Clinical Characteristics of Colorectal Carcinoid Tumors

대장내시경연구회 대한대장항문학회 2011 Annals of Coloproctolgy Vol.27 No.1

Purpose: The carcinoid tumor was recently categorized as a malignant disease due to its possibility of metastasis. This study was aimed to investigate the clinical characteristics and the metastatic rate of colorectal carcinoid tumors. Methods: Charts were reviewed for 502 patients diagnosed with and treated for colorectal carcinoid tumors between January 2006 and December 2009. The location, size, depth and metastatic status of the tumors were collected. Results: Including 24 synchronous tumors from 12 patients, 514 carcinoid tumors were removed. Most of them were found in the rectum (97.3%). The male-to-female ratio was 1.38 to 1, and mean age was 50.2 ± 11.4 years. The mean tumor size was 5.8 ± 3.6 mm. Less than 10-mm-sized tumors had a 1.95% lymph node metastatic rate; tumors with sizes from 10 mm to 20 mm and larger than 20 mm had 23.5% and 50% lymph node metastatic rates, respectively. Two cases had distant metastasis;one with a 22-mm-sized tumor metastasized to the liver, and the other with a 20-mm-sized tumor metastasized to the peritoneum. Among 414 patients who completed metastatic studies, 93.8% were classified as stage I, 0.9% as stage II, 4.8% as stage III and 0.5% as stage IV. Conclusion: Colorectal carcinoid tumors smaller than 10 mm have a low rate of lymph node metastasis, but those sized 10mm or larger incur significant risk. Further investigation regarding additional risk factors should be done to develop proper treatment guidelines for these tumors.

유암종에 대한 임상적 고찰

장남수,성기철,편유장,전경홍,황기은,김기택,박창영,김병익,정을순 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.2

하부위장관 유암종 제거 후의 임상 경과

구자충 ( Ja Chung Goo ),김병욱 ( Byeong Uk Kim ),정지인 ( Jee In Jeong ),한정호 ( Joung Ho Han ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),이호창 ( Ho Chang Lee ) 대한장연구학회 2010 Intestinal Research Vol.8 No.2

목적: 내시경 검사의 빈도가 늘면서 이전에는 매우 드물던 유암종의 빈도도 늘고 있다. 특히 대장 내시경을 시행하면서 우연히 발견되는 작은 유암종들은 내시경적 절제술 및 외과적 국소절제술을 통하여 비교적 간단히 치료되고 있다. 저자들은 이러한 하부위관 유암종의 임상적 특징과 치료 결과 및 재발 등에 대해 분석하고자 하였다. 대상 및 방법: 1999년 9월부터 2009년 9월까지 10년간 충북대학교병원에서 하부위장관의 유암종을 진단받은 41명의 환자를 후향적으로 조사하였다. 결과: 41명의 환자 중 남녀비는 1:0.64 이었고, 평균 연령은 47.4±12.4세였다. 41명의 환자 중직장 유암종이 38예(92.7%), 충수돌기 유암종이 2예(4.9%), S자결장 유암종이 1예(2.4%)였다. 내시경을 통한 유암종의 육안적 평균 크기는 9.4±4.8 mm였다. 초기치료를 시행받은 41명 중 수술적 절제를 시행받은 사람이 12명(29.3%), 내시경적 절제를 시행받은 사람이 29명(70.7%)이었다. 수술적 절제를 시행한 군의 평균 크기는 13.8±5.8 mm였고 내시경적 절제를 시행한 군의 평균 크기는 8.0±3.4 mm로 차이가 있었다 (P=0.011). 초기 치료 후 절제연 종양 양성을 보인 예는 총 41예 중 10예(24.4%)로 용종절제술을 시행하였던 28예 중에서 10예 모두가 발생(35.7%)하여 용종절 제술이 다른 치료방법에 비하여 유의하게 높은 치료후 절제연 종양 양성을 나타내었다(P=0.013). 41명의 환자 중 29명(70.7%)에서 추적 관찰이 이루어졌다. 이들의 평균 추적 관찰 기간은 19.2±14.5개월이었다. 재발은 추적 관찰하던 29명 중 직장 유암종으로 치료받았던 2명(6.1%)에서 발생하였다. 결론: 하부위장관의 유암종은 내시경적 절제술을 통해 쉽게 절제될 수 있으나 용종절제술의 경우 비교적 높은 절제연 종양 양성률(35.7%)을 보여 보다 신중한 치료적 접근이 필요하다. 또한 작은 크기의 직장 유암종도 재발의 가능성은 있으므로 추적 관찰은 반드시 시행되어야 하겠다. Background/Aims: The increase of colonoscopy procedures has led to an increase in the diagnosis of carcinoid tumors in the lower gastrointestinal tract. The purpose of this study was to identify the clinical and pathological characteristics that affect the treatment and recurrence of carcinoid tumors of the lower gastrointestinal tract. Methods: A 10-year (1999-2009) retrospective analysis of 41 patients with carcinoid tumors of the lower gastrointestinal tract at the Chungbuk National University Hospital was conducted. Patient and tumor characteristics, treatment and recurrence were analyzed. Results: The mean age was 47.4±12.4 (range, 22-79 years) and the male to female ratio was 1:0.64. The mean tumor size was 9.4±4.8 (3-20) mm. In the lower gastrointestinal tract, the rectum was the most frequent location of the lower gastrointestinal carcinoid tumors (92.7%). Twenty-nine out of 41 patients were treated by endoscopy (mean size of tumor: 8.0±3.4 mm) and 12 were treated by surgery (mean size of tumor: 13.8±5.8 mm)(P=0.011). Among the patients treated by endoscopy, only one patient had a complete resection. However, the histology showed that 10 patients treated by endoscopy had positive resection margins; all 10 cases (35.7%) had a polypectomy (P=0.013). The mean follow-up duration was 19.2±14.5 months, and there were two recurrences of rectal carcinoid tumors. Conclusions: Both endoscopic and surgical resections were effective methods for the treatment of lower gastrointestinal carcinoid tumors. However, endoscopic polypectomy should be carefully considered because of the possibility of more frequent incomplete histological resections. Moreover, even for small rectal carcinoid tumors, follow-up examination should be performed to evaluate for tumor recurrence. (Intest Res 2010;8:142-150)

증례 : 유암종(Carcinoid)과 선암이 공존한 위의 충돌종양 1예

이광재 ( Kwang Jae Lee ),김영수 ( Young Soo Kim ),함기백 ( Ki Baek Hahm ),김진홍 ( Jin Hong Kim ),조성원 ( Sung Won Cho ),임현이 ( Heon Yi Im ) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6

Carcinoid tumors display wider histologic spectrum than those we have previously known. The simultaneous association of a gastric carcinoid tumor with adenocarcinoma as a synchronous dual malignancy of the stomach in a same patient is extremely rare. The collison tumor, which is quite rare in the worldwide literature, means the simultaneous presence of separate tumor in the same patient, which is different from composite tumor. We report a case with collision tumor composed of adenocarcinoma and carcinoid tumor, which is extremely rare. The tumor mass was histologically diagnosed as adenocarcinoma by gastroscopic biopsy before operation. The operative specimen grossly disclosed two different types of tumor and was histologically identified as concurrent occurence of carcinoid tumor adjacent gastric adenocarcinoma.(Korean J Gastroenterol 1997;29:841-846)

직장 유암종 2례

장진석,한상영,김동현 啓明大學校 醫科大學 2002 계명의대학술지 Vol.21 No.1

직장 유암종은 최근 항문 직장 부위의 검사 증가로 인하여 점차로 증가하는 추세를 보이고 있는데, 크기가 작고 원격전이가 없는 경우는 내시경적 국소 절제술로 치료를 하고 있다. 저자들은 직장에 발견된 작은 크기의 유암종을 내시경적 국소 절제술로 제거한 2례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Carcinoid tumors are enigmatic slow growing malignancies which occur most frequently (74%) in the gastrointestinal tract. Rectal carcinoids comprise 12.6% of all carcinoid tumors and represent the third largest group of the gut carcinoids. The initial symptoms of carcinoid may be nonspecific when present and symptoms are dependent on the location and extent of the tumor. The majority of patients with rectal carcinoid tumors are asymptomatic, and the tumor is after diagnosed incidentally at endoscopy, surgery, or autopsy. Rectal carcinoid tumors are generally small and rarely metastatic and it is known that about 15% of these tumors frequently metastasize to distant organs (especially, liver) when its size is larger than 2 ㎝. Endoscopic resection may be the best treatment for small tumors. Recently, we experienced two cases of rectal carcinoid tumors which were treated by endoscopic polypectomy, therefore, the cases are presented in this paper with a relevant literature review.

위장관 유암종의 내시경적 치료 성적에 대한 고찰

박용범 ( Yong Bum Park ),김진일 ( Jin Il Kim ),하병화 ( Byung Hwa Ha ),정대영 ( Dae Young Cheung ),김태호 ( Tae Ho Kim ),김창환 ( Chang Hwan Kim ),김성수 ( Sung Soo Kim ),조세현 ( Se Hyun Cho ),박수헌 ( Soo Heon Park ),채현석 ( Hi 대한내과학회 2007 대한내과학회지 Vol.73 No.3

목적: 유암종은 위장관 및 기관지 등의 신경 내분비 세포에서 발생하는 종양으로 전이 및 주위 조직의 침범을 일으킬 수 있어 외과적 절제술을 포함한 광범위 절제가 기본 치료로 생각되었다. 그러나 최근 내시경 시행 증가 및 술기의 발달로 비교적 작은 크기의 유암종에 대한 내시경 절제술이 많이 시행되어지고 있다. 그러나 국내에서 내시경 절제의 적응증 및 치료 성적에 대한 연구는 거의 없기에 저자들은 위장관 유암종으로 진단 후 내시경 절제술을 시행 받은 환자들을 대상으로 치료 성적을 조사하였다. 방법: 2001년 1월부터 2006년 12월까지 가톨릭대학교 성모병원, 성가병원, 의정부 성모병원에서 위장관 유암종으로 진단된 환자를 후향적으로 분석하였다. 총 50명의 환자를 대상으로 증상, 진단 및 치료 방법, 그리고 치료 성적 등을 조사하였다. 결과: 대상 환자는 남자 31명, 여자 19명이었고, 연령분포는 17세에서 77세, 평균 연령은 52.6±13.6세였다. 발생 부위는 직장이 30예(60%)로 가장 많았으며, 위 9예(18%), 십이지장 7예(14%), 충수 돌기 2예(4%), 대장 2예(4%)였다. 전체 유암종의 크기는 3~25 mm였고, 평균 크기는 10.1±5.6 mm였다. 50예의 유암종 중 38예는 내시경으로, 11예는 외과적 수술로 절제하였으며, 1예는 다발성 전이가 있어 원발 병소의 치료가 불가능하였다. 내시경 절제술을 시행한 유암종의 평균 크기는 8.6±4.5 mm, 수술적 절제술을 시행한 유암종의 평균 크기는 13.5±6.1 mm였다. 내시경 치료 총 38예 중 25예(65.8%)는 내시경 점막절제술 또는 점막하 박리법을 13예(34.2%)는 올가미를 이용한 용종절제술을 시행하였다. 내시경 치료 중 불완전 절제된 잔류 병변은 올가미를 이용한 용종절제술을 시행했던 2예에서 발생하였고, 추가적인 점막절제술을 통해 완전히 제거하였다. 십이지장 유암종의 경우 10 mm 이하, 위 및 직장의 경우 15 mm 이하에서 내시경으로 합병증 없이 치료가 가능하였으며, 모든 예에서 재발 소견은 관찰되지 않았다. 결론: 위장관 유암종은 빈도가 증가하고 있고 악성화 가능성이 있어 적극적으로 치료해야 하는 질환이다. 유암종이 점막하층에 국한되어 있다면 십이지장에서 10 mm 이하인 경우, 위 및 직장에서 15 mm 이하인 경우 내시경 절제술이 위장관 유암종의 일차 치료로 가능할 수 있다. Background: The treatment of choice of gastrointestinal carcinoid tumors has been thought to be radical excision. However, surgical treatment has been substituted by endoscopic treatment in cases of small gastrointestinal carcinoid tumors. We evaluated the effectiveness of endoscopic treatment for gastrointestinal carcinoid tumors. Methods: We reviewed the medical records and endoscopic findings of 50 cases of gastrointestinal carcinoid tumors diagnosed in St. Mary`s Hospital, Holy Family Hospital, and Uijeongbu St. Mary`s Hospital, all affiliated organizations of the Catholic University Medical Center of Korea, from January 2001 to December 2006. Results: The mean age of the patients was 52.6±13.6 years-old. The mean tumor size was 10.1±5.6 mm. Thirty-eight cases were treated by endoscopy (mean tumor size: 8.6±4.5 mm), eleven cases were treated by surgery (mean tumor size: 13.5±6.1 mm), and one case with multiple metastases was untreatable by either endoscopy or surgery. Twenty five cases of endoscopic therapy were treated by endoscopic mucosal resection or endoscopic submucosal dissection. Thirteen cases were resected by use of a conventional polypectomy. Two cases of the conventional polypectomy were resected incompletely, and were treated with an additional endoscopy. No cases of endoscopic treatment have recurred during the follow-up period. Conclusions: Recently, the incidence of carcinoid tumors is on the increase in the gastrointestinal tract, as determined by performing frequent endoscopic examinations in Korea. If the gastrointestinal carcinoid tumor is limited to the submucosal layer, endoscopic treatment could be sufficient as the primary treatment in selected patients with a tumor diameter of 10 mm or less in the duodenum and 15 mm or less in the stomach and rectum.(Korean J Med 73:274-282, 2007)

조기 위암과 동반된 위선암과 유암종이 같이 있는 중복종양

김은영 ( Kim Eun Yeong ),박경찬 ( Park Gyeong Chan ),권중구 ( Kwon Jung Gu ) 대한소화기학회 2003 대한소화기학회지 Vol.42 No.6

Carcinoid tumors show variety of pathological features and some of them are admixed with adenocarcinoma. The carcinoma-carcinoid spectrum is a concept of classifying tumors based on the tumor mass differentiation which is composed of tissues of both endocrine and nonendocrine functions. When two types of tissues exist within one tumor intermingled with each other in a similar proportion, it is called composite tumor. On the other hand, collision tumor is characterized by the presence of two localized tissue types adjacently together. Gastric composite tumors are relatively rare. According to the reports on the Korean literature, there are several collision tumors, but only one case of gastric composite tumor has been cited. Reports of multiple synchronous or metachronous cancers have increased steadily during the last decades. Multiple gastric carcinoids or carcinoid tumors developed in association with gastric adenocarcinoma contribute to this trend. We report one case of gastric composite tumor simultaneously occurring with a early gastric adenocarcinoma with review of the literature. (Korean J Gastroenterol 2003;42:533-538)

The Effect of Preceding Biopsy on Complete Endoscopic Resection in Rectal Carcinoid Tumor

이상표,성인경,김정환,이선영,박형석,심찬섭 대한의학회 2014 Journal of Korean medical science Vol.29 No.4

Biopsy of rectal carcinoid tumor is commonly taken before endoscopic resection. Howeverthe preceding biopsy can inhibit complete resection by causing blurred tumor border andfibrosis of the tissue. The objective of the study was to investigate the effect of precedingbiopsy on complete endoscopic resection in rectal carcinoid tumor. It was also determinedif rectal carcinoid tumors can be macroscopically distinguished by endoscopy. We reviewedretrospectively the records of patients with rectal carcinoid tumor who had undergone anendoscopic treatment at our hospital, during a 7-yr period. The resection margin was clearin 57 of 98 cases. The preceding biopsy was taken in 57 cases and the biopsy wassignificantly associated with the risk of incomplete tumor resection (OR, 3.696; 95% CI,1.528-8.938, P = 0.004). In 95.9% of the cases, it was possible to suspect a carcinoidtumor by macroscopic appearance during initial endoscopy. The preceding biopsy maydisturb complete resection of rectal carcinoid tumor. In most cases, the carcinoid tumorcould be suspected by macroscopic appearance. Therefore the preceding biopsy is notessential, and it may be avoided for the complete resection.

Peptide YY producing strumal carcinoid tumor of the ovary in a postmenopausal woman: a rare cause of chronic constipation

( Hye Kyung Noh ),( Byung Su Kwon ),( Yoon Hwa Kim ),( Nam Kyung Lee ),( Kyung Un Choi ),( Dong Soo Suh ),( Dong Hyung Lee ),( Ki Hyung Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.6

Strumal carcinoid tumor of the ovary is a rare subtype of ovarian carcinoid tumors; it is characterized by an intimate mixture of thyroid and carcinoid tissues. We present a case of a 64-year-old woman who presented with the chief complaint of persistent, severe constipation for over 5 years; she was later found to have an ovarian strumal carcinoid tumor. Computed tomography showed a well-defined solid mass measuring 6.4 cm at the right adnexa. The patient underwent right salpingo-oophorectomy and was histopathologically diagnosed as having a strumal carcinoid tumor. Immunohistochemical examination showed immunoreactivity for peptide YY (PYY), which exerts an inhibitory effect on the peristaltic actions of the distal intestine. After surgery, the patient's constipation resolved rapidly, suggesting a correlation between PYY producing ovarian carcinoid tumor and constipation. This is the first case report of PYY producing primary strumal carcinoid tumor of the ovary associated with persistent, severe constipation from Korea.

증례 : 복강 내 종양으로 오인된 미소 위유암종의 림프절 전이 1예

이지숙 ( Jee Suk Lee ),김규종 ( Kyu Jong Kim ),고지호 ( Ji Ho Ko ),박이천 ( Lee Chun Park ),문원 ( Won Moon ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

위유암종은 드문 질환으로 전체 원발성 위종양의 0.3%, 전체 유암종의 2% 이하로 알려져 있고, 대부분 무증상이다. 그러나 최근 들어 위내시경 검사의 시행이 빈번해지고 면역조직검사의 발달로 이들의 발견 빈도가 점차 증가하고 있는 추세이다. 위유암종은 크게 세 가지 형태로 분류되며, 산발적으로 발생하는 제3형의 경우 공격적인 임상상을 가지고 전이가 잘되는 것으로 알려져 있으나, 크기가 1.0 cm 이하인 미소 위유암종의 경우 일반적으로 전이는 극히 드물다. 저자 등은 연고지 병원에서 우연히 발견된 복강 내 종물을 주소로 내원한 42세 여자의 상부 위내시경 검사에서 약 0.8 cm 크기의 미소 위유암종을 발견하여 내시경적 절제술을 시행한 후 복강 내 종물에 대한 외과적 절제에서 이들이 위유암종의 림프절 전이로 확인된 1예를 경험하였기에 문헌고찰과 함께 보고한다. Gastric carcinoid tumors have been regarded as rare neoplasms, accounting for just 0.3% of all gastric tumors and fewer than 2% of all carcinoid tumors. Recently, there has been an increase in the number of reported studies of gastric carcinoid tumors with the widespread use of gastroscopy and improvements in immunohistochemical methods. Gastric carcinoid tumors are classified into three types. For type III gastric carcinoids not associated with hypergastrinemia, which tend to be larger and demonstrate a biologically more aggressive behavior with metastasis, and also for sporadic lesions, excision with regional lymph node clearance has been recommended. Tumors that are less than 1cm in size are called minute carcinoids, which seldom give rise to regional lymph node metastasis, except in rare cases. We report here a rare case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass in a 42-year-old woman. Furthermore, we review the available literature on this entity. (Korean J Med 72:411-414, 2007)