HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph B. Shrager Cameron D. Wright John C. Wain David F. Torchiana Hermes C. Grillo Douglas J. Mathisen Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shrager, J. B. Articles by Mathisen, D. J. Search for Related Content PubMed PubMed Citation Articles by Shrager, J. B. Articles by Mathisen, D. J.

J Thorac Cardiovasc Surg 1997;114:367-375
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

BRONCHOPULMONARY CARCINOID TUMORS ASSOCIATED WITH CUSHING'S SYNDROME: A MORE AGGRESSIVE VARIANT OF TYPICAL CARCINOID

Received for publication Jan. 27, 1997; revisions requested Feb. 26, 1997; revisions received April 21, 1997; accepted for publication April 22, 1997. Address for reprints: Douglas J. Mathisen, MD, Thoracic Surgical Unit, 11 Warren, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.

Abstract

Objectives: Our objectives were to delineate the clinicopathologic characteristics of adrenocorticotropin-secreting bronchopulmonary carcinoid tumors causing Cushing's syndrome and to derive from these findings a rational approach to diagnosis and surgical management of this unusual condition. Methods: We conducted a retrospective, chart-review analysis of seven consecutive patients treated at the Massachusetts General Hospital over a 16-year period. Results: The patients uniformly had symptoms of marked hypercortisolism, and the underlying lung lesions remained clinically occult for a mean of 24 months. Standard endocrine testing was misleading in 83% of patients, reinforcing the need for an alternative diagnostic strategy based on petrosal sinus catheterization and computed tomography of the chest. Although 72% of the tumors were typical carcinoids by standard criteria, 57% demonstrated microscopic evidence of local invasiveness, and 43% were associated with mediastinal lymph node metastases. Eighty-six percent of patients have been cured by pulmonary resection a mean of 59 months after the operation, but 50% of these required a second operation for resection of involved lymph nodes after an initial relapse. Conclusions: These data suggest that adrenocorticotropin-secreting bronchopulmonary carcinoid tumors represent a distinct, more aggressive subtype of the usual, typical carcinoid. The high rate of lymphatic and local spread demands a surgical approach consisting of anatomic resection and routine mediastinal lymph node dissection.

This article has been cited by other articles:

				R. Atoui, S. Almarzooqi, W. Saleh, S. Marcovitz, and D. Mulder Bronchopulmonary Carcinoid Tumor Associated with Cushing Syndrome Ann. Thorac. Surg., November 1, 2008; 86(5): 1688 - 1690. [Abstract] [Full Text] [PDF]

				L. R. Salgado, M. C. B V. Fragoso, M. Knoepfelmacher, M. C. Machado, S. Domenice, M. A. A. Pereira, and B. B. de Mendonca Ectopic ACTH syndrome: our experience with 25 cases. Eur. J. Endocrinol., November 1, 2006; 155(5): 725 - 733. [Abstract] [Full Text] [PDF]

				S. J. Deb, F. C. Nichols, M. S. Allen, C. Deschamps, S. D. Cassivi, and P. C. Pairolero Pulmonary Carcinoid Tumors With Cushing's Syndrome: An Aggressive Variant or Not? Ann. Thorac. Surg., April 1, 2005; 79(4): 1132 - 1136. [Abstract] [Full Text] [PDF]

				P. L. Filosso Possible Tx N2 M0 atypical bronchial carcinoid associated with Cushing syndrome J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1224 - 1225. [Full Text] [PDF]

				P. Loli, F. Vignati, E. Grossrubatscher, P. Dalino, M. Possa, F. Zurleni, G. Lomuscio, O. Rossetti, M. Ravini, A. Vanzulli, et al. Management of Occult Adrenocorticotropin-Secreting Bronchial Carcinoids: Limits of Endocrine Testing and Imaging Techniques J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1029 - 1035. [Abstract] [Full Text] [PDF]

				T. Sugawara, M. Sato, K. Itoi, A. Sugawara, Y. Matsuda, K. Shimada, T. Sado, S. Wu, and T. Kondo Successful localization and treatment for ectopic adrenocorticotrophic hormone secretion in a rare case of possible Tx N2 M0 carcinoid tumor with Cushing syndrome J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1237 - 1238. [Full Text]

				M. de Perrot, A. Spiliopoulos, S. Fischer, M. Totsch, and S. Keshavjee Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing's syndrome Ann. Thorac. Surg., February 1, 2002; 73(2): 675 - 681. [Abstract] [Full Text] [PDF]

				R. Kumar, S. Samuel, K S. Sai, M. Vakamudi, R. Saldanha, K. R. Balakrishnan, R. Kumar, S. Samuel, K S. Sai, M. Vakamudi, et al. Extracardiac Fontan/Kawashima Procedure Without Cardiopulmonary Bypass Asian Cardiovasc Thorac Ann, September 1, 2000; 8(3): 264 - 265. [Abstract] [Full Text] [PDF]

				A. Tabarin, N. Valli, P. Chanson, Y. Bachelot, V. Rohmer, V. Bex-Bachellerie, B. Catargi, P. Roger, and F. Laurent Usefulness of Somatostatin Receptor Scintigraphy in Patients with Occult Ectopic Adrenocorticotropin Syndrome J. Clin. Endocrinol. Metab., April 1, 1999; 84(4): 1193 - 1202. [Abstract] [Full Text]