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ABSTRACT
Typical and atypical carcinoids are neuroendocrine epithelial lung tumours which are difficult to distinguish. Confusion has been introduced by designating atypical carcinoids as well differentiated neuroendocrine carcinomas and including some tumours which are large cell neuroendocrine carcinomas.
We therefore investigated 32 typical and 23 atypical carcinoids of the lung, and 9 combined forms of atypical carcinoid and small cell carcinoma. The following parameters were each independently correlated in a multivariate analysis with 10-year survival data: nuclear and nucleolar polymorphism, mitotic counts, vascular invasion, lymph node metastasis, structural pattern, location of the tumours, immunohistochemistry, age and sex of the patients.
Typical carcinoids were characterized by an absence of vascular invasion and lymph node metastases, and a mean mitotic rate of 0.75/10 high power fields (HPFs), while atypical carcinoids were characterized by vascular invasion and/or metastases, a mean mitotic rate of 4.25/10 HPFs and nuclear pleomorphism. Combined forms of atypical carcinoid and small cell carcinoma were characterized by vascular invasion, metastases and a mean mitotic rate of 20.7/10 HPFs. Vascular invasion, lymph node metastases, mitotic counts and nuclear pleomorphism significantly correlated with 10-year survival data, whereas location, size and structural pattern of the tumour, age and sex did not correlate with survival. All tumours were positive for cytokeratins and at least two out of three general neuroendocrine markers. However, positive reactivity for different peptides, hormones, and neurotransmitters did not correlate with one of the structural subtypes of carcinoid or with patient survival.
Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
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Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
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Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA
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site after the gastrointestinal tract ( Modlin et al. 2003 ). Lung NETs have a wide spectrum of clinical behavior and a unique pathologic classification as either typical carcinoids (grade 1) or atypical carcinoids (grade 2) ( Travis et al. 2015
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Introduction Bronchopulmonary (BP) neuroendocrine tumors (NETs; typical carcinoids and atypical carcinoids (TCs and ACs)) account for 20–25% of NETs and 1–2% of lung malignancies ( Öberg et al. 2012 , Filosso et al. 2018 , Baudin et al
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choice for low-to-intermediate grade (i.e. typical carcinoids (TCs) or atypical carcinoids (ACs)) and localized tumors, while in HG and/or disseminated lesions chemotherapy is generally preferred ( Pelosi et al . 2006 , Garcia-Yuste et al . 2008
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Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands
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Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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Introduction Pulmonary carcinoids are uncommon neuroendocrine epithelial malignancies characterised by indolent clinical behaviour. Pulmonary carcinoids can be subdivided into typical carcinoid (TC) and atypical carcinoid (AC) based on
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Institute of Anatomic Pathology, Service of Biometry and Clinical Epidemiology, Service of Pathology, Thoracic Unit, Medical Oncology Unit, Unit of Pathological Anatomy, Medical Oncology Unit of Respiratory Tract and Sarcomas, Division of Thoracic Surgery, Department of Thoracic Surgery, Division of Pathology, Division of Thoracic Surgery, Division of Pathology and Laboratory Medicine, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università Cattolica del Sacro Cuore – Policlinico A. Gemelli, Rome, Italy
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, typical carcinoid; AC, atypical carcinoid; LCNEC, large-cell neuroendocrine carcinoma; SCLC, small-cell lung carcinoma; RL, right lung; LL, left lung; T, tumor definition according to the American Joint Cancer Committee 2010 ( Edge et al . 2010 ); N
Università Cattolica del Sacro Cuore, Rome, Italy
ENETS Center of Excellence, Neuroendocrine Tumour (NET) Center, Rome, Italy
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ENETS Center of Excellence, Neuroendocrine Tumour (NET) Center, Rome, Italy
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anterior pituitary and outlined their aggressive and malignant behavior. This was also the case for the lung, where the definitions of typical and atypical carcinoid still hold ( Travis et al. 2015 ). NEN may also display high grade malignancy. Indeed
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MA Muguruza I 2007 Typical and atypical carcinoid tumours: analysis of the experience of the Spanish Multi-centric Study of Neuroendocrine Tumours of the Lung . European Journal of Cardio-Thoracic Surgery 31 192 – 197 doi:10.1016/j
Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
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National Hospital Organization, Sendai Medical Center, Sendai, Japan
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Member of the German Cancer Consortium (DKTK)
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carcinomas (SCLC) ( Travis et al . 2015 ). Carcinoid tumors are low-to-intermediate grade neoplasms that are subclassified into typical and atypical carcinoids on the basis of mitotic count and/or presence of necrosis. Although atypical carcinoids are more
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the lung, either large cell NEC or atypical carcinoid ( Fig. 2 ). Immunohistochemical staining (IHC) was positive for cytokeratin 7, TTF-1, synaptophysin, and Cam 5.2, consistent with primary pulmonary origin and arguing against adrenal origin