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肺和胸腺类癌

已有 146 次阅读2020-4-27 23:26 |系统分类:医学科学| 胸腺类癌

肺和胸腺类癌
Lung and Thymic Carcinoids.
肺癌和胸腺类癌是罕见的胸部肿瘤。一般来说,肺癌预后良好,尤其是早期诊断和外科手术切除。胸腺神经内分泌肿瘤可能与多发性内分泌肿瘤-1综合征有关,倾向于有更具侵袭性的自然病史,并且相对频繁地分泌异位促肾上腺皮质激素。
Carcinoids of the lung and thymus are rare thoracic cancers. In general, lung carcinoid tumors have a favorable prognosis, particularly when diagnosed at an early stage and treated with surgical resection. Thymic neuroendocrine tumors may be associated with multiple endocrine neoplasia-1 syndrome, tend to have a more aggressive natural history, and relatively frequently secrete ectopic adrenocorticotropic hormone.
大约5%到20%的典型类癌与局部淋巴结病变有关,这可能是由于局部炎症反应而不是肿瘤受累所致。据报道,CT对肺癌肺门和纵隔转移的阳性预测价值较低(20%-45%)。通过免疫组化,60%到80%的肺类癌表达生长抑素受体;因此,生长抑素受体成像可能有助于本病的分期。
Approximately 5% to 20% of typical carcinoid tumors are associated with localregional lymphadenopathy, which may be due to a local inflammatory reaction rather than tumor involvement. The positive predictive value of computed tomography (CT) in assessing hilar and mediastinal metastases from lung carcinoid tumors is reportedly low (20%–45%).16,17 

铟-111(111In)-DTPA-D-Phe-1-奥曲肽(用于奥曲肽扫描)或镓-68(68Ga)-dotatate-为基础的PET显像有助于评估NETs的疾病程度,并可能有助于决定治疗方法。最近的数据支持68Ga-dotatate-PET比111In-pentetreotide成像具有更高的灵敏度。此外,基于PET/CT的成像允许更好的示踪剂区域的空间分辨率。不典型类癌通常在氟脱氧葡萄糖(FDG)PET显像上呈阳性,而典型类癌通常不呈阳性;因此,FDG-PET可能在生长抑素受体阴性的不典型类癌患者的分期中最有用。非典型性肺类癌脑转移发生率较高,对有神经症状或有广泛转移性疾病的患者应采用增强MRI脑显像。

By immunohistochemistry, 60% to 80% of pulmonary carcinoids express somatostatin receptors; thus, somatostatin receptor-based imaging may be useful in staging this disease. Indium-111 (111In)-DTPA-D-Phe-1-octreotide (used in Octreoscans) or gallium-68 (68Ga)-dotatate–based PET imaging are helpful in assessing the disease extent of NETs and may assist in decisions on therapeutic management. Recent data support that 68Ga-dotatate PET has higher sensitivity than does 111In pentetreotide imaging.18 In addition, PET/CT-based imaging allows for better spatial resolution of areas of tracer avidity. Atypical carcinoids are usually positive on fluorodeoxyglucose (FDG)-PET imaging, whereas typical carcinoids are usually not; therefore, FDG-PET may be most useful in staging patients with somatostatinreceptor negative atypical carcinoid tumors. Brain metastases occur relatively frequently in atypical pulmonary carcinoid tumors, and contrast-enhanced MRI brain imaging should be used for such patients who have neurologic symptoms or present with widely metastatic disease.​​​​​​​

Hann CL, Forde PM. Lung and Thymic Carcinoids. Endocrinol Metab Clin North Am.2018 Sep;47(3):699-709. doi: 10.1016/j.ecl.2018.04.011. Review. PubMed PMID:30098725.

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