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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 321-332, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WH Warren, LP Faber and VE Gould
One hundred forty-six cases of pulmonary neuroendocrine tumors are assessed
according to the classification of Gould and associates and are evaluated
for their clinical presentation and subsequent clinical course. Bronchial
carcinoids are characteristically found to be central tumors often
occurring in comparatively young patients; surgical resection with minimal
but clear margins is usually curative. The long- term prognosis is
excellent in the majority of patients, although rarely regional nodal and
distant metastases develop. Well- differentiated neuroendocrine carcinomas
are most frequently peripheral tumors. In stage I and II disease, surgical
resection alone is curative and patients with locally advanced tumors may
have a prolonged disease- free interval. The overall prognosis is less
favorable than that of bronchial carcinoids but considerably better than
that of small cell neuroendocrine carcinomas, with which they are still at
times confused. Intermediate-sized cell neuroendocrine carcinomas are often
wrongly categorized as large cell undifferentiated carcinoma. They have a
distinctly aggressive clinical course comparable with that of small cell
neuroendocrine carcinoma and should be treated similarly. Small cell
neuroendocrine carcinomas are aggressive, rapidly disseminating neoplasms.
Even in clinical stage I tumors, patients must be considered to have
disseminated metastases. The role of surgical therapy in these two latter
tumor types is adjuvant to aggressive systemic chemotherapy.
ARTICLES
Neuroendocrine neoplasms of the lung. A clinicopathologic update
Department of Cardiovascular Thoracic Surgery, Rush Medical College, Chicago, Ill.
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