
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2
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Wang YZ, Diebold A, Boudreaux P, Raines D, Campeau R, Anthony L, Woltering E. Surgical Treatment Options for Rectal Carcinoid Cancer: LocalversusLow Radical Excision. Am Surg 2020. [DOI: 10.1177/000313481408000120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Yi-Zarn Wang
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
| | - Anne Diebold
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
| | - Philip Boudreaux
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
| | - Daniel Raines
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Medicine, and
| | - Richard Campeau
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Radiology, Louisiana State University Health Science Center, New Orleans, Louisiana; and
| | - Lowell Anthony
- Department of Medicine, The University of Kentucky, Lexington, Kentucky
| | - Eugene Woltering
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
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3
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de Mestier L, Lorenzo D, Fine C, Cros J, Hentic O, Walter T, Panis Y, Couvelard A, Cadiot G, Ruszniewski P. Endoscopic, transanal, laparoscopic, and transabdominal management of rectal neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2019; 33:101293. [PMID: 31326374 DOI: 10.1016/j.beem.2019.101293] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rectal neuroendocrine tumors (RNET) are rare tumors but their prevalence is constantly increasing due to a prolonged survival and rising incidence related to a growing number of colonoscopies and improved knowledge. Their main prognostic determinant is tumor stage. While most RNET are localized, their management should be tailored depending on the presence or absence of the factors predictive of lymph-node metastases including tumor size, endoscopic aspect, T stage, grade and lymphovascular invasion. Endoscopic ultrasonography is the most relevant technique for locoregional assessment. Low-risk RNET can be treated using advanced endoscopic resection techniques or transanal endoscopic microsurgery, in expert centers because they require technicity and experience. Conversely, radical surgery with lymphadenectomy should be proposed in the presence of any pejorative factor. The long-term evolution of RNET remains to be specified, and prospective studies should be conducted in order to determine the relevance of the current management strategies.
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Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France.
| | - Diane Lorenzo
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France
| | - Caroline Fine
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Jérôme Cros
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Olivia Hentic
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Thomas Walter
- Department of Digestive Oncology, ENETS Centre of Excellence, Edouard Herriot University Hospital, Lyon, France
| | - Yves Panis
- Université de Paris, France; Department of Colorectal Surgery, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France
| | - Anne Couvelard
- Université de Paris, France; INSERM UMR1149, Paris, France; Department of Pathology, ENETS Centre of Excellence, AP-HP, Bichat/Beaujon Hospital, Clichy, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré Hospital and Reims-Champagne-Ardennes University, Reims, France
| | - Philippe Ruszniewski
- Department of Pancreatology and Gastroenterology, ENETS Centre of Excellence, AP-HP, Beaujon Hospital, Clichy, France; Université de Paris, France; INSERM UMR1149, Paris, France
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4
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Ezekian B, Adam MA, Turner MC, Gilmore BF, Freischlag K, Leraas HJ, Mantyh CR, Migaly J. Local excision results in comparable survival to radical resection for early-stage rectal carcinoid. J Surg Res 2018; 230:28-33. [PMID: 30100036 DOI: 10.1016/j.jss.2018.04.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Controversy exists regarding current National Comprehensive Cancer Network guidelines, which recommend local excision for rectal carcinoids ≤2 cm and radical resection for tumors >2 cm. Given the limited data examining optimal surgical approach for these lesions, we queried a national database to determine the impact of extent of resection on survival. METHODS Patients undergoing treatment for clinical stage I and II rectal carcinoid (RC) were identified from the National Cancer Data Base (1998-2012). The association between extent of surgery, tumor size, and the likelihood of pathologic lymph node positivity was examined. Kaplan-Meier analysis was used to compare overall survival. RESULTS In total, 1900 patients were identified, of whom 1644 (86.5%) were treated with local excision, and 256 (13.5%) were treated with radical resection. A significant majority of patients with tumors ≤2.0 cm (89.0%) and nearly half with tumors 2.1-4.0 cm (44.8%) or >4.0 cm (45.8%) underwent local excision. Nodal positivity was correlated with tumor size (7.1% positivity with ≤2.0 cm tumors, 31.3% with 2.1-4.0 cm tumors, and 50.0% with >4 cm tumors). However, 5-y survival was equivalent between surgical approaches for tumors ≤2 cm (93.0% versus 93.0%) and tumors 2.1-4.0 cm (76.0% versus 76.0%). CONCLUSIONS We demonstrate in early-stage RC that nearly half of intermediate and large tumors are being treated with local excision outside National Comprehensive Cancer Network guidelines. In addition, radical resection does not appear to be associated with improved overall survival for tumors of any size. These findings suggest that the preferred approach to early-stage RCs without aggressive biological characteristics is local excision due to the decreased morbidity and mortality versus radical resection.
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Affiliation(s)
- Brian Ezekian
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Mohamad A Adam
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Megan C Turner
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian F Gilmore
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | | | | | - John Migaly
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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5
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Wang YZ, Beyer DT, Hall M. Obturator Canal Lymph Node Metastasis from Rectal Carcinoid Tumors: Total Mesorectal Excision May Be Insufficient. J Gastrointest Surg 2016; 20:1247-52. [PMID: 27000128 DOI: 10.1007/s11605-016-3128-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/07/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Optimal surgical treatment for small early rectal carcinoids is controversial. Large tumors (greater than 2 cm) and those with imaging evidence of lymph node metastasis are generally treated by low anterior resection (LAR) with total mesorectal excision (TME). We first observed and reported that midgut carcinoid with extensive mesenteric lymphadenopathy often develops alternated lymphatic drainage pathways. We hypothesize that rectal carcinoids have the same potential to develop alternated lymphatic pathways outside the mesorectal envelope, which allows tumor deposits to be missed by traditional TME. METHODS Twenty-two consecutive rectal carcinoid surgical patient charts were reviewed to determine if alternated lymphatic drainage occurred and resulted in extra-mesorectal metastasis. We attempted to identify any risk factor(s) that may lead to developing such alternated lymphatic drainage pathways. RESULTS Thirteen patients underwent initial LAR with TME (13/22, 59 %) and nine underwent a staged debulking for locoregional residual disease or regional/distant metastasis after previous resection (9/22, 41 %). Fourteen (14/22, 64 %) underwent radio-guided surgery in attempt to achieve a higher level of pelvic/distant metastatic disease detection and debulking. Six patients (6/22, 27 %) had obturator canal lymph node metastases confirmed histologically. CONCLUSIONS Based on our study, at least 27 % of rectal carcinoid patients may have extra-mesorectal metastasis that would be missed by the traditional TME. Radio-guided surgery can identify and remove such metastasis. The effect of having such extra-mesorectal metastasis and its surgical removal on long-term survival has yet to be determined.
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Affiliation(s)
- Yi-Zarn Wang
- Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 747, New Orleans, LA, 70112, USA.
| | - David T Beyer
- Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 747, New Orleans, LA, 70112, USA
| | - Michael Hall
- Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 747, New Orleans, LA, 70112, USA
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6
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Maranki J, Stavropoulos SN. Endoscopic Submucosal Dissection in the Colorectum: Not Just for Mucosal Lesions. Clin Gastroenterol Hepatol 2016; 14:582-4. [PMID: 26687914 DOI: 10.1016/j.cgh.2015.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Jennifer Maranki
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Stavros N Stavropoulos
- Division of Gastroenterology, Hepatology & Nutrition, Winthrop University Hospital, Mineola, New York; Temple University School of Medicine, Philadelphia, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York
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7
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Purysko AS, Coppa CP, Kalady MF, Pai RK, Leão Filho HM, Thupili CR, Remer EM. Benign and malignant tumors of the rectum and perirectal region. ACTA ACUST UNITED AC 2016; 39:824-52. [PMID: 24663381 DOI: 10.1007/s00261-014-0119-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although most rectal masses are histologically characterized as adenocarcinomas, the rectum and perirectal region can be affected by a wide variety of tumors and tumor-like conditions that can mimic the symptoms caused by rectal adenocarcinoma, including mucosal or submucosal rectal tumors such as lymphoma, gastrointestinal stromal tumor, leiomyosarcoma, neuroendocrine tumor, hemangioma, and melanoma, as well as tumors of the perirectal region such as developmental cyst, neurogenic tumor, osseous tumor, and other miscellaneous conditions. As a group, tumors of the rectum are considerably different from the group of tumors that arise in the perirectal region: they are most often neoplastic, symptomatic, and malignant, whereas tumors arising in the perirectal region are most commonly congenital, asymptomatic, and benign. Proctoscopy with biopsy is the most important method for the diagnosis of rectal tumors, but this procedure cannot determine the precise intramural extension of a rectal tumor and cannot accurately distinguish submucosal and intramural tumors from extramural tumors. Cross-sectional imaging, especially transrectal ultrasound and magnetic resonance imaging, allows evaluation of the entire bowel wall thickness and the perirectal tissues, helping further characterize these tumors. Recognition of the existence of these masses and their key clinical and imaging features is crucial for clinicians to accurately diagnose and appropriately manage these conditions.
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Affiliation(s)
- Andrei S Purysko
- Abdominal Imaging Section, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, JB3, Cleveland, OH, 44195, USA,
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8
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Metastatic Neuroendocrine Tumour in a Renal Transplant Recipient: Dual-Tracer PET-CT with (18)F-FDG and (68)Ga-DOTANOC in This Rare Setting. Nucl Med Mol Imaging 2015; 49:57-60. [PMID: 25767623 DOI: 10.1007/s13139-014-0297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022] Open
Abstract
Recipients of renal transplant are at increased risk of developing various malignancies, especially post-transplant lymphoproliferative disorder (PTLD) and skin cancers. Neuroendocrine tumours (NET) of the gastrointestinal tract have not been reported in this setting. Here we describe the case of a 75-year-old male who had undergone renal transplant 8 years back and now presented with significant weight loss and backache, clinically suspected as PTLD. (18)F-Fluordeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) showed hypermetabolic lesions in the liver and rectum, raising the suspicion of PTLD. However, biopsy from the liver lesion showed poorly differentiated NET. (68)Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI(3)-octreotide ((68)Ga-DOTANOC) PET-CT was then done, which confirmed the primary lesion in the rectum with liver metastases.
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9
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Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes. Gastrointest Endosc 2014; 80:144-51. [PMID: 24462168 DOI: 10.1016/j.gie.2013.11.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 11/20/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a paucity of data pertaining to the natural history and outcomes of patients with well-differentiated rectal carcinoids. OBJECTIVE To correlate endoscopic size with the natural history and outcome. DESIGN Retrospective study. SETTING Single tertiary referral center. PATIENTS Eighty-seven patients with endoscopically identified well-differentiated rectal carcinoid tumors. INTERVENTION Colonoscopy. MAIN OUTCOME MEASUREMENTS Prevalence of metastasis at diagnosis, disease progression, and survival. RESULTS Metastasis was present at diagnosis in 3%, 66%, and 73% of tumors measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. Metastasis was predicted with 100% sensitivity and 87% specificity using an endoscopic lesion size ≥9 mm. In patients without identified metastasis, 64% were identified during screening colonoscopy. Within this select cohort, subsequent metastasis was discovered only at distant extra pelvic sites, in 1.6%, 50%, and 100% of patients with tumors initially measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. The carcinoid related 5- and 10-year survival rates for locally confined disease were 96%. The corresponding survival rates for local and advanced metastatic disease were 60% and 35%, respectively. LIMITATIONS Subjective estimation of tumor size, mitotic index or Ki-67 labeling index not reported, and lack of formal and standardized baseline staging algorithm and surveillance program. CONCLUSIONS The clinical behavior of 11- to 19-mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, we propose to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.
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Liu J, Wang ZQ, Zhang ZQ, Chen X, Zhang Y. Evaluation of colonoscopy in the diagnosis and treatment of rectal carcinoid tumors with diameter less than 1 cm in 21 patients. Oncol Lett 2013; 5:1667-1671. [PMID: 23761832 PMCID: PMC3678599 DOI: 10.3892/ol.2013.1214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/08/2013] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to evaluate colonoscopy in the diagnosis and treatment of rectal carcinoid tumors with diameter <1 cm. Elevated lesions with normal mucosal appearance under colonoscopy were identified. Endoscopic ultrasound (EUS) was performed in 16 patients. Lesions diagnosed as rectal carcinoid tumors were resected by endoscopic mucosal resection (EMR). The diagnosis of specimens by EMR was confirmed by pathological examination. Immunohistochemical staining was undertaken and follow-up data were collected. Twenty-two lesions were found among the 21 cases. The majority of these were located within 10 cm of the anal opening. Twenty two cases with rectal carcinoids were diagnosed by EUS under colonoscopy and all cases were verified by pathological examination. The resection rate was 95.5% (21/22). Of the lesions, six were mucosal and 10 were submucosal. Immunohistochemistry was undertaken for carcinoid tumors. Histological patterns of rectal carcinoids revealed solid nests or trabecular patterns. Eleven cases were synaptophysin (SYN)-positive, 8 cases were neurone-specific enolase (NSE)-positive and 5 cases were chromogranin A (CgA)-positive. Colonoscopy combined with EUS is effective in the diagnosis and determination of small rectal carcinoids. Endoscopic treatment is effective for small-sized tumors. Pathology and immunohistochemistry remain the diagnostic gold standard.
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Affiliation(s)
- Jing Liu
- Department of Endoscopy of the South Building, The PLA General Hospital, Beijing 100853, P.R. China
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11
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Jeon SM, Lee JH, Hong SP, Kim TI, Kim WH, Cheon JH. Feasibility of salvage endoscopic mucosal resection by using a cap for remnant rectal carcinoids after primary EMR. Gastrointest Endosc 2011; 73:1009-14. [PMID: 21316666 DOI: 10.1016/j.gie.2010.12.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/20/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Secondary endoscopic treatment for remnant lesions of rectal carcinoid tumors after primary EMR or polypectomy is technically difficult because of fibrosis of residual tissues. EMR by using a cap (EMR-C), a method to resect the submucosal layer by suction by using a transparent cap, may be feasible as a salvage treatment. OBJECTIVE To assess the feasibility of salvage EMR-C. DESIGN Retrospective analysis. SETTING Tertiary academic health care system. PATIENTS Thirty-one patients who were referred for salvage treatment of a failed en bloc excision of rectal carcinoid tumors after primary EMR or polypectomy between January 2007 and December 2009. INTERVENTIONS Salvage EMR-C for remnant carcinoid tumors in the rectum. MAIN OUTCOME MEASUREMENTS Rate of complete resection, complications, length of procedure, and recurrence rate. RESULTS The mean age of the patients was 52.0±11.8 years (range 30-78 years). The mean tumor size was 8.9±3.2 mm (range 5.0-13.0 mm). The mean procedure time was 9.1±3.7 minutes, and clear resection margins were pathologically confirmed in all 31 patients. The most common complication of salvage EMR-C was bleeding (7 patients, 22.6%), which was successfully treated by hemoclipping in all cases. The 1-year follow-up colonoscopy and CT results for all patients were negative for recurrence. LIMITATIONS Retrospective design and limited cases at a single center. CONCLUSIONS EMR-C is a feasible salvage therapeutic option for failed en bloc excision after primary endoscopic treatment of rectal carcinoid tumors.
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Affiliation(s)
- Soung Min Jeon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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12
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Carcinoid tumor of the appendix: report on ten cases. Eur J Trauma Emerg Surg 2010; 37:491-3. [PMID: 26815420 DOI: 10.1007/s00068-010-0066-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 11/19/2010] [Indexed: 01/30/2023]
Abstract
AIM To conduct a retrospective analysis of the incidence and long-term outcomes of carcinoid tumor of the appendix in emergency appendectomies. METHODS From a histopathologic database of 2197 appendectomies from a single center, all appendiceal carcinoid tumors were identified and case notes reviewed. Demographic data, clinical presentation, histopathology, operative reports, and survival were scored and compared with those reported in the literature. RESULTS Ten patients (0.45%) with appendiceal carcinoid tumor were identified (2 male, 8 female; mean age, 29.2 years; age range, 14-56 years). In all cases, the clinical presentation resembled the symptoms of acute appendicitis. Open appendectomy was performed in all patients. All tumors were located at the tip of the appendix, with a mean diameter of 0.4 cm (range, 0.1-0.9 cm), and the mesoappendix was invaded in one patient. No patient had repeat surgery after the initial operation. After a mean follow-up period of 55 months (range, 26-82 months), all patients were alive and disease- and symptom-free. CONCLUSION To conclude, carcinoid tumors are extremely rare, and the diagnosis is often made after surgery. We emphasise the value of obtaining histopathological analysis of every removed appendix because visual examination does not always correlate with later pathological examination. Furthermore, small appendiceal carcinoids (<1 cm) have an excellent prognosis after appendectomy.
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