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Mowat A, Werpachowska A, du Rand I. A ball valving carcinoid tumour as a cause of post bronchoscopy chest pain. Respir Med Case Rep 2023; 45:101900. [PMID: 37577122 PMCID: PMC10413194 DOI: 10.1016/j.rmcr.2023.101900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
The ball valve effect occurs when an obstructing lesion allows inspiration of air, but opposes the egression of exhaled air, causing gas trapping. The phenomenon is commonly described secondary to bronchial foreign body inhalation. However, it is less well reported in other disease processes. We report a unique case of a carcinoid tumour causing ball valving following diagnostic bronchoscopy in a young patient. The procedure caused swelling and oedema around an isolated carcinoid tumour in the left main bronchus. An inspiratory chest X-ray was normal, complicating the diagnosis. At repeat bronchoscopy the tumour was cored with LASER.
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Affiliation(s)
- Andrew Mowat
- Wye Valley NHS Trust, Stonebow Road, Hereford, HR12BN, United Kingdom
| | - Anna Werpachowska
- Wye Valley NHS Trust, Stonebow Road, Hereford, HR12BN, United Kingdom
| | - Ingrid du Rand
- Wye Valley NHS Trust, Stonebow Road, Hereford, HR12BN, United Kingdom
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Snene H, Badri I, Mehiri N, Ben Salah N, Blibech H, Aouina H, Belhadj S, Boussen H, Chaouch N, Charfi R, Fenniche S, Gharbi L, Ghrairi H, Hamzaoui A, Megdiche L, Merai S, Mezni F, Tritar F, Daghfous J, Marghli A, Louzir B. [Diagnostic and therapeutic management of operable bronchopulmonary carcinoid tumours]. Rev Mal Respir 2021; 38:249-256. [PMID: 33674138 DOI: 10.1016/j.rmr.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial carcinoid tumours (CT), divided into typical carcinoid (TC) or atypical carcinoid (AC), are rare tumours whose therapeutic management remains unspecified. METHODS Retrospective study collecting cases of bronchial CT operated at the thoracic surgery department of Abderrahmane-Mami hospital of Ariana and recruited from the pneumology departments of Northern Tunisia, during a 12-year period. RESULTS Ninety patients were collected (74 cases of TC and 16 cases of AC). The mean age was 45 years and the sex ratio H/F=0.5. The chest X-ray was normal in 11 cases, as well as flexible bronchoscopy in seven cases. The tumour was classified: stage IA (10 cases), IIA (28 cases), IIB (31 cases), IIIA (15 cases) and IIIB (six cases). Surgery resulted in a complete resection in 78 patients, an extensive resection in six patients, and a conservative resection in six patients. Adjuvant chemotherapy was given in 10 patients. The survival was 84% at five years and 42% at 10 years. CONCLUSION The prognosis of CT depends directly on the histological subtype. It is excellent for TC after complete resection, unlike ACs that are similar to well-differentiated bronchial carcinomas.
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Affiliation(s)
- H Snene
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie.
| | - I Badri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Mehiri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Ben Salah
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Blibech
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Aouina
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Charles-Nicolle, Tunis, Tunisie
| | - S Belhadj
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, hôpital régional de Menzel-Bourguiba, Bizerte, Tunisie
| | - H Boussen
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'oncologie médicale, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - N Chaouch
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 2, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - R Charfi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital des forces de sécurité intérieur, Tunis, Tunisie
| | - S Fenniche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 4, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Gharbi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon D, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - H Ghrairi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital Taher-Maamouri, Nabeul, Tunisie
| | - A Hamzaoui
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon B, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Megdiche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon Ibn Nafis, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - S Merai
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, CHU La Rabta, Tunis, Tunisie
| | - F Mezni
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'anatomie pathologie, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - F Tritar
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon C, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - J Daghfous
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - A Marghli
- Faculté de médecine de Tunis, université de Tunis El Manar, service de chirurgie thoracique et cardiovasculaire, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - B Louzir
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
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Rodriguez-Freixinos V, Capdevila J, Pavel M, Thawer A, Baudin E, O'Toole D, Herrmann K, Welin S, Grozinsky-Glasberg S, de Herder WW, Valle JW, Herman J, Kolarova T, Bouvier C, Falconi M, Ferone D, Singh S. Practical recommendations for the management of patients with gastroenteropancreatic and thoracic (carcinoid) neuroendocrine neoplasms in the COVID-19 era. Eur J Cancer 2020; 144:200-214. [PMID: 33370645 PMCID: PMC7836777 DOI: 10.1016/j.ejca.2020.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 12/30/2022]
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous family of uncommon tumours with challenging diagnosis, clinical management and unique needs that almost always requires a multidisciplinary approach. In the absence of guidance from the scientific literature, along with the rapidly changing data available on the effect of COVID-19, we report how 12 high-volume NEN centres of expertise in 10 countries at different stages of the evolving COVID-19 global pandemic along with members of international neuroendocrine cancer patient societies have suggested to preserve high standards of care for patients with NENs. We review the multidisciplinary management of neuroendocrine neoplasms during the COVID-19 pandemic, and we suggest potential strategies to reduce risk and aid multidisciplinary treatment decision-making. By sharing our joint experiences, we aim to generate recommendations for proceeding to other institutions facing the same challenges.
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Affiliation(s)
- Víctor Rodriguez-Freixinos
- Department of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jaume Capdevila
- Department of Medical Oncology, Vall D'Hebron University Hospital, Vall D'Hebron Institute of Oncology (VIHO), Barcelona, Spain
| | - Marianne Pavel
- Department of Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Alia Thawer
- Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Eric Baudin
- Department of Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
| | - Dermot O'Toole
- Department of Gastroenterology, St. Vincent's University Hospital and St James's Hospital, And Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Staffan Welin
- Endocrine Oncology Unit, Department of Medical Sciences, University Hospital, Uppsala, Sweden
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Wouter W de Herder
- Section of Endocrinology, Department of Internal Medicine, Erasmus MC Cancer Center, Erasmus MC, Rotterdam, the Netherlands
| | - Juan W Valle
- University of Manchester & Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jackie Herman
- Canadian Neuroendocrine Tumour Society (CNETS), Canada
| | - Teodora Kolarova
- International Neuroendocrine Cancer Alliance (INCA), Boston, MA, USA
| | - Catherine Bouvier
- International Neuroendocrine Cancer Alliance (INCA), Boston, MA, USA; Neuroendocrine Cancer United Kingdom, United Kingdom
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Diego Ferone
- Department of Internal Medicine & Medical Specialties, Section of Endocrinology, University of Genova, Italy
| | - Simron Singh
- Department of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Ramage JK, Valle JW, Nieveen van Dijkum EJM, Sundin A, Pascher A, Couvelard A, Kloeppel G. Colorectal Neuroendocrine Neoplasms: Areas of Unmet Need. Neuroendocrinology 2019; 108:45-53. [PMID: 30219817 DOI: 10.1159/000493767] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/14/2018] [Indexed: 12/15/2022]
Abstract
The subject of colorectal neuroendocrine neoplasms (NENs), subdivided into well-differentiated NENs, termed neuroendocrine tumours (NETs; grade (G) 1 and 2), and poorly differentiated NENs, termed neuroendocrine carcinomas (NECs; G3) according to the 2010 World Health Organisation (WHO) classification, has arguably not had as much attention or study as NENs occurring in other sites. Colorectal NETs and NECs are however easier to study than many others since they are usually not difficult to remove and are increasingly detected because of intensified colorectal cancer screening and surveillance programmes. Colorectal NETs and NECs show site-specific heterogeneity with variable behaviour and different therapeutic options; these various aspects provide unique challenges. Because of bowel cancer screening programmes, colorectal NENs, like conventional adenocarcinomas, may be diagnosed at a stage that is associated with improved survival. In this article we intend to describe and define areas of unmet needs relating to the epidemiology, classification, pathology, diagnosis and therapy of colorectal NETs (including NETs G3), colorectal NECs, and finally, mixed adeno-neuroendocrine carcinomas (MANECs) by reviewing and discussing the relevant literature.
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Affiliation(s)
- John K Ramage
- Department Gastroenterology, Hampshire Hospitals NHS Trust, Kings College Hospital ENETS centre of Excellence, Basingstoke, United
| | - Juan W Valle
- Department of Medical Oncology, University of Manchester, The Christie ENETS Centre of Excellence, Manchester, United Kingdom
| | | | - Anders Sundin
- Department of Radiology, Institution Surgical Sciences, Uppsala University and ENETS centre of excellence, Uppsala University Hopsital, Uppsala, Sweden
| | - Andreas Pascher
- Department of Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Visceral and Transplant Surgery, University of Muenster, Muenster, Germany
| | - Anne Couvelard
- Department of Pathology, Bichat Hospital AP-HP and University of Paris Diderot, Paris, France
| | - Guenter Kloeppel
- Department of Pathology, Technical University Munich, Munich, Germany
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Tancredi A, Muscarella LA, la Torre A, Scaramuzzi R, Valori VM, Fazio VM, Scaramuzzi G. The Post-Surgical Long-Term Behaviour of Lung Carcinoid Tumours. Indian J Surg 2015; 77:481-5. [PMID: 26884654 DOI: 10.1007/s12262-015-1290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/20/2015] [Indexed: 10/23/2022] Open
Abstract
Here, we report a retrospective evaluation of long-term behaviour of lung carcinoids after surgery. A total of 23 patients (17 with typical pulmonary carcinoids and 6 with atypical pulmonary carcinoids) were enrolled in our hospital from April 1994 to July 2009. All patients underwent intervention at the Unit of Surgery and then were followed at the Unit of Oncology. The standard protocol for patient monitoring consisted of follow-up at 3 months after surgery, 6 months after first control and annually for 5 years. The follow-up evaluations consisted in blood tests, imaging of chest and abdomen, bone scintigraphy, and brain computed tomography. In case of disease recurrence, patients underwent chemotherapy (etoposide, carboplatin) and radiotherapy. All patients were followed for a mean of follow-up period of 100 months, ranging between 20 and 203 months. In the group of typical carcinoid, the observed recurrence rate at 5 years was zero, at 10 years was 5.8 %, whereas the observed mortality rate at 5 and 10 years was zero. In the group of atypical carcinoid, both the recurrence rate and the mortality rate at 5 and 10 years were 16.6 %. A statistical significant difference (p = 0.002) in the recurrence rate between stage I and stage II was observed. The overall prognosis of pulmonary carcinoids was favourable, and the typical carcinoids presented a better prognosis than the atypical ones. The stage at time of diagnosis could be considered as a predictive prognostic factor.
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Abstract
INTRODUCTION Small bowel carcinoid tumours are indolent neuroendocrine tumours usually seen in the 6(th) and 7(th) decades. Most often, they are silent with non-specific symptoms. They generate serotonin, provoking a desmoplastic reaction in the mesentery leading to bowel ischemia and obstruction. While CECT abdomen can help raise suspicion and show regional spread, elevated 24-hour urinary 5-HIAA levels, histopathology and immunohistochemistry for Chromogranin A are confirmatory. AIM To analyse a single surgeon's experience of clinical features and diagnosis of carcinoid tumours of the small intestine. SETTING AND DESIGN Retrospective study conducted at MS Ramaiah Medical College and Hospital, Bangalore, India. MATERIALS AND METHODS Fourteen cases of carcinoid of the small bowel presenting to our institution over a 9-year period between December 2005 and November 2014 comprised the study. This included 10 males to 4 females aged 43 to 67 years (Mean: 54.4 years). The patients were investigated using x-ray abdomen, barium study, CECT abdomen, colonoscopy and 24-hour urinary 5- HIAA levels. All patients were surgically treated and histological examination of the resected tumours and immunohistochemistry for Chromogranin A was performed. RESULTS Twelve patients with ileal carcinoids presented with long standing intestinal colic and sub-acute obstruction. Two patients with jejunal carcinoids had epigastric pain. X-ray abdomen was suggestive of small bowel obstruction in 12 patients. CECT abdomen done in 6 patients, showed ileal narrowing causing proximal dilatation; and cocooining of ileal loops at ileo-caecal junction in 2 cases. Ten patients underwent segmental resection-anastomosis of the tumour-bearing intestine while 4 patients underwent a right hemicolectomy. Lymph node spread was seen in 8 patients of whom 4 had liver metastases. Histopathology and Chromogranin A positivity confirmed the diagnoses. Postoperatively, 24-hour urinary 5-HIAA was mildly elevated in 2 patients. 12 patients were disease free at mean follow up of 4.3 years. 2 patients died due to inanition at 3 and 5 months postoperatively. CONCLUSION Carcinoid tumours of small intestine are uncommon in southern India. But they should be considered as differential diagnosis when intestinal tuberculosis is suspected in the elderly presenting with intestinal colic or sub-acute obstruction. They are associated with good prognosis after adequate resection.
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Affiliation(s)
- Sreevathsa Maddibande Ramachar
- Senior Professor & Unit Head, Department of General Surgery, MS Ramaiah Medical College and Hospital , Mathikere, Bangalore, India
| | - Nishchit Hegde
- Resident, Department of General Surgery, MS Ramaiah Medical College and Hospital , Mathikere, Bangalore, India
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Vandevelde A, Gera P. Carcinoid tumours of the appendix in children having appendicectomies at Princess Margaret Hospital since 1995. J Pediatr Surg 2015; 50:1595-9. [PMID: 26259557 DOI: 10.1016/j.jpedsurg.2015.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 01/28/2023]
Abstract
AIM The diagnosis of carcinoid tumour is a relatively rare one. Our surgical approach has changed over the last two decades from predominantly open to predominately laparoscopic with a tendency to leave the mesoappendix in situ. The aim of this audit was to identify how many cases we had at PMH and to see whether the shift in surgical approach allowed us to make prognostic decisions in keeping with current best practice and whether this made any difference in further surgery requirements or outcome for patients. METHODS A retrospective review of all cases of carcinoid identified in our search of all appendicectomy histopathology results was conducted. Results were compared to those found in other studies. Duration of follow up and further investigations was reviewed, as was whether or not there was any recurrence. RESULTS Our incidence of carcinoid tumours in patients undergoing appendicectomy since 1995 was 0.35%, similar to that in other centres. None of our patients had surgery beyond an appendicectomy and our active follow up varied from none to 6 months. There were no recurrences in this time. CONCLUSIONS The literature review carried out suggests further meta-analysis is needed including data on long term follow up before definitive guidelines regarding extent of surgical treatment and follow up based on histopathology are created. The condition is rare and the studies small, resulting in no clear consensus on the best practice for tumours measuring between 1 and 1.5 cm in diameter. Our surgical approach to appendicectomies has changed; it is unclear whether this has resulted in a change in outcome.
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Abstract
Adenocarcinoma, neuroendocrine tumours, sarcomas and lymphomas are the four most common malignant tumours arising in the small intestine, although over forty different histological subtypes are described. Collectively these account for only 2% of cancers of the digestive system. The incidence of small bowel cancer has increased in recent decades with a four-fold increase in carcinoid tumours. Risk factors for small bowel tumours include coeliac disease, inflammatory bowel disease and a number of genetic abnormalities. The non-specific nature of their symptoms and the difficulty in visualising these tumours with normal endoscopic techniques often results in late diagnosis. Furthermore the paucity of literature on this topic has made it difficult to standardise management. There has however been marked improvement in imaging methods resulting in earlier diagnosis in many cases. As expected, early detection of localised, well differentiated tumours followed by surgical resection with negative margins offers the best chance of long term survival. Better adjuvant treatment, notably for gastrointestinal stromal tumours, has improved 5-year survival rates significantly. Development of surveillance guidelines for at risk populations may be a valuable way of improving early diagnosis of this challenging group of conditions.
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Affiliation(s)
- Ian Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Paul Healy
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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