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%