CARCINOID (grech, karkinos crab, cancer + eidos look; synonym: argentaffinoma, carcinoid tumor) — neuroepithelial, in the majority a benign tumor of various localization.
To. are localized preferential in went. - kish. path: to 90% they are found in a worm-shaped shoot (fig. 1), is more rare in a stomach, thin (fig. 2), thick and direct guts. Besides, To. it can be localized in bronchial tubes (fig. 3), a pancreas, a liver, a gall bladder, a prostate, testicles and ovaries, ureters, a mesentery and other bodies. To. — rather rare, slowly growing tumors.
The term «carcinoid» is offered by S. Oberndorfer in 1907 for designation of the tumor of intestines having looking alike a carcinoma, but possessing a smaller zlokachestvennost than cancer of the same localization. The initial value of the term characterizing an intermediate position of this group of tumors is not lost. The facts which are available in literature do not contradict representation about To. as about a tumor with long-term and rather high-quality current (especially for some localizations), but potentially malignant and in this or that percent of cases constantly finding this quality. Therefore it is impossible to accept occasionally used term «malignizirovanny carcinoid», and also unconditional inclusion To. in group of benign tumors.
In 1924. K. L. P. Masson established ability of enterokhromaffinotsit (Kulchitsky's cells) otjedinyatsya from an epithelium of intestinal crypts (liberkyunovy glands) and to plunge into fabric of an intestinal wall, appearing in close connection with elements of neuroplex of a mucous membrane. A basis arisen thus To. make enterokhromaffinotsita (see. Argentaffin cells ), capable to produce serotonin. Further similar cells were found not only in all departments of a digestive tract, but also in other bodies (lungs, a thyroid gland, etc.). The term «carcinoid», according to K.L.P. of Masson, shall remind of that ambiguity, to-ruyu the authors who described it enclosed in idea of this tumor, meaning that this tumor possesses only nek-ry, but not all symptoms of cancer. Research K. L. P. Masson it was confirmed with comparative study of normal enterokhromaffinny cells To. with use gistokhy. reactions and fluorescent microscopy. Other point of view on an embryogenesis of elements from which afterwards develop To., reflects the neuroendocrinal nature of these tumors. Her followers carry To. together with nek-ry other tumors to the apudoma which are formed of derivatives of a neyralny crest.
it is macroscopic To. represents the dense roundish tumoral education which is seldom exceeding 2 cm in the diameter on a section of Yellowish color. The tumor happens single or multiple.
Microscopically To. has looking alike alveolar cancer. The tumor consists of small homogeneous cells of a rounded or polygonal shape with round is central the located kernel and plentiful cytoplasm; figures of a mitosis are extremely rare, figures of amitotichesky division sometimes meet. Cells can form sockets or tyazh which sometimes alternate with islands of a solid look. Sometimes cells To., taking the prismatic form, create on the periphery of such islands of the socket with the round cavity having a kutikulyarny border on an inner surface. The stroma of a tumor is expressed poorly, plentifully supplied with blood vessels and argyrophil fibers; sometimes in it smooth muscle bunches and sites of a hyalinosis are found. Hormonal and active To. allocates in blood of substance, the localizations of a tumor causing considerable fibrosis of connecting fabric in close proximity to the place. The main sign To. existence in protoplasm of its cells of birefringent lipids which during the fixing in liquids with chromic salts come to light in the form of yellow granularity can serve, and at impregnation as silver by Masson's method — Fontana — in the form of fine argyrophil grains. For confirmation of the diagnosis To. use fluorescent microscopy. As serotonin of whole blood contains in the basic in thrombocytes where it is protected from effect of enzymes, some authors suggested to determine by a fluorescent method with the diagnostic purpose the content of serotonin in the isolated thrombocytes at patients with suspicion on To. At the same time compare the content of serotonin in thrombocytes of patients to its contents in thrombocytes of a healthy rabbit (the highest content): at parallel fluorescent and ultramicroscopic examination quantity of granules of serotonin in the presence To. equally or above, than at a rabbit.
In cases of spread of a tumor it occurs on circulatory and limf, to ways: most often To. metastasize in regional limf, nodes and a liver, however metastasises in bones, a brain, a pleura and lungs, a spleen, etc.
the Clinical picture
Clinically are described To. divide on quietly current (mute) and To. with endocrine manifestations; biol, activity also cells of metastatic nodes have. In this case the so-called carcinoid syndrome — a complex a wedge, the manifestations connected with allocation by cells of a tumor first of all takes place serotonin (see), and also histamine (see) and kinin (see). Activity To. and its metastasises it is estimated on the content of serotonin at blood and its metabolite — 5-oxyindolyacetic to - you in urine. The maintenance of a histamine in blood and urine of patients, in particular at To. a stomach, happens much raised.
The carcinoid syndrome develops slowly; in the presence of the considerable mass of a tumor it is observed most often at localization To. in bronchial tubes, a stomach, a small bowel, especially with metastasises in a liver. Y. Geffroy in 1964 systematized manifestations of this syndrome, having divided them on paroxysmal and constant. The symptoms connected with vasculomotor effects of the humoral substances emitted by a tumor usually have paroxysmal character. The most frequent of them is sudden diffusion or spotty erubescence of the person, breast and shoulders. Often at the same time patients complain of feeling of heat in skin of an upper half of a body; usually the hyperemia of a throat and conjunctivitis joins it. The redness at some patients is replaced by cyanosis, and then sharp pallor. Vasculomotor attacks can spontaneously appear, but are more often connected with emotional factors, meal or alcoholic beverages, a palpation of a tumor etc. Sometimes at the same time increase of pulse, falling of the ABP up to a collapse are observed; in certain cases the ABP raises. In many cases attacks are followed by spastic pains in an anticardium or in a stomach, a diarrhea, some patients during an attack have a constraint in a breast and a throat, asthmatoid cough. Duration of an attack of several seconds till several o'clock.
Constants or it is long observed symptoms also have generally the nature of skin, cardiovascular manifestations and enteropathies. The expansion of superficial vessels of skin accompanied with edematous infiltration can lead to formation of teleangiectasias on a face and other parts of a body. At late stages of the disease accompanied with a carcinoid syndrome the xanthopathy inherent to the patient with a pellagra is observed. Very idiosyncrasy of a carcinoid syndrome — the damage of an endocardium of three-leaved and pulmonary valves of heart leading to a stenosis of a pulmonary artery and insufficiency of the three-leaved valve. This defeat develops only at the long course of a disease as result of endocrine and metabolic activity of K. Neredko patients have phenomena of a hyperphrenia.
To. went. - kish. a path can be also shown by the symptoms inherent to a carcinoid syndrome but expressed incomparably more weakly and proceeding in the form of separate attacks. These To. often are a find on section, at appendectomy.
At localization in a worm-shaped shoot To. is followed by symptoms hron, or acute appendicitis (see), and in cases large To. a small bowel the phenomena of intestinal impassability can develop (see. Impassability of intestines ). At localization To. in a bronchial tube the atelectasis of a lung can develop, bleedings are observed.
Treatment operational. Removal of primary tumor is shown even in the presence of metastasises. In this case the postoperative chemotherapy in combination with a symptomatic treatment is applied.
Forecast rather favorable in connection with the slow tumoral growth and radicalism of operational treatment.
Bibliography Malinovsky H. N and Fedorova O. D. Kartsinoid and carcinoid syndrome, Surgery, JVe 11, page 108, 1976; Menshikov V. V., Bassalyk L. S. and Shapiro G. A. Carcinoid syndrome, M., 1972, bibliogr.; The guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smolyanniko-va, page 111, etc., M., 1976; Sapozhniko-va M. A. To a question of carcinoids and a carcinoid syndrome, Arkh. patol., t. 35, No. 3, page 80, 1973; Friesen S. R., H e of sh of e with k A. S. a. Mantz F. A. Glucagon, gastrin and carcinoid tumors of the duodenum, pancreas and stomach, Amer. J. Surg., v. 127, p. 90, 1974, bibliogr.; Ha j du S. I., W inawe r S. J. a. Myers W. P. Carcinoid tumors, Amer. J. clin. Path., v. 61, p. 521, 1974; L o t i t o Page A. Mengel of Page E. Effect of melphalan in the malignant carcinoid syndrome, Arch, intern. Med., v. 124, p. 36, 1969; Mason R. A. a. Stea-n e P. A. Carcinoid syndrome, Anaesthesia, v. 31, p. 228, 1976; SalyerD, S., S a-1 at e r W. R. a. E g g 1 e s t o n J. C. Bronchial carcinoid tumors, Cancer (Phi-lad.), y. 36, p. 1522, 1975; S m i t h L. H. Oat cell carcinoma as a malignant apudoma, J. thorac. cardiovasc. Surg., v. 70, p. 147, 1975; Sokoloff B. Carcinoid and serotonin, B. — N. Y., 1968.
E. Ch. Pukhalskaya.