American Association of Endocrine SurgeonsCarcinoids of unknown origin: Comparative analysis with foregut, midgut, and hindgut carcinoids☆
Section snippets
Patients
Between 1970 and 1997 more than 750 patients with carcinoid tumors were evaluated by 1 author (J. M. F.) at the Duke University Medical Center and the Durham Veterans Affairs Hospital. This study focuses on 143 patients with metastatic carcinoids of unknown primary. Groups selected for comparison included all patients with carcinoids originating from the stomach, duodenum, jejunum, ileum, cecum, and rectum. These patients were analyzed as foregut (stomach and duodenum), midgut (jejunum, ileum,
Demographics
The patient demographics including carcinoid site of origin, gender, and age are summarized in Table I.
Site of origin Patients Gender (male/female) Age at diagnosis (y) (median [range]) Foregut 52 28/24 59 (26-86) Stomach 34 14/20 60 (26-79) Duodenum 18 14/4 54 (30-86) Midgut 207 127/80 59 (19-89) Jejunum 16 9/7 58 (27-88) Ileum 175 106/69 59 (19-89) Cecum 16 12/4 60 (33-75) Hindgut 32 22/10 61 (29-81) Rectum 32 22/10 61 (29-81) Unknown 143 87/57 59 (16-87) Total 434
Discussion
The term “karzinoide” was first coined by Oberndorfer15 in 1907 to describe a group of ileal tumors that were distinct from the more common intestinal carcinomas in that they followed a more benign clinical course. Although this initial clinical impression has proved correct, approximately 45% to 70% of patients with carcinoid tumors will have metastatic disease at the time of diagnosis.3, 7 Despite this high incidence of metastatic disease, these patients can expect prolonged survival, with
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Pathologic Classification of Neuroendocrine Neoplasms
2016, Hematology/Oncology Clinics of North AmericaLimitations of somatostatin scintigraphy in primary small bowel neuroendocrine tumors
2014, Journal of Surgical ResearchCitation Excerpt :Despite advanced presentation, surgery remains the first line of treatment for this disease, as resection of the primary tumor and aggressive debulking of liver metastases are associated with greater overall and progression free survival [2–7]. Additionally, patients with unknown primary tumors have worse overall survival compared with patients with known primary sites [8]. Therefore, a thorough search for the primary tumor should be undertaken to afford the patient the best outcome.
Surgery for metastatic neuroendocrine tumors with occult primaries
2013, Journal of Surgical ResearchCitation Excerpt :Yao et al. reported that 13% of patients with metastatic disease have no identifiable primary lesion [14]. Importantly, patients with metastatic disease and unknown primaries reportedly have poorer survival compared with those with known primaries [15–17]. Improved survival after resection of the primary tumor has been suggested, even in the setting of unresectable liver metastases [18].
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Reprint requests: Douglas S. Tyler, MD, Department of Surgery, PO Box 3118, Duke University Medical Center, Durham, NC 27710.