Typical carcinoids (TC) are still considered by many authors as associated with a fairly benign behaviour and therefore at times treated with a more or less conservative surgical approach. Furthermore long term clinical follow-up is often judged as not strictly necessary. Purpose of this study is to retrospectively analyse the features and behaviour of 83 patients with typical bronchial carcinoids, treated surgically and followed-up in our Department from February 1983 to March 2004.
Diagnostic work-up included CT scan, bronchoscopy, bronchial biopsy or fine needle aspiration biopsy, 111In-pentetreotide scan (OctreoScan), and mediastinoscopy in selected patients. Neuroendocrine (NE) differentiation was assessed on the basis of morphology and immunohistochemical reactivity for the pan-neuroendocrine markers NSE, CGA, Synaptophysin, PGP 9.5 and Leu-7. Multiple forms and tumorlets were carefully researched performing serial sections of lung parenchyma. Histological subtypes were diagnosed according to Travis WHO Classification (1999) criteria. Staging was established according to the International System for Staging of Lung Cancer (2002). Survival data were analysed using Kaplan-Meyer method by Log-Rank test (Mantel-Cox) at 5,10 and 15 years.
Presenting symptoms were invariably respiratory-related in central forms. History of tobacco abuse was 52%. Lymph-node involvement was present in 12%. Overall survival was 97.5% at five years, 95% at 10 years, and 92% at 15 years. Synchronous multicentric forms were found performing serial sections of the pulmonary parenchyma specimens in 13% of cases (4 multicentric carcinoids and 7 cases with multiple tumorlets). Multiple bronchiectases were associated in 19% of cases.
The high frequency of multicentric forms, associated bronchiectasis and lymph-node involvement reinforce the statement that well-differentiated NE tumors require major surgical procedures with radical node dissection.
Due to the finding of tumor recurrence (not infrequently more than 10 years following surgery), careful search for multifocal lesions should always be performed and follow-up in these cases must be accurate and protracted.
P. Ferolla, None.