Ureteral carcinoid tumor

Most ureteral tumors are transitional cell neoplasms. Neuroendocrine tumors of the genitourinary tract are extremely rare. To our knowledge, only one ureteral carcinoid tumor has been reported before. We report a second case of ureteral carcinoid tumor found in a 70-year-old female.     

A proposed staging system for small bowel carcinoid tumors based on an analysis of 6,380 patients

Background

Little is known about the long-term prognosis of small bowel carcinoids because currently no staging system exists.

Methods

A search of the Surveillance, Epidemiology and End Results (SEER) database identified 6,380 patients with small bowel carcinoid tumors from 1977 to 2004. Patients were analyzed according to various clinicopathologic factors and a tumor (T1, T2, T3), lymph node (N0, N1), and metastasis (M0, M1) staging system was created according to these parameters.

Results

Among the 6,380 patients, 2,985 women and 3,395 men, with a median age of 66 years (range 14-98), the median tumor size was 1.9 cm (range .1-30 cm). Multivariate analysis demonstrated that age, size of the primary tumor, and depth of invasion were significant factors. Four stages were created according to statistically significant prognostic factors: 13% of patients were classified into stage I, 31% into stage II, 16% into stage III, and 40% into stage IV. Five-year survival rates were 96%, 87%, 74%, and 43% for stages I through IV, respectively.

Conclusions

The newly developed TNM staging system accurately discriminates prognosis for small bowel carcinoid tumors.     

直肠类癌的临床诊断与治疗分析

为探讨直肠类癌的临床特点、诊断、治疗及预后,回顾分析26例直肠类癌患者的临床资料,并进行随访。结果显示,26例患者中,男性多于女性;平均年龄51岁;肿瘤位于距肛缘8cm以内直肠为21例（80．8％）;主要临床表现为肛周坠胀不适（4例）、大便带血（10例）、排便习惯改变（7例）、不完全性肠梗阻（1例）,无症状者健康体检时发现（4例）;诊断主要依赖于直肠指检、直肠镜检查、电子结肠镜检查及活检结果;26例均行手术治疗且经术后病理证实;术后5年生存率76．9％（20／26）。结果表明,直肠指检对发现直肠类癌有重要作用,影响直肠类癌预后的主要因素为肿瘤大小、肿瘤的浸润及转移情况;早期诊断及早期个体化的手术是治疗本病的关键。     

Staged Second-Look Laparoscopy to Evaluate Ischemic Bowel

Background and Objectives:

An open, second-look laparotomy often is required to assess ischemic bowel after extensive mesenteric lymphadenectomy to cytoreduce midgut carcinoids. Aggressive resection of tumor at the base of the mesentery may compromise the integrity of the blood supply to the involved segment of intestine. Long segments of bowel that initially appear ischemic are sometimes created. The surgeon is faced with the decision to perform a resection or to close the abdomen temporarily knowing that this patient will require a second-look laparotomy.

Methods:

Segments of bowel showing signs of possible ischemia were preserved based on signs of perfusion. A side-side anastomosis was performed in the standard fashion. A Jackson Pratt drain was placed in an area adjacent to the anastomosis and brought out through the abdominal wall, and the incision was closed. Forty-eight hours later, a laparoscopic second-look operation was performed. A pneumoperitoneum was established using the drain tubing as the CO₂ inflation port. The drain was removed, and a 5-mm trocar was inserted into the abdomen via its tract. Segments of previously questionable dusky bowel and the anastomosis were inspected with a laparoscope.

Results:

Our 3 second-look operations were completed in approximately 5 minutes, and the patients recovered without complication or prolonged hospital course. Our fourth patient progressed extremely well postoperatively and was able to avoid the planned second-look laparos-copy.

Conclusions:

This technique provides an easy solution for the intraoperative finding of questionable blood supply in the intestines.     

2000～2005年我国类癌文献计量分析

目的 从文献外部特征介绍我国近6年对类癌研究的概况.方法 运用FULLTEXT='类癌/fld=关键词,题名,外文题名,摘要 AND #年＞=2000 AND #年＜=2005'检索表达式从CMCC数据库获取所有文献,并对文献各项外部特征进行分项统计.结果共检得728篇,主要作者、发文机构、刊文期刊、刊文地区、发病部位以及基金资助等,依次为马毅(5篇),中国医学科学院、中国协和医科大学(19篇),诊断病理学杂志(24篇),北京市85 篇,阑尾70篇,32篇得到基金资助.结论 对我国近6年类癌研究的概况进行了描述,有助研究者更上一层楼.     

卵巢囊性成熟性畸胎瘤并发类癌3例报告及文献复习

目的：探讨卵巢囊性成熟性畸胎瘤并发类癌的临床特点、诊断思路、治疗方法及预后,总结该类疾病的基本特征,提高临床医生对该病的认识。方法：患者因体检发现一侧卵巢肿物入院,行相关肿瘤标记物检查均未见异常,术前诊断为卵巢瘤,2例患者行患侧附件切除术,1例行患侧肿瘤剥除术。结果：3例患者手术顺利,术后病理诊断均为卵巢成熟性囊性畸胎瘤并发类癌,术后恢复良好,随访15个月未见复发及转移。结论：卵巢囊性成熟性畸胎瘤并发类癌术前极易误诊。患侧附件切除术是治疗该种疾病较为常见的手术方式,预后较好。     

十二指肠类癌的诊断和治疗(附4例报告并文献复习)

目的探讨十二指肠类癌的诊断及治疗方法。方法回顾性分析2000年1月～2007年8月收治的4例十二指肠类癌并复习国内近7年10篇文献报道的29例病例资料。结果诊断方法主要为胃镜、超声检查、电子计算机扫描X线体层摄影、磁共振、上消化道造影等,确诊需要病理学诊断,多需要免疫组织化学帮助。本组中行内镜下切除4例,手术局部切除4例,十二指肠肠段切除8例,胰头十二指肠切除11例。结论治疗主要以手术为主,选择局部切除、十二指肠肠段切除及胰头十二指肠切除等术式。对中晚期或广泛转移的患者可采用联合化疗。药物治疗主要是尽可能减少具有生物活性胺类物质的分泌,缓解、控制类癌综合征的发生,减轻肿瘤的生物化学作用。     

Changes in Weight Associated With Telotristat Ethyl in the Treatment of Carcinoid Syndrome

Purpose

In the placebo-controlled Phase III TELESTAR (Telotristat Etiprate for Somatostatin Analogue Not Adequately Controlled Carcinoid Syndrome) trial, the oral tryptophan hydroxylase inhibitor telotristat ethyl significantly reduced bowel movement (BM) frequency during a 12-week, double-blind treatment period in 135 patients with metastatic neuroendocrine tumors with carcinoid syndrome and ≥4 BMs per day. Patients (mean [SD] age, 63.5 [8.9] years; mean [SD] body mass index, 24.9 [4.9] kg/m²) received placebo, telotristat ethyl 250 mg, or telotristat ethyl 500 mg 3 times per day (TID) in addition to somatostatin analogue therapy. Weight loss is associated with uncontrolled carcinoid syndrome and may be associated with reduced survival.