Primary renal neuroendocrine tumors:report of five cases and review of the literature / 中华泌尿外科杂志

Objective To analyze the features of diagnosis, treatment and prognosis of primary renal neuroendocrine tumors, and to improve the understanding of primary renal neuroendocrine tumors. Methods From January 2008 to June 2015, 5 cases of primary renal neuroendocrine tumors were hospitalized and their data was analyzed retrospectively, with 1 male 4 females, aged 40-73 years with the middle age of 48 years.Tumors were all located in the left kidney, whose diameters arranged from 4 to 9 cm, with an average of 6.5cm.One case presented with hematuria, one case was identified because of abdominal pain, and the other three cases were identified via physical examination.Four cases underwent a renal contrast-enhanced ultrasound, which indicated a medium-hypoechoic mass in three cases and a hyperechoic mass in one case.All five cases underwent CT scan, presenting irregularly shape and density. Calcification was found in three cases on plain scanning.Significantly heterogeneous enhancement was found in three cases and moderate heterogeneous enhancement was found in one case on enhanced scanning. Results All five cases underwent operations, with two cases undergoing radical nephrectomy and three cases undergoing partial nephrectomy.Pathological examination showed three cases of tumor cells arranged in a nest slug or ribbon-like infiltrative growth, with no or rare mitosis and no necrosis, which is consistent with renal carcinoids.Three out of 4 renal hilar lymph nodes containing tumor cells were identified in one case. The tumor cells in another case exhibited a ribbon-like arrangement, with some round nuclei, no significant atypia, and rare mitosis, which is consistent with renal atypical carcinoid.Two out of two renal hilar lymph nodes containing tumor cells were identified in this case. The tumor tissue of one case showed morphologically uniform, medium-sized cells arranged in nest slug form with necrosis, a high nuclear cytoplasm ratio, an obvious allotype and frequent mitosis, which is consistent with renal small cell carcinoma.The immunohistochemistry of the five cases indicated synaptophysin( Syn) and chromogranin A ( CgA) positive in varying degree.One case of renal carcinoid relapsed approximately 78 months after partial nephrectomy, following with radical surgery.The other two cases were followed up for 8 or 27 months and no recurrence or metastasis was detected.One case of renal atypical carcinoid was followed up for 4 months after radical nephrectomy and no recurrence or metastasis was detected.One case of renal small cell carcinoma died of multiple organ failure 11 months after radical nephrectomy plus hepatic metastatic carcinoma radio-frequency ablation approximately.Conclusions Primary renal neuroendocrine tumors are rare clinically. Renal neuroendocrine tumors may be expressed as carcinoid, atypical carcinoid or small cell carcinoma, and the clinical manifestations, pathological characteristics and prognosis varied.Primary renal carcinoids may be treated by surgery with a nice prognosis.Patients with primary renal small cell carcinoma require comprehensive treatment, and their prognosis is poor.

Atypical carcinoid of the esophagus.

Occurrence of carcinoid tumors in the esophagus is exceedingly rare. We present a case of an atypical carcinoid in the mid esophagus in a 56-year-old male, presenting with dysphagia. Esophagectomy was performed followed by postoperative chemotherapy. Histopathological and immunohistochemical studies were carried out. The patient succumbed to liver and lung metastasis, 6 months after the initial diagnosis, highlighting the poor prognosis of the condition.

Tumor carcinoide pulmonar: A propósito de un caso / The Pulmonary Carcinoid Tumor. A Case Report

El Tumor Carcinoide es un tipo de tumor cancerígeno formado por células neuroendocrinas. Representa el 1 al 2% de todos los tumores. En el pasado, fueron agrupados en una categoría de neoplasias denominada adenomas bronquiales. Se los consideraba benignos o poco agresivos. Se clasifican según su ubicación en centrales y periféricos y de acuerdo a su histología, dependiendo del número de mitosis y la presencia o no de necrosis, en típicos y atípicos. Tienen una gran variedad de presentación clínica, con diferentes grados de agresividad y pronóstico. Generalmente su diagnóstico es tardío. Nuestro objetivo fue presentar un caso pediátrico de Tumor Carcinoide pulmonar, central y típico.

The pulmonary carcinoid tumor (CT) is a type of cancerous tumor composed of neuroendocrine cells. It represents 1 or 2% of all pulmonary tumors. In the past, these tumors were grouped into a category of neoplasias called bronchial adenomas. They are considered benign or little aggressive. They are classified in central and peripheral tumors depending on their location and in histologic typical and atypical tumors depending on the number of mitosis and the presence or absence of necrosis. They have a wide variety of clinical presentation, with different degrees of aggressiveness and prognosis. The diagnosis is usually late. Our purpose was to present a pediatric case of central and typical pulmonary carcinoid tumor.

Morphologic Analysis of Pulmonary Neuroendocrine Tumors

BACKGROUND: Few studies on how to diagnose pulmonary neuroendocrine tumors through morphometric analysis have been reported. In this study, we measured and analyzed the characteristic parameters of pulmonary neuroendocrine tumors using an image analyzer to aid in diagnosis. METHODS: Sixteen cases of typical carcinoid tumor, 5 cases of atypical carcinoid tumor, 15 cases of small cell carcinoma, and 51 cases of large cell neuroendocrine carcinoma were analyzed. Using an image analyzer, we measured the nuclear area, perimeter, and the major and minor axes. RESULTS: The mean nuclear area was 0.318+/-0.101 microm2 in typical carcinoid tumors, 0.326+/-0.119 microm2 in atypical carcinoid tumors, 0.314+/-0.107 microm2 in small cell carcinomas, and 0.446+/-0.145 microm2 in large cell neuroendocrine carcinomas. The mean nuclear circumference was 2.268+/-0.600 microm in typical carcinoid tumors, 2.408+/-0.680 microm in atypical carcinoid tumors, 2.158+/-0.438 microm in small cell carcinomas, and 3.247+/-1.276 microm in large cell neuroendocrine carcinomas. All parameters were useful in distinguishing large cell neuroendocrine carcinoma from other tumors (p=0.001) and in particular, nuclear circumference was the most effective (p=0.001). CONCLUSIONS: Pulmonary neuroendocrine tumors showed nuclear morphology differences by subtype. Therefore, evaluation of quantitative nuclear parameters improves the accuracy and reliability of diagnosis.

Primary carcinoid tumor of the kidney: Case report and brief review of literature.

Primary carcinoid tumor of the kidney is an extremely uncommon tumor. As a consequence, very little is known about its histogenesis, clinicopathologic features and prognosis. We herein describe a case of renal carcinoid with atypical features.

Primary neuroendocrine carcinoma of thymus: A rare cause of Cushing's syndrome.

Thymomas constitute majority of the thymic neoplasms. In contrast, neuroendocrine tumors (carcinoid and neuroendocrine carcinoma) of thymus are extremely rare. Thymic carcinoids may present rarely with Cushing's syndrome due to the ectopic production of adrenocorticotropic hormone (ACTH). Recognition of this association is imperative for appropriate management of patients. We describe three cases of rare atypical carcinoid tumor (neuroendocrine carcinoma) of the thymus. Case 1, of a 26-year-old man presenting with Cushing's syndrome, case 2 - a 23-year-old female with Cushingoid features, and Case 3 - a 39-year-old man complaining of progressively worsening dyspnea. Computed tomography (CT) scans of chest in all three patients revealed anterior mediastinal mass. Excision of tumors and histological examination of the three tumors showed a carcinoid tumor with nuclear pleomorphism, increased mitotic activity and focal necrosis. The features suggested a diagnosis of atypical carcinoid tumor in all the three cases. The tumor cells in Cases 1 and 2 showed focal immunohistochemical staining for ACTH. Atypical carcinoid (neuroendocrine carcinoma, well-differentiated and moderately-differentiated) of the thymus is a rare thymic tumor which carries a worse prognosis compared to thymoma and requires aggressive therapy. Hence, an accurate diagnosis is essential.

A Case Report of Atypical Rectal Carcinoid / 대한소화기내시경학회지

Carcinoid tumors arise from enterochromaffin cells of neural crest origin. Rectal carcinoid tumors make up 1 to 2% of all rectal tumors. Approximately 50% of rectal carcinoid tumors are found incidentally on routine endoscopy, and they are asymtomatic. Rectal carcinoid is easily diagnosed by the characteristic submucosal tumor with yellowish color. There have been, however, some rare cases where the rectal carcinoid tumor was not easily diagnosed because of its atypical feature. We report a case of atypical rectal carcinoid tumor misdiagnosed as rectal cancer on endoscopic finding: this atypical gross morphology on endoscopy may be due to atypical histopathologic findings.

A Case of an Atypical Carcinoid Tumor Arising in Ulcerative Colitis / 대한소화기내시경학회지

Ulcerative colitis is a chronic inflammatory bowel disease manifested by diffuse continuous mucosal and submucosal inflammation. Adenocarcinoma of the colon may be complicated in the long-standing, extensive ulcerative colitis. But the case of an atypical carcinoid tumor arising in the chronic ulcerative colitis has been very rarely reported. A case was experienced involving a 54-year-old woman with chronic ulcerative pancolitis that was complicated by an atypical carcinoid tumor of the sigmoid colon. A small, flat, elevated lesion was found at the sigmoid colon, 8 years after the initial diagnosis of ulcerative colitis had been made. The microscopic finding of the lesion showed the nest of moderately differentiated, medium sized cells with large nuclei. The immunohistochemical stains for cytokeratin, NSE, chromogranin A, and synaptophysin were positive.The patient was treated with a total colectomy accompanied with an ileostomy, and is now in a very favor able state of recovery.

Fine Needle Aspiration Cytology of Atypical Carcinoid Tumor of the Lung: 2 Cases Report / 대한세포병리학회지

Two cases of pulmonary atypical carcinoid tumor were diagnosed by fine needle aspiration cytology. Although the cytologic features of atypical carcinoid tumor have been relatively well described, it is easy to confuse atypical carcinoid tumor with typical carcinoid tumor, small cell carcinoma and adenocarcinoma of the lung. Atypical carcinoid tumor has been recognized as a distinct variant of pulmonary neuroendocrine carcinoma, with characteristic histopathologic and clinical features that separate it from both carcinoid and small cell carcinoma. The distinction of atypical carcinoid tumor from small cell carcinoma has important prognostic and therapeutic implications. The cytologic characteristics of atypical carcinoid tumor included polygonal to fusiform cells with a variable amount of lacy cytoplasm, oval nuclei with coarsely dispersed chromatin and frequent nucleoli, and mild pleomorphism. The malignant cells were arranged either in acinus-like clusters or in epithelial sheets.

A Case of Bronchopulmonary Atypical Carcinoid Tumor with Liver Metastasis / 결핵

Bronchial carcinoid tumors are uncommon, constituting approximately 5% of all primary lung cancers. Carcinoid tumors belong to the calss of neuroendocrine tumors that consist of cells that can store and secrete neuramines and neuropeptides. Neuroendocrine tumors of the lung include three pathologic types: a low-grade malignancy, the so-called "typical carcinoid", a more aggressive tumor, the "atypical carcinoid" and the most aggressive malignant neoplasm, the small-cell carcinoma. Atypical carcinoid tumor, have a higher malignant potential, is more commonly peripheral than is the typical carcinoid tumor. Histologic features would characterize a carcionoid as hitologically atypical: increased mitotic activity, pleomorphism and irregularity of neuclei with promonent nucleoli, hyperchromatin, and abnormal nuclear-cytoplasmic ratio, areas of increased cellularity with disorganization of architecture, and areas of tumor necrosis. Metastatic involvement of regional lymph nodes and distant organ is common. The prognosis is related to size of the tumor, typical or atypical appearance, endoluminal or extraluminal growth, vascular invasion, node metastasis. Pulmonary resection is the treatement of choice for bronchial carcinoid. We experienced one case of bronchopulmonary atypical carcinoid tumor. In the case, radiologic study showed solitary lung mass with liver metastasis and the level of 5-HIAA was elevated. There was no history of cutaneous flushing, diarrhea, valvular heart disease. The authors reported a case of brochopulmonary atypical carcinoid tumor with review of literatures.

Primary Atypical Carcinoid Tumor of Liver: A case report

Primary hepatic carcinoid tumors are extremely rare although the liver is a frequent site of metastases from intestinal carcinoids. Recently we investigated a case of primary hepatic atypical carcinoid in a 47-year-old man who had infested with Clonorchis sinensis for 20 years. The resected right lobe of the liver was almost completely occupied by a huge tumor, measuring 20 x 19 x 12 cm. The cut surfaces of the mass were solid, soft and pale yellow, accompanied by several small satellite nodules, measuring up to 1.5 cm in diameter. Microscopically, the tumor consisted of polygonal to columnar cells with eosinophilic granular cytoplasm forming Lym-numerous small acini and large trabeculae. Their nuclei were round to polygonal with coarse stone chromatin, had obscure to small nucleoli and frequent mitoses. There were multiple necrotic foci of varing sizes. The surrounding dilated bile ducts contained several degenerating worms on in of Clonorchis sinensis. The tumor cells were argyrophil-positive but argentaffin-negative. Immunohistochemically, the tumor cells were positive for cytokeratin, chromogranin and somatostatin but were negative for CEA, AFP, insulin, glucagon, ACTH, growth hormone and volve-prolactin. Ultrastructually, the tumor cells contained variable-sized numerous electron dense of neurosecretory granules.

Atypical Carcinoid of the Larynx: A report of two cases

Atypical laryngeal carcinoid is a rare tumor with a poor prognosis, mostly occurring in the supraglottic larynx. It is a subtype of neuroendocrine carcinoma which should be separated from typical carcinoid and small cell carcinoma. The histogenesis and standardized classification of laryngeal neuroendocrine carcinoma have not been clearly defined. In this report, we present two cases of atypical laryngeal carcinoid, one occurring in a 67 year old male and the other in a 54 year old female. Indirect laryngoscopy revealed a polypoid supraglottic mass, approximately 3 cm in diameter. Microscopically, each case showed a moderate degree of pleomorphism, tumor necrosis and frequent mitoses. The immunohistochemistry revealed a strong positive reaction for chromogranin, neuron specific enolase and cytokeratin. Each patient had distant metastasis, noted within 4 months after resection (liver and stomach), and died postoperatively at 5 and 20 months, respectively. A brief review of the literature concerning the biological behavior, histogenesis and pathology of atypical laryngeal carcinoid was performed.