Carcinoid

Carcinoid - carcinoid syndrome) is a potentially occurring potentially malignant hormone-active tumor originating from argenophilic cells. The primary localization of this swelling was in the worm-like process, less frequently in the iliac, thick (especially straight) gut, even less often in the stomach, gallbladder, pancreas; Rarely occurs in the bronchi, ovary and other organs.

The etiology of the carcinoid, as well as of other tumors, is still unclear. The origin of many symptoms of the disease is due to the hormonal activity of the tumor. The significant isolation of tumor cells by serotonin, lysylbadicinin and bradykinin, histamine, prostaglandins has been demonstrated.

Symptoms, the course of the carcinoid, consist of local symptoms caused by the tumor itself, and the so-called carcinoid syndrome caused by its hormonal activity. Local manifestations are local soreness; Signs that resemble acute or chronic appendicitis (with the most frequent tumor localization in the appendix), or symptoms of intestinal obstruction, intestinal bleeding (with localization in the small or large intestine), pain during defecation and secretion with feces of scarlet blood (with carcinoid of the rectum) ), Weight loss, anemia. Carcinoid syndrome includes peculiar vasomotor reactions, attacks of bronchospasm, hyperperistals of the gastrointestinal tract, characteristic skin changes, lesions of the heart and pulmonary artery. In a pronounced form it is not observed in all patients, more often - with tumor metastases to the liver and other organs, especially multiple. The most characteristic manifestation of carcinoid syndrome is a sudden short-term reddening of the facial skin, the upper half of the trunk, accompanied by general weakness, sensation of heat, tachycardia, hypotension, sometimes tearing, runny nose, bronchospasm, nausea and vomiting, diarrhea and cramping abdominal pain. Attacks last from a few seconds to 10 minutes, during the day they can be repeated many times. Over time, skin hyperemia can become permanent and is usually combined with cyanosis, hyperkeratosis and hyperpigmentation of the pellagroide skin occur. Often in patients, the failure of the tricuspid heart valve and stenosis of the pulmonary artery mouth (less often other heart defects), circulatory insufficiency is determined.

The laboratory study in the vast majority of cases shows an elevated blood 5-hydroxytoldacetamine (up to 0.1-0.3 μg / ml) in the blood and in the urine-final product of its conversion, 5-hydroxyndolacetic acid (over 100 mg / day). Radiographic examination of the tumor is difficult to detect because of its small size and eccentric growth. The tumor is characterized by a slow growth and a relatively rare metastasis, as a result of which the average life expectancy of patients is 4-8 years or more. The most common metastasis is found in the regional lymph nodes of the liver. Death can come from multiple metastases and cachexia, heart failure, intestinal obstruction.

Surgical treatment (radical removal of tumor and metastases). Symptomatic therapy consists in the appointment of alpha and beta adrenergic receptor blockers (anaprilin, phentolamine, etc.), corticosteroids, aminazine and antihistamines are less effective.