Pancreatic carcinoid

The term "carcinoid" was suggested by S. Oberndorfer in 1907. However, the first described the histological picture of this new growth of O. Lubarsch in 1888. There are also data on an earlier description of this tumor Th. Langhans (1868).

[1], [2], [3], [4], [5]

Epidemiology

Carcinoid pancreatic tumor occurs mainly in middle-aged and elderly people. It can be localized in any part of it. The size of the tumor varies from a few millimeters to 13-14 cm.

[6], [7], [8], [9], [10], [11], [12]

Causes of the pancreatic carcinoid

Carcinoids originate from enterochromaffin type cells (more often) that produce serotonin (5-hydroxytryptamine) and (more rarely) from related cells of the diffuse endocrine system, in particular from cells secreting histamine, kinins, prostaglandins, polypeptide hormones, ie, carcinoid tumors refer to hormonal-active. They are relatively rare and can be located in any part of the gastrointestinal tract, less often in the pancreas, bronchi, gall bladder, ovaries and other organs.

The main difference between carcinoid and true carcinoma is that the protoplasm of their cells contains birefringent lipoids and argenta- and chromafin granules.

Carcinoid tumors are considered potentially malignant, but with very slow growth and relatively late metastasis. First of all, they give metastases to the regional lymph nodes, from the distant, metastases often appear in the liver, cervical lymph nodes, less often in the lungs, brain, ovaries, bones. Metastases, like the primary tumor, grow slowly.

[13], [14], [15]

Symptoms of the pancreatic carcinoid

The clinical symptoms of carcinoid are primarily due to products secreted by the tumor, primarily serotonin. The leading symptoms of pancreatic carcinoid are abdominal pain and watery diarrhea. It is known that serotonin causes intestinal hypermotorics. When exhausting diarrhea occurs a large loss of fluid, protein, electrolytes. Therefore, in severe cases of the disease may develop hypovolemia, electrolyte disorders, hypoproteinemia, oliguria.

Complete carcinoid syndrome - hot flashes, diarrhea, endocardial fibrosis, asthmatic attacks - is hardly observed in every fifth patient with carcinoid. With a typical bout of the tide, face, neck, neck, upper body blush, there is a feeling of heat and burning in these areas, paresthesia, often conjunctiva injection, increased tear and salivation, periorbital edema and face swelling, tachycardia and lowering of blood pressure. Hyperemia of the skin can pass into prolonged spotted cyanosis with a cooling of the skin and sometimes an increase in blood pressure.

Symptoms of pancreatic carcinoma 

Diagnostics of the pancreatic carcinoid

Pancreatic carcinoid with absent or incomplete carcinoid syndrome (about 80% of cases) remains unrecognized or is diagnosed accidentally. At the expressed carcinoid syndrome the diagnosis is proved (in the presence of a pancreatic tumor) by definition of the raised maintenance in blood of a serotonin and the increased excretion with urine of its metabolite 5-GOIUK. Before the study within 3-4 days, all medicines (primarily phenothiazines, reserpine-containing, laxatives, diuretics) should be canceled. From food should be excluded serotonin and tryptophan-containing foods (bananas, walnuts, pineapples, avocados, plums, currants, tomatoes, eggplant, cheddar cheese). The upper limit of normal daily excretion of 5-GOIUK is 10 mg. Isolation of 10-25 mg of 5-GOIUK per day is suspicious for the presence of carcinoid.

Diagnosis of pancreatic carcinoid

[16], [17], [18]

Treatment of the pancreatic carcinoid

Carcinoids grow slowly, so it is often possible to carry out a radical operation. In the presence of multiple metastases in the liver, surgery to remove them is very traumatic. Recently, other methods of eliminating metastases in the liver have also been used - their destruction through selective de-sterilization, by local intra-arterial infusion of cytostatic drugs. Palliative surgery and subsequent medication often allow the disappearance of symptoms. In such situations, the survival of patients is often 10 and even 20 years.

Treatment of pancreatic carcinoid