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1. Nikou GC, Lygidakis NJ, Toubanakis C, Pavlatos S, Tseleni-Balafouta S, Giannatou E, Mallas E, Safioleas M: Current diagnosis and treatment of gastrointestinal carcinoids in a series of 101 patients: the significance of serum chromogranin-A, somatostatin receptor scintigraphy and somatostatin analogues. Hepatogastroenterology; 2005 May-Jun;52(63):731-41
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Current diagnosis and treatment of gastrointestinal carcinoids in a series of 101 patients: the significance of serum chromogranin-A, somatostatin receptor scintigraphy and somatostatin analogues.
  • BACKGROUND/AIMS: Carcinoids are relatively rare tumors that arise from neuroendocrine cells and have proved to be slow growing malignancies which involve many organs and most frequently the gastrointestinal (GI) tract.
  • Herein we present in this study 101 pts with carcinoid tumors that originated from the GI tract and pancreas.
  • Also, we analyze the clinical and pathological features, pointing out the characteristics of this group of neoplasms and describing our diagnostic and therapeutical approach, in parallel with a brief review of the literature.
  • The primary tumors originated from the GI tract in 97/101 pts (appendix 34%, small intestine 31%, stomach 14%, duodenum 6%, colon 6%, rectum 3%) and from the pancreas in 4/101 (4%).
  • The diagnosis was confirmed histologically in all cases, after surgical excision of the primary tumor or by biopsies taken during endoscopy.
  • All pts were evaluated several times per year with clinical, biochemical and imaging assessments, including neuroendocrine markers [urinary 5-Hydroxyindoleacetic acid (5-HIAA), serum Chromogranin-A (CgA)] and Somatostatin Receptor Scintigraphy (OCTREOSCAN).
  • RESULTS: Patients were referred to us with gastrointestinal symptoms or symptoms of the "carcinoid syndrome" (flushing, and diarrhea), depending mainly on the location of the primary tumors and the existence or not of metastases.
  • CgA and 5-HIAA levels were increased especially in metastatic tumors.
  • Localization of the primary tumors to facilitate surgery was made by many imaging techniques (US, CT, MRI, Enteroclysis, OCTREOSCAN) and endoscopic procedures.
  • OCTREOSCAN was positive in 94% pts with metastatic disease.
  • Furthermore, it revealed the primary and the metastatic lesions in 16% and 33% of pts with carcinoids of the small intestine respectively, while other conventional imaging procedures (including MRI) were negative at the same time.
  • Seventy-four percent of the pts underwent a surgical resection of the primary tumor, while in 21%, an endoscopic polypectomy was performed.
  • All pts with metastatic tumors and positive OCTREOSCAN, were treated with Somatostatin analogues, which resulted in control of symptoms (75%), stabilization of tumor growth (71%) or tumor shrinkage (9%).
  • A combined therapy with the addition of interferon-a was initiated in pts in whom, despite the increase of drug dosage and the shortening of administration intervals, a complete clinical and biochemical response was no more achieved with Somatostatin analogues alone.
  • Pancreatic carcinoids and also those that originated from the proximal colon were found to have worst prognosis.
  • CONCLUSIONS: a) Tumor size (especially in appendiceal and gastric carcinoids) and, also, the dispersion of disease, highly predict the evolution of the patients;.
  • b) serum Chromogranin-A seems to be a very useful tumor marker for the diagnosis and follow-up of pts with GI carcinoids;.
  • c) the introduction of new imaging techniques and especially OCTREOSCAN contributes to a better localization of the primary tumors and their metastases, as well as, to the right decision of the appropriate medical treatment;.
  • d) surgical excision is the treatment of choice in nonmetastatic tumors; and e) in pts with metastatic disease, the administration of Somatostatin analogues improves their quality of life.
  • [MeSH-major] Biomarkers, Tumor / blood. Carcinoid Tumor / diagnosis. Chromogranins / blood. Gastrointestinal Neoplasms / diagnosis. Receptors, Somatostatin / blood. Somatostatin / analogs & derivatives
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Chromogranin A. Disease Progression. Female. Follow-Up Studies. Humans. Hydroxyindoleacetic Acid / blood. Male. Middle Aged. Palliative Care. Quality of Life

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  • (PMID = 15966194.001).
  • [ISSN] 0172-6390
  • [Journal-full-title] Hepato-gastroenterology
  • [ISO-abbreviation] Hepatogastroenterology
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / CHGA protein, human; 0 / Chromogranin A; 0 / Chromogranins; 0 / Receptors, Somatostatin; 51110-01-1 / Somatostatin; 54-16-0 / Hydroxyindoleacetic Acid; G083B71P98 / pentetreotide
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2. Grossman AB, Kelly P, Rockall A, Bhattacharya S, McNicol A, Barwick T: Cushing's syndrome caused by an occult source: difficulties in diagnosis and management. Nat Clin Pract Endocrinol Metab; 2006 Nov;2(11):642-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Cushing's syndrome caused by an occult source: difficulties in diagnosis and management.
  • She did not take tobacco, recreational drugs or alcohol.
  • INVESTIGATIONS: Serum potassium and bicarbonate, circadian rhythm of cortisol, low-dose and high-dose dexamethasone suppression tests, plasma adrenocorticotropic hormone (ACTH), corticotropin releasing-hormone stimulation test, CT scan of the pituitary, plain chest radiology, CT scan of the chest and abdomen, trans-sphenoidal pituitary biopsy and histology, CT scan and MRI of the thorax, MRI of the pituitary, octreotide scintigraphy, gastroscopy, colonoscopy, gut peptides, tumor markers, urine 5-hydroxyl-indole-acetic acid, resection, histology, immunocytochemistry and in situ hybridization.
  • DIAGNOSIS: Occult ectopic ACTH syndrome from a presumed appendiceal neuroendocrine tumor.
  • The tumor was only identified some 20 years from initial presentation.
  • MANAGEMENT: Adrenolytic therapy before bilateral adrenalectomy to cure Cushing's syndrome, glucocorticoid and mineralocorticoid replacement therapy, and then repeated surveillance over 20 years to locate the ectopic source of ACTH.
  • [MeSH-major] ACTH Syndrome, Ectopic / complications. ACTH Syndrome, Ectopic / diagnosis. Cushing Syndrome / diagnosis. Cushing Syndrome / etiology
  • [MeSH-minor] Adrenalectomy. Adult. Appendiceal Neoplasms / diagnosis. Appendiceal Neoplasms / secretion. Appendiceal Neoplasms / surgery. Appendiceal Neoplasms / ultrasonography. Carcinoid Tumor / diagnosis. Carcinoid Tumor / secretion. Carcinoid Tumor / surgery. Carcinoid Tumor / ultrasonography. Female. Humans. Long-Term Care

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  • [ErratumIn] Nat Clin Pract Endocrinol Metab. 2007 Jan;3(1):69. Balwick, Tara [corrected to Barwick, Tara]
  • (PMID = 17082811.001).
  • [ISSN] 1745-8366
  • [Journal-full-title] Nature clinical practice. Endocrinology & metabolism
  • [ISO-abbreviation] Nat Clin Pract Endocrinol Metab
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
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3. Miquel C, Sabourin JC, Elias D, Grandjouan S, Viguier J, Ducreux M, Duvillard P, Praz F: An appendix carcinoid tumor in a patient with hereditary nonpolyposis colorectal cancer. Hum Pathol; 2004 Dec;35(12):1564-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] An appendix carcinoid tumor in a patient with hereditary nonpolyposis colorectal cancer.
  • Gastrointestinal carcinoid tumors are often associated with other tumors, particularly colon adenocarcinomas; but the association between carcinoid tumors and hereditary nonpolyposis colorectal cancer (HNPCC) syndrome has not yet been explored.
  • We report an unusual case of a 28-year-old woman with HNPCC who underwent surgery for a transverse colon adenocarcinoma in whom an appendix carcinoid tumor was incidentally found.
  • To assess whether the carcinoid tumor displayed the characteristic molecular features of HNPCC tumors, we investigated the expression of mismatch-repair (MMR) proteins and microsatellite instability (MSI) status in both tumors.
  • Both tumors demonstrated normal expression of the MMR proteins hMLH1, hMSH2, hMSH6, and hPMS2.
  • Interestingly, the adenocarcinoma exhibited an MSI phenotype but the carcinoid tumor did not, indicating that these 2 tumors arose through different molecular pathways.
  • [MeSH-major] Appendiceal Neoplasms / pathology. Carcinoid Tumor / pathology. Colonic Neoplasms / pathology. Colorectal Neoplasms, Hereditary Nonpolyposis / pathology
  • [MeSH-minor] Adult. Antimetabolites, Antineoplastic / therapeutic use. Chemotherapy, Adjuvant. DNA, Neoplasm / analysis. DNA-Binding Proteins / analysis. Drug Therapy, Combination. Female. Fluorouracil / therapeutic use. Humans. Leucovorin / therapeutic use. Microsatellite Repeats / genetics. Treatment Outcome

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  • (PMID = 15619218.001).
  • [ISSN] 0046-8177
  • [Journal-full-title] Human pathology
  • [ISO-abbreviation] Hum. Pathol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / DNA, Neoplasm; 0 / DNA-Binding Proteins; 0 / MSH3 protein, human; Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil
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4. Northrop JA, Lee JH: Large bowel carcinoid tumors. Curr Opin Gastroenterol; 2007 Jan;23(1):74-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Large bowel carcinoid tumors.
  • PURPOSE OF REVIEW: Gastrointestinal carcinoids comprise 90% of all carcinoid tumors and all carcinoids have malignant potential.
  • This review focuses on the morphology, prognosis, detection and treatment for appendiceal, colonic and rectal carcinoids.
  • RECENT FINDINGS: Computed tomography exists as an initial examination for the primary carcinoid tumor as well as for metastases.
  • Octreotide scanning has a sensitivity of primary tumor detection of 90%; additionally, I- or I-meta-iodobenzylguanidine scanning and tracer-specific positron emission tomographic scans have demonstrated encouraging results.
  • Further advancements in treatment with tumor-targeted therapy and biochemical evaluation of carcinoids have shown promise.
  • SUMMARY: The recent progress with scintigraphic and radiologic modalities has provided better means for diagnosis of primary and metastatic carcinoid tumors.
  • These newly discovered diagnostic modalities have been more encouraging than the recent treatment approaches that have been studied with regard to metastatic carcinoids.
  • While surgery remains the mainstay of treatment of nonmetastatic carcinoid, there have been studies for various medical treatments of metastatic disease.
  • Unfortunately, there have been disappointing results with regard to improvement of tumor response and patient survival, but a foundation has been established for future trials employing alternative agents and exploration of combination therapies.
  • [MeSH-major] Carcinoid Tumor / diagnosis. Carcinoid Tumor / therapy. Intestinal Neoplasms / diagnosis. Intestinal Neoplasms / therapy. Intestine, Large / pathology

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  • (PMID = 17133089.001).
  • [ISSN] 0267-1379
  • [Journal-full-title] Current opinion in gastroenterology
  • [ISO-abbreviation] Curr. Opin. Gastroenterol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 25
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5. Zuetenhorst JM, Hoefnageli CA, Boot H, Vald├ęs Olmos RA, Taal BG: Evaluation of (111)In-pentetreotide, (131)I-MIBG and bone scintigraphy in the detection and clinical management of bone metastases in carcinoid disease. Nucl Med Commun; 2002 Aug;23(8):735-41
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Evaluation of (111)In-pentetreotide, (131)I-MIBG and bone scintigraphy in the detection and clinical management of bone metastases in carcinoid disease.
  • Bone metastases are assumed to be rare in carcinoid disease and to be associated mainly with bronchial primaries.
  • The aim of the present study was to evaluate the occurrence of bone metastases in patients with metastatic carcinoid tumours, and the role of various nuclear medicine modalities (bone scintigraphy, (111)In-pentetreotide and (131)I-MIBG) in its detection and clinical management.
  • Nine (2 women, 7 men, median age 65 years) out of 86 consecutive carcinoid patients treated between 1987 and 1998 developed bone metastases (10%) with a median interval of 37 months between the diagnosis of metastatic carcinoid and bone metastases.
  • Seven of them had non-bronchial primaries. (111)In-pentetreotide scintigraphy failed to detect the bone lesions in 50% of the cases, and (131)I-meta-iodobenzylguanidine(MIBG) scintigraphy in almost 80% of cases.
  • It is concluded that bone metastases in carcinoid patients may be missed on (131)I-MIBG and (111)In-pentetreotide scintigraphy.
  • Diagnostic nuclear medicine modalities may be helpful in the clinical management of carcinoid disease.
  • [MeSH-major] 3-Iodobenzylguanidine. Bone Neoplasms / radionuclide imaging. Bone Neoplasms / secondary. Carcinoid Tumor / radionuclide imaging. Carcinoid Tumor / secondary. Octreotide / analogs & derivatives
  • [MeSH-minor] Aged. Aged, 80 and over. Appendiceal Neoplasms / radiography. Appendiceal Neoplasms / radionuclide imaging. False Negative Reactions. Female. Humans. Lung Neoplasms / radiography. Lung Neoplasms / radionuclide imaging. Male. Middle Aged. Neoplasms, Unknown Primary / radiography. Neoplasms, Unknown Primary / radionuclide imaging. Radiopharmaceuticals. Rectal Neoplasms / radiography. Rectal Neoplasms / radionuclide imaging. Technetium Tc 99m Medronate

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  • (PMID = 12124478.001).
  • [ISSN] 0143-3636
  • [Journal-full-title] Nuclear medicine communications
  • [ISO-abbreviation] Nucl Med Commun
  • [Language] eng
  • [Publication-type] Clinical Trial; Comparative Study; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0 / indium-111-octreotide; 35MRW7B4AD / 3-Iodobenzylguanidine; RWM8CCW8GP / Octreotide; X89XV46R07 / Technetium Tc 99m Medronate
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6. Gilboa Y, Fridman E, Ofir K, Achiron R: Carcinoid tumor of the appendix: ultrasound findings in early pregnancy. Ultrasound Obstet Gynecol; 2008 May;31(5):576-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Carcinoid tumor of the appendix: ultrasound findings in early pregnancy.
  • Ultrasound examination of a woman in early pregnancy with right lower quadrant abdominal pain demonstrated an edematous appendix with amorphous fluid surrounding the appendix.
  • At laparotomy, these findings were confirmed.
  • On pathological evaluation following surgical removal of the appendix a rare case of carcinoid tumor of the appendix was diagnosed.
  • This is the first description of the transvaginal ultrasound features of a carcinoid tumor of the appendix.
  • [MeSH-major] Appendiceal Neoplasms / ultrasonography. Carcinoid Tumor / ultrasonography. Pregnancy Complications, Neoplastic / ultrasonography
  • [MeSH-minor] Abdominal Pain / etiology. Abortion, Spontaneous / drug therapy. Adult. Female. Humans. Pregnancy. Treatment Outcome

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  • [Copyright] Copyright (c) 2008 ISUOG
  • (PMID = 18393270.001).
  • [ISSN] 1469-0705
  • [Journal-full-title] Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
  • [ISO-abbreviation] Ultrasound Obstet Gynecol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
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