ABSTRACT
@#Objective To investigate the clinical features, diagnosis, treatment and prognosis of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by bronchopulmonary carcinoid. Methods Twenty patients (13 males and 7 females) with ectopic ACTH syndrome caused by bronchopulmonary carcinoid confirmed by surgical pathology were selected from March 2007 to May 2016 in our hospital. We collected and arranged the important clinical data of 20 patients and analyzed carefully. Results The mean age of 20 patients including 14 patients of typical carcinoid and 6 patients of atypical carcinoid was 38.85±15.31 years ranged 13-70 years. All patients had the typical clinical manifestation of Cushing's syndrome. All the thoracic lesions were located by thoracic computed tomography (CT) eventually. The concentration of serum cortisol and ACTH significantly decreased after surgery. Postoperative complications in 3 patients (15.00%) were severe pulmonary infection. Eighteen patients including 13 patients of typical carcinoid and 5 patients of atypical carcinoid were followed up. The median time of follow-up was 31.5 (12-122) months. There were 7 patients of stage Ⅰa, 1 patient of stage Ⅰb, 2 patients of stage Ⅱa and 8 patients of stage Ⅲa in the patients followed up. One patient underwent postoperative radiotherapy, and 4 patients with postoperative chemotherapy. During the follow-up period, one patient relapsed and there was no death. Conclusion Ectopic ACTH syndrome caused by bronchopulmonary carcinoid is a very rare disease. It is every difficult for clinicians to make early diagnosis and draw up plans of treatment without multidisciplinary collaboration. Chest CT is an important method of finding lesions and assessing the viability of surgery. Surgical treatment in early stage will be effective for this disease. And almost all of patients can achieve long-term survival after complete resection of tumors early.
ABSTRACT
Objective:We aimed to explore the clinical features, computed tomography (CT) findings, treatment, and prognosis of bronchopulmonary carcinoid. Methods:Clinical data of 31 patients with primary carcinoid tumor of the lung were retrospectively re-viewed. The prognostic factors were analyzed via Cox univariate and multivariate analyses. Results: Clinical symptoms included coughing or expectoration in 17 of the 31 cases, hemoptysis or blood-stained sputum in 7 cases, and chest pains or shortness of breath in 8 cases. Six cases were asymptomatic. The CT scans showed round or oval nodules with clear boundaries, and enhancement CT scans indicated mild, homogeneous enhancement. Immunohistochemistry results revealed the positive expression rates of synaptophy-sin (Syn), chromogranin A (CgA), and neuron-specific enolase (NSE) were 90.3%(28/31), 87.1%(27/31), and 90.3%(28/31), respec-tively. Therapy and prognosis results were as follows:28 of the total number of patients underwent surgery, among which 3 underwent postoperative adjuvant therapy, 2 received chemotherapy; and only 1 refused treatment. The 1-year overall survival rates were 100%(18/18) and 92.3%(12/13), whereas the 3-year survival rates were 94.4%(17/18) and 69.2%(9/13) in the typical and atypical carcinoid cases, respectively. Cox univariate analysis results revealed that lymphatic metastasis (P=0.02), tissue types (P=0.017), TNM stage (P=0.005), and therapies (P=0.01) were the prognostic factors. Cox multivariate analysis results showed that lymphatic metastasis (P=0.032) and tissue types (P=0.002) were the independent prognostic factors. Conclusion:Compared with other lung cancers, the bron-chopulmonary lung carcinoid has no special clinical manifestation in clinical and radiographic images. The diagnosis was mainly based on histopathology results. Surgery was the main and effective treatment, whereas chemotherapy and radiotherapy showed unsatisfactory results. The overall prognosis was satisfactory. However, the atypical carcinoid was inferior to the typical carcinoid in terms of progno-sis. Pathological typing and lymph node metastasis were significant prognostic factors.