Marzocca Giuseppe, Caputo Edda, Varrone Fabrizio, Lo Gatto Marianna, Rocchi Barbara, Polito Salvatore, Sorbellini Franca
Dipartimento di Chirurgia Generale e Specialità Chirurgiche, Azienda Ospedaliera Universitaria "Santa Maria alle Scotte", Siena.
Ann Ital Chir. 2008 Nov-Dec;79(6):457-61.
Ileal carcinoids diagnosis, generally, is late because patients have aspecific symptoms.
The two cases described presented for a long time peristaltic abdominal pains, vomit episodes and reduction of weight, with negativity of radiologic reports. The first diagnosis was adhesion syndrome produced by previous abdominal surgical operation; just emergency surgical operation executed for intestinal occlusion noticed carcinoids, located into the distal ileum, which infiltrated muscular wall and interested regional lymph nodes.
Ileal carcinoids diagnosis, generally, takes place during emergency laparotomy for intestinal occlusion which is the most frequent complication of this tumor. At the moment of diagnosis the tumor presents an advanced stage of evolution.
Ileal carcinoids behave malignant because of their biologic aggressiveness and because of at the moment of diagnosis they present an advanced stage of evolution. Symptomatology is aspecific, just a carcinoid syndrome could addressed clinical diagnosis, but this is an rare event and however it needs of liver metastases to appear. In case there is an clinical suspect scintigraphy with Octreoscan can locate tumor and metastases.
Surgical treatment of ileal carcinoids is based on large resections en bloc. Ileal carcinoids survival to 5 years is estimated inferior to 60% after surgical treatment.
由于患者症状不特异,回肠类癌的诊断通常较晚。
所描述的两例患者长期存在腹部蠕动性疼痛、呕吐发作及体重减轻,影像学报告为阴性。最初诊断为既往腹部手术所致的粘连综合征;因肠梗阻进行急诊手术时才发现位于回肠远端的类癌,其浸润肌层并累及区域淋巴结。
回肠类癌的诊断通常在因肠梗阻进行急诊剖腹手术时作出,肠梗阻是该肿瘤最常见的并发症。诊断时肿瘤已处于进展期。
回肠类癌因其生物学侵袭性以及诊断时已处于进展期而表现为恶性。症状不特异,只有类癌综合征可提示临床诊断,但这很罕见,且需要出现肝转移。如有临床怀疑,使用奥曲肽扫描进行闪烁扫描可定位肿瘤及转移灶。
回肠类癌的手术治疗基于整块大切除。回肠类癌手术治疗后5年生存率估计低于60%。