Pancreatic carcinoid.

The term “carcinoid” was proposed by S. Oberndorfer in 1907. However, the first to describe the histological picture of this neoplasm was O. Lubarsch in 1888. There is also evidence of an earlier description of this tumor by Th. Langhans (1868).

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Epidemiology

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

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Causes pancreatic carcinoid.

Carcinoids originate from cells of the enterochromaffin type (more often), producing serotonin (5-hydroxytryptamine) and (less often) from related cells of the diffuse endocrine system, in particular from cells secreting histamine, kinins, prostaglandins, polypeptide hormones, i.e. carcinoid tumors are hormonally active. They are relatively rare and can be localized 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 lipids and argenta- and chromaffin granules.

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

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Symptoms pancreatic carcinoid.

The clinical symptoms of carcinoid are primarily caused by the 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 hypermotility. With debilitating diarrhea, there is a large loss of fluid, protein, and electrolytes. Therefore, in severe cases of the disease, hypovolemia, electrolyte disturbances, hypoproteinemia, and oliguria may develop.

Complete carcinoid syndrome - flushes, diarrhea, endocardial fibrosis, asthmatic attacks - is observed in hardly every fifth patient with carcinoid. In a typical flush attack, the face, back of the head, neck, upper body turn red, there is a feeling of heat and burning in these areas, paresthesia, often - conjunctival injection, increased lacrimation and salivation, periorbital edema and facial edema, tachycardia and decreased blood pressure. Hyperemia of the skin can develop into prolonged spotted cyanosis with cold skin and sometimes increased blood pressure.

Symptoms of pancreatic carcinoid

Diagnostics pancreatic carcinoid.

Pancreatic carcinoid in the absence or incomplete carcinoid syndrome (about 80% of cases) remains unrecognized or is diagnosed incidentally. In the presence of a severe carcinoid syndrome, the diagnosis is confirmed (in the presence of a pancreatic tumor) by determining the elevated blood serotonin content and increased urinary excretion of its metabolite 5-HIAA. Before the study, all medications (primarily phenothiazines, reserpine-containing drugs, laxatives, diuretics) should be discontinued for 3-4 days. Serotonin- and tryptophan-containing foods (bananas, walnuts, pineapples, avocados, plums, currants, tomatoes, eggplants, cheddar cheese) should be excluded from the diet. The upper limit of normal daily excretion of 5-HIAA is 10 mg. The excretion of 10-25 mg of 5-HIAA per day is suspicious for the presence of carcinoid.

Diagnosis of pancreatic carcinoid

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Treatment pancreatic carcinoid.

Carcinoids grow slowly, so radical surgery is often possible. In the presence of multiple metastases in the liver, surgery to remove them is very traumatic. Recently, other methods of eliminating liver metastases have been used - their destruction by selective dearterialization, by local intra-arterial infusion of cytostatic drugs. Palliative surgery and subsequent drug therapy often make it possible to achieve the disappearance of symptoms. In such situations, patient survival of 10 and even 20 years is not uncommon.

Treatment of pancreatic carcinoid