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Bronchial carcinoid tumors. Analysis of 41
cases.Rev
Clin Esp. 2004 Apr;204(4):202-5.
OBJECTIVE:
The objective of this study has been the description of the cases
of carcinoid tumor diagnosed in our Pneumology Service along the
last 15 years. METHODS: The study has been conducted
retrospectively, including the period between January 1, 1987 and
December 31, 2001. The clinical histories of all patients with a
diagnosis of carcinoid tumor have been reviewed, collecting the
demographic clinical, radiological, bronchoscopic, therapeutic,
and evolutionary data. RESULTS. On the whole, 41 cases were
diagnosed, 36 typical (88%) and 5 atypical (12%), representing 2%
of the total of lung neoplasms. The average age was 50 years, and
66% patients were males, with 61% of smokers and ex-smokers. The
most relevant clinical parameter was cough with 68% of cases.
Chest X-ray was pathological in 88% and CAT in 100%. Bronchoscopy
was done in 40 patients, being the localization of the tumor
peripheral in 10% and central in 90%. In 37.5% the classical
endoscopic image suggestive of this tumor was observed. The
definitive diagnosis was obtained in 26 cases by bronchial biopsy,
in 14 cases through thoracotomy, and in 1 case by CAT-guided
fine-needle aspiration biopsy. Surgical treatment was carried out
in 36 patients (88%). Five year follow-up has been completed in 16
(39%) patients, with 5 recurrences (2 local and 3 systemic). Five
patients were lost for follow-up (12%), and in the 20 patients
remaining (49%) the evolution is less than 5 years, with no
recurrences up to now. There has not been any death. CONCLUSIONS:
We conclude that carcinoid tumors are infrequent, most of them
central in location, and are diagnosed preferably by bronchoscopy,
although the number of cases with suggestive findings is less than
50%. The treatment is surgical except for contraindications, and
the percentage of recurrences has been limited.
Fine
needle aspiration cytology of carcinoid tumors.Acta
Cytol. 1996 Jul-Aug;40(4):695-707.
OBJECTIVE:
To define the cytomorphologic features of carcinoid tumor. STUDY
DESIGN: The study consisted of 19 carcinoid tumors sampled by fine
needle aspiration. These included 6 pulmonary carcinoids. 11
intestinal carcinoids and 2 aspirates from a patient with a
mediastinal carcinoid. The cytomorphologic features of carcinoid
tumor were documented, and, in selected cases, immunocytochemical
findings were noted. Additionally, the cytology literature
concerning carcinoid tumor was reviewed and summarized. RESULTS:
Morphologically, the carcinoid tumors consisted predominantly of
loose groups with a background of single cells. A striking degree
of cellular and nuclear monomorphism was seen in all cases. Nuclei
were small and round to oval, and all exhibited a characteristic
finely granular, evenly distributed chromatin pattern. Cytoplasm
was minimal to moderate in amount and finely granular in
appearance. Necrosis and prominent nucleoli were not seen.
Positive staining was noted in all seven cases in which
immunostaining for chromogranin was performed. Neuron-specific
enolase was positive in four of five cases. CONCLUSION: The
cytomorphologic characteristics of carcinoid tumors are
distinctive, and appropriate ancillary studies can assist in
confirming the diagnosis.
Fine
needle aspiration cytology of pulmonary carcinoid tumors.Acta
Cytol. 1990 Jul-Aug;34(4):505-10.
Twenty-four cases coded as pulmonary carcinoid tumors initially
sampled by fine needle aspiration (FNA) biopsy were reviewed in
order to determine the cytologic features most useful in making
the FNA diagnosis. The diagnosis of carcinoid tumor had been
confirmed in 23 cases; the remaining case, though closely
resembling a carcinoid tumor on the FNA specimen, proved to be a
sclerosing hemangioma of the lung. Comparison of the original and
review interpretations of the FNA specimens revealed that all
typical spindle cell carcinoids and all atypical carcinoids were
correctly diagnosed and classified. Of the 15 typical round cell
carcinoids, the original cytologic diagnosis was lymphoma in 2
cases and benign bronchial lining cells in 2 cases. Thus, it
appears that diagnostic errors are most likely in "typical"
carcinoids. Review of the FNA findings suggests that the
frequently stripped cytoplasm (with resulting non-cohesive bare
nuclei), coupled with the almost universal plexiform vascularity
(seen in 21 of 23 cases), should allow an accurate cytologic
diagnosis in virtually all cases.
Pulmonary
spindle cell carcinoid. Needle aspiration biopsy, histologic and
immunohistochemical findings.
Acta Cytol.
1990 Jan-Feb;34(1):50-6.
Six
pulmonary spindle cell carcinoids were reviewed. The patients were
asymptomatic women ranging from 56 to 76 years of age. Four cases
were diagnosed or suspected by percutaneous needle aspiration
biopsy. The four patients treated by wedge resection or lobectomy
showed no recurrence during the followup period; one patient was
followed radiologically without resection for over five years,
during which time the lesion remained stable. The cytologic
preparations showed groups and single oval or elongated cells that
had nuclei with finely granular, evenly dispersed chromatin,
usually one small nucleolus and easily disrupted, finely granular
cytoplasm. The histologic sections showed circumscribed or
infiltrative neoplasms growing as sheets or vaguely organoid cell
masses with vascular, focally hyalinized stroma. Immunoreactivity
for chromogranin, neuron-specific enolase, synaptophysin, S-100
protein and Leu-7 was typically present; bombesin, serotonin,
insulin and calcitonin were focally present in some cases. No
reactivity for adrenocorticotropic hormone, somatostatin, gastrin,
vasoactive intestinal polypeptide, pancreatic polypeptide,
low-molecular-weight cytokeratin (MAK-6) or carcinoembryonic
antigen was observed.
Carcinoids,
atypical carcinoids, and small-cell carcinomas of the lung:
differential diagnosis of fine-needle aspiration biopsy specimens.Diagn
Cytopathol. 1988 Mar;4(1):1-8.
The
acceptance of fine-needle aspiration biopsy in the diagnostic
work-up of pulmonary masses has resulted in an increased number of
neuroendocrine tumors of the lung first encountered as aspiration
cytology specimens. The accurate cytologic identification of these
neuroendocrine neoplasms is important in that they have relatively
specific clinical and prognostic features in contrast to
nonneuroendocrine neoplasms. We report on the cytologic features
of 46 primary pulmonary neuroendocrine neoplasms initially
encountered on fine-needle aspiration biopsies. The neoplasms are
separated into three distinct cytologic groups, including the
typical carcinoid (13 cases), the atypical carcinoid (3 cases),
and small-cell carcinomas (30 cases). The clinical features of all
cases--and histologic findings when they were available--are also
considered. Finally, a detailed cytologic description of the three
groups of neuroendocrine neoplasms is presented with emphasis on
differential diagnosis including nonneuroendocrine pulmonary
neoplasms.
Aspiration
biopsy cytology of adenocarcinoid tumor of the bronchial tree.Acta
Cytol. 1987 Nov-Dec;31(6):726-30
Aspirated
material from two cases of histologically and ultrastructurally
confirmed adenocarcinoid tumor of the lung was evaluated. In one
case, columnar and cuboidal cells with ill-defined cytoplasm and
round or oval nuclei were seen in large sheets and syncytiumlike
clusters with focal glandular arrangement. In the other case,
spindle-shaped and columnar cells with ovoid nuclei and
ill-defined cytoplasm were seen singly and in loose clusters.
Fragments of tumor epithelium with nuclei arranged in
pseudo-stratified pattern were noted. Staining of tumor cells by
the Grimelius technique demonstrated numerous intracytoplasmic
brown-black granules. The cytologic differential diagnosis between
adenocarcinoid tumor and other primary and metastatic
adenocarcinomas of the lung is briefly discussed.
Fine
needle aspiration cytology of atypical carcinoid of the lung.Acta
Cytol. 1987 Jul-Aug;31(4):471-5
The
cytologic features of eight atypical carcinoid tumors of the lung,
as observed in fine needle aspiration (FNA) specimens, are
described in detail. They were compared with 21 pulmonary squamous-cell
carcinomas, 16 adenocarcinomas, 5 small-cell undifferentiated
carcinomas, 3 large-cell undifferentiated carcinomas and 1 typical
carcinoid tumor. Atypical carcinoid tumor was easily distinguished
from the other pulmonary neoplasms in most instances. Only two
poorly differentiated squamous-cell carcinomas (one of which had
atypical carcinoid as a component) and one small-cell
undifferentiated carcinoma had similar cytologic features. One
atypical carcinoid also had cytologic features similar to
small-cell undifferentiated carcinoma. Because atypical carcinoid
and small-cell undifferentiated carcinoma, at times, may be
difficult to separate in FNA specimens, surgical resection of all
stage I neoplasms with cytologic features evocative of either
neoplasm is recommended.
Pulmonary
carcinoid with glandular features. Report of two cases with
positive fine needle aspiration biopsy cytology.Acta
Cytol. 1983 Sep-Oct;27(5):511-4.
A detailed
description is given of two challenging cases of pulmonary
carcinoid with glandular features that were diagnosed
cytologically on fine needle aspiration biopsy material. The
histologic type in the first case was identified on the aspirated
material obtained from the tumor at the time of its radiologic
discovery; for the second case, after a prior diagnosis of
adenocarcinoma, the correct diagnosis was made upon review of the
material; the diagnosis was warranted by the indolent clinical
course. The cytologic diagnoses were unequivocally confirmed by
the histology of the surgical specimen in the first case and by an
ultrastructural investigation of the second.
Fine
needle aspiration cytopathology of bronchial carcinoid tumors: an
analytical study of the cells.Anal
Quant Cytol. 1982 Jun;4(2):105-9
While
frequently considered to originate in a common stem-cell of
neuroendocrine origin, bronchial carcinoid tumors and small-cell
anaplastic carcinomas differ significantly in their biologic
potential and treatment. Patient management is often dependent on
the diagnostic specificity of a pulmonary fine needle aspiration
specimen. This study evaluated the cellular features in fine
needle aspiration samples from seven bronchial carcinoid tumors
and four small-cell anaplastic carcinomas of the "intermediate"
type. Planimetric measurements were performed on tracings of 1,100
cells. An analysis of specific cytoplasmic and nuclear features
was also obtained on 2,200 cells. Significant quantitative and
qualitative differences in the cytomorphology of the cells derived
from bronchial carcinoid and small-cell anaplastic neoplasms were
obtained, clearly demonstrating that differentiation of these
neoplasms is possible on a cytopathologic basis in fine needle
aspiration samples.
Cytomorphology of carcinoid tumors.Acta
Cytol. 1979 Sep-Oct;23(5):360-5.
This
report is based on a review and study of carcinoid tumors as seen
in smears prepared from exfoliative or aspiration smears. During a
period of eight years (1970 to 1978), 236 cytologic specimens were
examined from 64 patients treated for carcinoid tumors at Memorial
Hospital. Thirty-eight cytologic specimens from 18 patients were
interpreted as either suspicious or positive for malignant cells.
Tumor cells were identified most often in tracheobronchial
specimens, effusions and percutaneous aspirates. A striking
similarity in cell morphology was found between exfoliated and
aspirated tumor cells. Certain specific or suggestive cytologic
features were recognized. The histogenesis of carcinoids and the
role of intracytoplasmic neurosecretory granules in the
differential diagnosis is discussed together with the
clinicopathologic implication of positive cytologic findings.
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