Biology and management of the midgut carcinoid

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Midgut carcinoid tumors derive from gut entoderm. These tumors may cause a complex of symptoms comprising the carcinoid syndrome by secreting a wide variety of bioactive agents in addition to serotonin. Such symptoms generally follow metastases to the liver but may also occur in primary ovarian or retroperitoneal tumors. After localization and biochemical characterization, the bioactivity of these tumors should be blocked by octreotide, sometimes in combination with other pharmacologic antagonists, so that primary resection may be performed safely. If curative resection is impossible, then a cytoreductive management scheme should be employed that includes surgical debulking and hepatic arterial embolization, followed by palliation with octreotide.

References (99)

  • OberndorferS

    Karzenoide tumoren des duenndarms

    Frankf Zschr Path

    (1907)
  • GossetA et al.

    Tumeurs endocrines de l'appendice

    Presse Med

    (1914)
  • ErspamerV et al.

    Identification of enteramine, the specific hormone of the enterochromaffin cell system as 5-hydroxytryptamine

    Nature

    (1952)
  • LembeckF

    5-Hydroxytryptamine in carcinoid tumor

    Nature

    (1953)
  • MassonP

    Carcinoid tumours (argentaffin tumours) and nerve hyperplasia of the appendicular mucosa

    Am J Pathol

    (1928)
  • MassonP

    Neural proliferations in the vermiform appendix

  • DanischF

    Zur histogenese der sogenannten Appendix-Karzinoide

    Beitr Pathol Anat

    (1924)
  • PearseAGE

    5HT tryptophan uptake by dog thyroid ‘C’ cells and its possible significance in polypeptide hormone production

    Nature

    (1966)
  • PearseAGE

    Common cytochemical properties of cells producing polypeptide hormones, with particular reference to calcitonin and thyroid ‘C’ cells

    Vet Rec

    (1966)
  • ChengH et al.

    Origin, differentiation and renewal of the four main epithelial cell types in the mouse small intestine. III. Entero-endocrine cells

    Am J Anat

    (1974)
  • AndrewA

    Further evidence that enterochromaffin cells are not derived from the neural crest

    J Embryol Exp Morph

    (1974)
  • FontaineJ et al.

    Analysis of endoderm formation in the avian blastoderm by the use of quail-chick chimaeras: the problem of the neuroectodermal origin of the cells of the APUD series

    J Embryol Exp Morph

    (1977)
  • ThompsonEM et al.

    Gastric endocrine cells share a clonal origin with other gut cell lineages

    Development

    (1990)
  • PonderBAJ et al.

    Derivation of mouse intestinal crypts for single progenitor cells

    Nature

    (1985)
  • KirklandSC

    Clonal origin of columnar, mucous, and endocrine cell lineages in human colorectal epithelium

    Cancer

    (1988)
  • ShawPAV

    Comparison of immunological detection of 5-hydroxytryptamine by monoclonal antibodies with standard silver stains as an aid to diagnosing carcinoid tumors

    J Clin Pathol

    (1988)
  • McEnteeGP et al.

    Cytoreductive hepatic surgery for neuroendocrine tumors

    Surgery

    (1990)
  • GardnerB et al.

    Studies of the carcinoid syndrome: its relation to serotonin, bradykinin and histamine

    Surgery

    (1967)
  • MajcherSJ et al.

    Carcinoid syndrome in bronchogenic carcinoma

    Arch Intern Med

    (1966)
  • MasonDJ et al.

    New understanding of the mechanism of the carcinoid flush

    Ann Intern Med

    (1966)
  • CheekRC et al.

    Carcinoid tumors

    Curr Probl Surg

    (1970)
  • GodwinDJ

    Carcinoid tumors: an analysis of 2,837 cases

    Cancer

    (1975)
  • WeberJD et al.

    Carcinoid tumors in Meckel's diverticula

    J Clin Gastroenterol

    (1989)
  • KravetzRE et al.

    The fate of carcinoid tumors arising in Meckel's diverticulum

    Am J Gastroenterol

    (1962)
  • StrodelWE et al.

    Small bowel carcinoid tumours and the carcinoid syndrome

  • DreisDJ et al.

    Gastrointestinal hemorrhage due to carcinoid tumors of the small intestine

    JAMA

    (1986)
  • NussinsonE et al.

    Concurrent collagenous colitis and multiple ileal carcinoids

    Dig Dis Sci

    (1988)
  • Murray-LyonIM et al.

    Malignant carcinoid tumour with gangrene of the small intestine

    BMJ

    (1973)
  • SwornMJ et al.

    Intestinal ischaemia associated with ileal carcinoid tumours

    Br J Surg

    (1978)
  • HarveyJN et al.

    Intestinal infarction caused by carcinoid-associated elastic vascular sclerosis: early presentation of a small ileal carcinoid tumour

    Gut

    (1989)
  • AhlmanH et al.

    Clinically diagnosed small intestinal tumours in an urban Swedish area

    Acta Chir Scand

    (1987)
  • ModlinIM

    Carcinoid syndrome

    J Clin Gastroenterol

    (1980)
  • CoupeM et al.

    Therapy for symptoms in the carcinoid syndrome

    Q J Med

    (1989)
  • BoijsenE et al.

    Radiologic diagnosis of ileal carcinoid tumours

    Acta Radiol

    (1974)
  • AhlmanH et al.

    Management of disseminated midgut carcinoid tumours

    Digestion

    (1991)
  • LambertsSWJ et al.

    Somatostatin-receptor imaging in the localization of endocrine tumors

    N Engl J Med

    (1990)
  • HansonMW et al.

    Carcinoid tumors: iodine-131 MIBG scintigraphy

    Radiology

    (1989)
  • FeldmanJM

    Carcinoid tumors and syndrome

    Semin Oncol

    (1987)
  • FeldmanJM et al.

    Role of neuropeptides and serotonin in the diagnosis of carcinoid tumors

    Am J Med

    (1986)
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    1

    From the Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, and the Department of Surgery, Sahlgrenska Hospital, University of Göteborg, Göteborg, Sweden. These studies were supported in part by grants F-32-DK-08123 (MDB) and RO1-DK-38063 (IMM) from the National Institutes of Health, and grant 5520 (HA) from the Swedish Medical Research Council.

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