Kartsinoid of a bronchial tube
Kartsinoid of a bronchial tube – seldom found new growth from group of neuroendocrine tumors affecting mainly large bronchial tubes. It is characterized by rather slow growth at ability to give metastasises. Is considered as potentially malignant neoplasia. It is shown by cough, short wind, a blood spitting and recurrent pneumonia. The Kartsinoidny syndrome develops seldom. The diagnosis " a bronchial tube" is exposed on the basis of a X-ray analysis, by KT of lungs, bronkhoskopiya, laboratory analyses and other researches. Treatment is quick, the segment - a forehead - is more often in volume, than a pnevmonektomiya; bronkhoplastichesky interventions are possible.
Kartsinoid of a bronchial tube
Kartsinoid of a bronchial tube – the rare tumor coming from gormonalno active cages of diffusion neuroendocrine system. Makes 1-2% of total of malignant new growths of lungs and 20-30% of total number of kartsinoid. Takes the second place on prevalence of kartsinoid after similar neoplaziya of digestive tract. Kartsinoid of a bronchial tube meets in the wide age range, in literature cases at patients from 10 to 83 years are described. Middle age at the time of diagnosis makes 45-55 years. Insignificant prevalence of female patients is noted. Kartsinoid of a bronchial tube is the most widespread oncological damage of lungs at children, develops at late teenage age more often.
In recent years messages on increase in quantity of kartsinoid of a bronchial tube meet, however experts believe that it is connected more likely with use of the modern laboratory and tool techniques allowing to diagnose asymptomatic and malosimptomny tumors, than with true change of prevalence of a disease. The etiology of a kartsinoid of a bronchial tube is not found out, the hereditary syndrome causing development of multiple neuroendocrine tumors in certain cases comes to light. There is no communication with the risk factors increasing probability of developing of lung cancer (smoking, professional vrednost, chronic pulmonary diseases and bronchial tubes). More than in 60% of cases a bronchial tube it is localized in the central bronchial tubes, it is frequent – at a lung root. Treatment is performed by experts in the sphere of oncology, pulmonology and thoracic surgery.
Classification and patanatomiya of kartsinoid of a bronchial tube
According to the WHO classification in edition of 2010, taking into account morphological features allocate the following groups of kartsinoid of a bronchial tube:
- High-differentiated with the favorable forecast.
- Umerennodifferentsirovanny (atypical) with the uncertain forecast.
- Krupnokletochny and melkokletochny neuroendocrine lung cancer with the adverse forecast.
High-differentiated a neoplasia make more than 60% of total of kartsinoid of a bronchial tube. Are characterized by extremely sluggish current. Metastasises come to light at 10-15% of patients. Perhaps metastatic damage of lymph nodes of a sredosteniye, bones and a liver, is more rare – soft fabrics. The moderate and low-differentiated kartsinoida of a bronchial tube make less than 30% of total number of neuroendocrine tumors of this localization, usually develop 60 years are aged more senior and differ in more malignant current. Are more often localized in peripheral departments of lungs, quickly grow, early spread in lymph nodes of a sredosteniye. Metastasises are found in 40-50% of patients.
All types of kartsinoid of a bronchial tube come from epitelialny endocrine cages. Tumors usually grow endobronkhialno and at achievement of a certain size block a bronchial tube gleam, becoming the reason of an atelektaz or obturatsionny pneumonia. Consist of small cages of a polygonal form. Cages of a kartsinoid of a bronchial tube are grouped in tyazh, congestions and pseudo-ferruterous structures. In cages of the high-differentiated neoplaziya the insignificant quantity of mitoses is found. The expressed atipizm and a large number of mitoses is characteristic of cages of the average and low-differentiated kartsinoid of a bronchial tube. In fabric of such tumors sites of a necrosis can come to light.
Symptoms of a kartsinoid of a bronchial tube
At 30% of patients a bronchial tube proceeds asymptomatically and comes to light when performing the next medical examination or inspection in connection with suspicion of other pathology. In other cases of manifestation depend on degree of a zlokachestvennost and localization of a new growth. At high-differentiated it is central the located bronchial tube kartsinoida symptoms can appear for many years until diagnosis. As a rule, occupies the leading role in a clinical picture at first dry, and then – damp cough because of which expose to some patients the diagnosis chronic bronchitis.
In process of growth of a kartsinoid more and more expressed there is a bronkhoobstruktion. At large tumors recurrent pneumonia develops. It is possible shares of easy or all lung. The blood spitting is sometimes observed. Peripheral malignant kartsinoida of a bronchial tube at early stages are not shown in any way, however progress much quicker than the central good-quality. The paraneoplastic syndrome at this pathology comes to light seldom. The Kartsinoidny syndrome which is followed by inflows, hyperaemia of an upper body, a bronchospasm, tachycardia, arterial hypotonia, diarrhea and damage of heart valves is found in 2% of patients with kartsinoidy a bronchial tube. As a rule, development of this syndrome is caused by the remote metastasis. The invasive procedure (usually – a biopsy) or surgical intervention becomes more rare a push to emergence of a kartsinoidny syndrome.
At 2% of patients with kartsinoidy a bronchial tube Cushing's syndrome which is shown characteristic obesity, striya, acne rashes, pigmentation of skin, a girsutizm, increase in arterial pressure, osteoporosis and some other symptoms comes to light. At metastasis of a kartsinoid of a bronchial tube in lymph nodes of a sredosteniye puffiness of the head and neck, expansion of veins of a forward surface of a thorax, change of a voice, a dysphagy and difficulties of breath are possible. At metastasises jaundice and a gepatomegaliya develop in a liver. In the started cases at patients kartsinoidy a bronchial tube the loss of weight, a loss of appetite, temperature increase of a body and other symptoms characteristic of late stages of oncological process are noted.
Diagnostics and treatment of a kartsinoid of a bronchial tube
The diagnosis is established by the oncologist on the basis of complaints, the clinical record, data of objective survey, results of laboratory and tool researches. The program of inspection includes blood test and urine on hormones (including – serotonin and And). The central kartsinoida of a bronchial tube quite often manage to be found when carrying out a bronkhoskopiya. At detection of peripheral tumors use a X-ray analysis of a thorax, KT, MRT, PET, a stsintigrafiya and other researches. For identification of metastasises in a liver appoint KT, MPT and ultrasonography of an abdominal cavity.
The main method of treatment of a typical kartsinoid of a bronchial tube is surgery. Depending on localization and prevalence of oncological process carry out a segmentektomiya, lobectomy or pnevmonektomiya. At a tumor arrangement in a share or main bronchial tube the circular resection of a bronchial tube with creation of an interbronchial anastomoz is in certain cases possible. Operation includes removal of lymph nodes of a sredosteniye. Opinions on tactics of surgical treatment at the atypical low-differentiated kartsinoida of a bronchial tube differ. One experts point to inexpediency of organ-preserving operations, others note the insignificant number of a recurrence when carrying out economical surgical interventions.
The endoscopic resection at a kartsinoida of a bronchial tube can have palliative character or be carried out before radical operation. The purpose of endoscopic removal of a tumor in the latter case is elimination of an atelektaz and restoration of respiratory function of the affected lung. The chemotherapy and radiation therapy at a kartsinoida of a bronchial tube are ineffective. At diarrhea appoint medicines of codeine and loperamide. At a bronchospasm apply bronkholitichesky means. In the presence of a kartsinoidny syndrome carry out symptomatic therapy with use of an oktreotid.
The forecast at a bronchial tube kartsinoida
The forecast at bronchial tube kartsinoida rather favorable. Predictively favorable factors are the high level of a differentiation of a tumor and lack of metastasises in sredosteniye lymph nodes at the time of surgical intervention. Average five-year and ten-year survival of patients with a typical kartsinoid of a bronchial tube in the absence of metastasises exceeds 90%. At typical neoplaziya with metastasises in lymph nodes up to 5 years from the moment of operation 90% of patients, are possible to live up to 10 – 76%. At atypical kartsinoida of a bronchial tube with damage of lymph nodes these indicators decrease respectively to 60% and 24%.