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Neuroendokrine Darm- und Pankreastumoren (Apudome)

  • B. Eriksson
  • K. Öberg

Zusammenfassung

Die Diagnose basiert auf dem Nachweis neuroendokriner Eigenschaften der Tumorzellen (APUD) mit positiver argyrophiler Färbung und Chromogranin AImmunreaktivität. Die klassischen „Midgut“-Karzinoide enthalten Serotonin und weisen eine positive Silberfärbung (Masson) auf. Andere neuroendokrine immunhistochemische Marker sind die neuronenspezifische Enolase (NSE) und das Synaptophysin. Das biologische Tumorverhalten zeigt eine Abhängigkeit von der Lokalisation des Primärtumors. Appendix-Karzinoide, die die häufigsten Tumoren darstellen (30%) und oft zufällig bei der Appendektomie mit einem Durchmesser von < 1 cm gefunden werden, sind selten maligne. Andere Dünndarmkarzinoide weisen eine potentielle Malignität auf und metastasieren vorzugsweise in regionale Lymphknoten und in die Leber. Multiple, synchrone Primärtumoren werden bei 20%–30% der Patienten beobachtet. Es werden üblicherweise fünf histologische Varianten des Karzinoids beschrieben: glandulär, trabeculär, nestförmig, undifferenziert und gemischtförmig. Tumoren mit nestförmigem Wachstumsverhalten sollen einen gutartigeren Verlauf aufweisen als Tumoren mit glandulärem oder undifferenziertem Wachstumsmuster.

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Literatur

  1. 1.
    Norheim I, Oberg K, Theodorsson-Norheim E et al. (1987) Malignant carcinoid tumours: An analysis of 103 patients with regard to tumour localization, hormone production and survival. Ann Surg 206: 115–125PubMedCrossRefGoogle Scholar
  2. 2.
    Berge T, Lindell F (1976) Carcinoid tumours. Scand Sect A 84: 322–330Google Scholar
  3. 3.
    Surveillance Epidemiology and End Results (SEER) Program: Division of Cancer Prevention and Control, National Cancer Institute, Bethesda MD (unpublished data)Google Scholar
  4. 4.
    Williams ED, Sandler M (1963) The classification of carcinoid tumours. Lancet i: 238–239Google Scholar
  5. 5.
    Moertel CG (1987) An odyssey in the land of small tumours. J Clin Oncol 5: 1503–1522Google Scholar
  6. 6.
    Johnson LA, Lavin P, Moertel CG et al. (1983) Carcinoids: The association of histologic growth pattern and survival. Cancer 51: 882–889Google Scholar
  7. 7.
    Godwin JD (1975) Carcinoid tumors: An analysis of 2837 cases. Cancer 36: 560–569PubMedCrossRefGoogle Scholar
  8. 8.
    Moertel CG, Sauer WG, Dockerty MB, Baggentoss AH (1961) Life history of the carcinoid tumor of the small intestine. Cancer: 901–912Google Scholar
  9. 9.
    Carrasco CH, Charusangavej C, Ajani J et al. (1986) The carcinoid syndrome: palliation by hepatic artery embolization. Am J Radiology 147: 149–154Google Scholar
  10. 10.
    Moertel CG, Hanley JA (ECOG) (1979) Combination chemotherapy trials in metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer Clin Trials 2: 327–334Google Scholar
  11. 11.
    Öberg K, Norheim I, Lundqvist G, Wide L (1987) Cytotoxic treatment in patients with malignant carcinoid tumors; Response to streptozotocin — alone or in combination with 5-FU. Acta Oncol 26: 429–432PubMedCrossRefGoogle Scholar
  12. 12.
    Ridolfi R, Amaducci L, Demi S et al. (1991) Chemotherapy with 5-Fluorouracil and Streptozotocin in carcinoid tumors of gastrointestinal origin: Experiences with 13 patients. J of Chemotherapy 3: 328–331Google Scholar
  13. 13.
    Moertel CG, Rubin J, O’Connell MJ (1986) Phase II study of Cisplatin therapy in patients with metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer Treat Rep 70: 1459–1460PubMedGoogle Scholar
  14. 14.
    Rougier P, Oliveira J, Ducreux M et al. (1991) Metastatic carcinoid and islet cell tumours of the pancreas: a phase II trial of the efficacy of combination chemotherapy with 5-Fluorouracil, Doxorubicin and Cisplatin. Eur J Cancer 27: 1380–1382Google Scholar
  15. 15.
    Moertel CG, Kvols LK, O’Connell MJ, Rubin J (1991) Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin. Cancer 68: 227–232PubMedCrossRefGoogle Scholar
  16. 16.
    Moertel CG, Rubin J, Kvols K (1989) Therapy of metastatic carcinoid tumor and the malignant carcinoid syndrome with recombinant leukocyte A interferon. J Clin Oncol 7 (7(: 865–868Google Scholar
  17. 17.
    Schober C, Schuppert F, Schmoll E et al. (1989) Interferon alpha-2b in patients with advanced carcinoids and apudoma. Blut, (abstract 34th Ann Cong German Soc Hematol + Oncol) Hannover, Oct 1.-4. 59 (3): 331Google Scholar
  18. 18.
    Hanssen LE, Schrumpf E, Kolbenstvedt AN et al. (1989) Treatment of malignant metastatic midgut carcinoid tumours with recombinant human alpha-2b interferon with or without prior hepatic artery embolization. Scand J Gastroenterol 24: 787–795PubMedCrossRefGoogle Scholar
  19. 19.
    Bartsch HH, Stockmann F, Arnold R, Creutzfeldt W (1990) Treatment of patients with metastatic carcinoid tumors by recombinant human interferon-alpha — results from a phase II study. J Cancer Res Clin Oncol (15th Intl Cancer Cong Hamburg, Aug. 16–22, 1990) 116: 305Google Scholar
  20. 20.
    Välimäki M, Jarvinen H, Salmela Pet al. (1991) Is the treatment of metastatic carcinoid tumor with interferon not as successful as suggested? Cancer 67: 547–549PubMedCrossRefGoogle Scholar
  21. 21.
    Öberg K, Norheim I, Lind E et al. (1986) Treatment of malignant carcinoid tumors with human leukocyte interferon. Long-term results. Cancer Treat Rep 70: 1297–1304Google Scholar
  22. 22.
    Öberg K, Alm G, Magnusson A et al. (1989) Treatment of malignant tumors with recombinant interferon alpha-2b (Intron-A); Development of neutralizing interferon antibodies and possible loss of antitumor activity. J Nat Canc Inst 81: 531–535Google Scholar
  23. 23.
    Öberg K, Eriksson B (1991) The role of interferons in the management of carcinoid tumours. Acta Oncol 30: 519–522PubMedCrossRefGoogle Scholar
  24. 24.
    Tiensuu Janson E, Rönnblom L, Ahlström H et al. (1992) Treatment with alpha-interferon versus alpha-interferon in combination with streptozotocin and doxorubicin in patients with malignant carcinoid tumors: A randomized trial. Annals of Oncol 3: 635–638Google Scholar
  25. 25.
    Tiensuu Janson E, Ahlström H, Andersson T, Öberg KE (1992) Octreotide and Interferon alpha: A new combination for the treatment of malignant carcinoid tumours. Eur J Cancer 28A: 1647–1650Google Scholar
  26. 26.
    Kvols LK, Moertel CG, O’Connell MJ et al. (1986) Treatment of the malignant carcinoid syndrome; Evaluation of a long-acting somatostatin analogue. N Engl J Med 315: 663–666Google Scholar
  27. 27.
    Öberg K, Norheim I, Theodorsson E (1991) Treatment of malignant midgut carcinoid tumours with a long-acting somatostatin analogue octreotide. Acta Oncol 30: 503–507PubMedCrossRefGoogle Scholar
  28. 28.
    Vinik Al, Thompson N, Eckhauser F, Moattari AR (1989) Clinical features of carcinoid syndrome and the use of somatostatin analogue in its management. Acta Oncol 28: 389–402CrossRefGoogle Scholar
  29. 29.
    Buchanan KD, Johnson LF, O’Hare MMT et al. (1986) Neuroendocrine tumors. A European view. Am J Med 81: 14–22Google Scholar
  30. 30.
    Eriksson B, Amberg H, Lindgren PG et al. (1990) Neuroendocrine pancreatic tumors: clinical presentation, biochemical and histopathological findings in 84 patients. J Int Med 228: 103–113CrossRefGoogle Scholar
  31. 31.
    Wilder RM, Allan FN, Power MH et al. (1927) Carcinoma of the islands of the pancreas. Hyperinsulinism and hypoglycemia. J Am Med Assoc 89: 348–355Google Scholar
  32. 32.
    Zollinger RM, Ellison EH (1955) Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas. Ann Surg 142: 709–728PubMedCrossRefGoogle Scholar
  33. 33.
    Verner-Morrison JV, Morrison AB (1958) Islet cell tumor and syndrome of refractory diarrhea and hypokalemia. Am J Med 25: 374–380CrossRefGoogle Scholar
  34. 34.
    Mallinson CN, Bloom SR, Warin AP et al. (1974) A glucagnoma syndrome. Lancet ii: 1–5Google Scholar
  35. 35.
    Ganda OP, Weir GC, Sveldner JS et al. (1977) “Somatostatinoma”: A somatostatin containing tumor of the endocrine pancreas. N Engl J Med 296: 963–967Google Scholar
  36. 36.
    mmura H (1980) Ectopic hormone syndromes. Clin Endocrinol Metab 9 (2): 235–259CrossRefGoogle Scholar
  37. 37.
    Kent RB, Heerden J van, Nejland L (1981) Non-functioning islet cell tumors. Ann Surg 193 (2): 185–190PubMedCrossRefGoogle Scholar
  38. 38.
    Grimelius L, Wilander E (1980) Silver stains in the study of endocrine cells of the gut and pancreas. Invest Cell Pathol 3: 3–12PubMedGoogle Scholar
  39. 39.
    Lloyd RV, Mermark T, Schmidt K et al. (1984) Immunohistochemical detection of chromogranin and neurone specific enolase in pancreatic endocrine neoplasms. Am J Surg Pathol 8: 607–614PubMedCrossRefGoogle Scholar
  40. 40.
    Eriksson B, Öberg K (1993) An update of the medical treatment of malignant endocrine pancreatic tumors. Acta Oncol (in press)Google Scholar
  41. 41.
    Wellboum RB, Wood SM, Polak JM et al. (1981) In: Bloom SR, Polak JM (eds) Gut Hormones, ed 2. Churchill Livingstone, London, pp 547–554Google Scholar
  42. 42.
    Ajani, Carrasco CH, Charnsangavej C et al. (1988) Islet cell tumors metastatic to the liver: Effective palliation by sequential hepatic artery embolization. Ann Intern Med 108: 340–344Google Scholar
  43. 43.
    Tennvall J, Ljungberg B, Gustaysson A et al. (1992) Radiotherapy for unresectable endocrine pancreatic carcinomas. Eur J of Surg Oncology 18: 73–76Google Scholar
  44. Moertel CG, Lefkopoulo M, Lipsitz M (1992) Streptozocin — doxorubicin, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326 (8): 519–523CrossRefGoogle Scholar
  45. 45.
    Eriksson B, Öberg K, Alm G et al. (1986) Treatment of malignant endocrine pancreatic tumors with human leukocyte interferon. Lancet íi: 1307–1309Google Scholar
  46. 46.
    Kvols L, Buck M, Moertel CG et al. (1987) Treatment of metastatic islet cell carcinoma with a somatostatin analogue (SMS 201–995). Ann Intern Med 107: 162–168PubMedCrossRefGoogle Scholar
  47. 47.
    Broder LE, Carter SK (1973) Pancreatic islet cell carcinoma. Results of therapy with streptozocin in 2 patients. Ann Intern Med 79: 108–118PubMedCrossRefGoogle Scholar
  48. 48.
    Moertel CG, Lavin P, Hahn G (1982) Phase II Trial of doxorubicin therapy for advanced islet cell carcinoma. Cancer Treat Rep 66 (7): 1567–1569PubMedGoogle Scholar
  49. 49.
    Altimari A, Badrinath K, Reisel H et al. (1987) DTIC therapy in patients with malignant intraabdominal neuroendocrine tumors.Google Scholar
  50. 50.
    Schrenck T von, Howard J, Doppman J (1988) Prospective study of chemotherapy in patients with metastatic gastrinoma. Gastroenterol 94: 1326–1334Google Scholar
  51. 51.
    Eriksson B, Skogseid B, Lundqvist G et al. (1990) Medical treatment and long-term survival in a prospective study of 84 patients with endocrine pancreatic tumors. Cancer 65 (9): 18831890Google Scholar
  52. 52.
    Moertel CG, Kvol L, O’Connell et al. (1991) Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin. Cancer 68: 227–232PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • B. Eriksson
  • K. Öberg

There are no affiliations available

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