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Carcinoid tumors

1.°³¿ä

GI endocrine tumorÁß °¡Àå ÈçÇÏ´Ù(75%)

GI bleeding, abdominal pain, obstruction, tumor-induced mesenteric fibrosis¸¦ À¯¹ßÇÒ

¼ö ÀÖÀ¸¸ç ¼­¼­È÷ »ý±â¹Ç·Î Áõ»ó¹ßÇöºÎÅÍ Áø´Ü½Ã±â±îÁö´Â Æò±Õ 4.5³âÀÌ °É¸°´Ù.

* ¹ß»ý±â¿ø : ¿ì¸®¸öÀÇ neuroendocrine cellÀÌ Àִ°÷¿¡¼­´Â ¾îµð¼­µç ¹ß»ýÇÒ¼ö ÀÖÁö¸¸

ÁÖ·Î GIT, pancreas, bronchus¿¡¼­ ¹ß»ýÇϸç

90%°¡ GIT³»ÀÇ enterochromaffin cell(Kulchitsky cell)¿¡¼­ ¹ß»ýÇÑ´Ù.

* mc site : appendix(50%), ileum, rectum

1) Gastric carcinoid tumor : enterochromaffin cell or histamine-secreting

ECL(enterochromaffin-like) cell¿¡¼­ ¹ß»ý

ECL cell-derived tumor : chronic atrophic gastritis, achlorhydria associated with

pernicious anemia, H.pylori infection°ú °ü·ÃµÇ¾î ºóµµ°¡

Áõ°¡ÇÑ´Ù.

* Gastrin : gastric ECL cellÀÇ growth factor

2) Appendiceal tumor(50%) - ¿ì¿¬È÷ ¹ß°ßµÇ´Â °æ¿ì°¡ ¸¹´Ù.

routine appendectomy specimenÀÇ 0.3-0.7%

local invasionÀº ÈçÇϳª metastatic spread´Â µå¹°´Ù.

3) Colorectal carcinoid : benign course, asymptomatic

4) small bowel or bronchial carcinoid : more malignant course

** metastatic spread risk´Â "tumor size" ¿¡ ´Þ·ÁÀÖ´Ù.

1 cm¡é : 2%

2 cm¡è : 100%

2. Áø´Ü

1) Carcinoid syndromeÀÌ ¾ø´Â°æ¿ì´Â tumorÀÚü·Î ÀÎÇÑ Áõ»ó(GI bleeding, abdominal pain

µî)À¸·Î ³»¿øÇÏ¿© ³»½Ã°æ, barium study, CT µîÀ¸·Î Áø´ÜµÈ´Ù.

2) Carcinoid syndromeÀ¸·Î ³»¿øÇÏ´Â °æ¿ì

-> 5-HIAA(plasma, platelet, urine)

* urine 5-HIAA°¡ most useful diagnostic testÀ̸ç

75%¿¡¼­ 15mg/dÀÌ»óÀÌ´Ù.

ƯÀ̵µ : 100%

* °Ë»ç½Ç ¼öÄ¡¸¦ Áõ°¡½ÃŰ´Â °ÍÀº °¢Á¾ °úÀÏÀÌ¸ç °¨¼Ò½ÃŰ´Â °ÍÀº aspirin, L-dopaÀÌ´Ù.

* CT, MRI, Angiography : liver metastasis¸¦ ¹ß°ßÇϴµ¥ °¡Àå ¹Î°¨ÇÑ °Ë»ç¹ý

* liver biopsy : Á¶Á÷ÇÐÀû Áø´ÜÀ» À§ÇØ

* bone scan : bone metastasisÈ®ÀÎÀ§ÇØ

* Echo : cardiac sequalaeÈ®ÀÎ

* Octreotide-radiolabelled scintigraphy : helpful, 2/3¿¡¼­ primary and metastatic tumor

siteÈ®Àΰ¡´É

3. Ä¡·á

1) Áõ»óÄ¡·á

2) octreotide : 150-1500 ug/day

diarrhea, flushing, wheezingÀ» control(75%À̻󿡼­)

3) surgery, TAE, CTx : tumor burden°¨¼Ò¸ñÀû

-> 2cm¹Ì¸¸ÀÏ ¶§ TOC

* 5 YSR : GI - 95%

LN - 65%

liver metastasis - 20%