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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