Duodenal carcinoid

Introduction to duodenal carcinoid Carcinoid is a low-grade tumor of the digestive tract, accounting for only 0.4% to 1.8% of digestive tract tumors. Duodenal carcinoids originate from the intestinal kultschitzsky cells (enteric chromaffin cells) and produce a variety of amine hormone peptides, which are in the category of neuroendocrine tumors. Tumors are generally small, single or multiple, and may be characterized by invasive growth of malignant tumors as the tumor grows. The incidence of duodenal carcinoids is lower, accounting for only 1.3% of total gastrointestinal carcinoids and 5% of small intestinal carcinoids. The second paragraph of the duodenum is more common, followed by the first paragraph. basic knowledge The proportion of sickness: 0.004% - 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction

Duodenal carcinoid cause

Cause of the disease (30%)

The occurrence of this disease may be related to chromaffin cells. There are pheochromocytic cells in the adrenal medulla and sympathetic ganglia of the human body, and catecholamine hormones such as adrenaline and norepinephrine are secreted. Pheochromocytoma is an endocrine disease that originates from these areas. This tumor releases a large amount of catecholamines continuously or intermittently, causing persistent or paroxysmal hypertension and multiple organ functions and metabolic disorders. Most diseases, such as early diagnosis and treatment, can be cured; but severe cases are dangerous, changeable, and some are malignant tumors.

Pathogenesis (25%)

1. Good hair parts:

Burke et al reported 99 cases of duodenal carcinoid, located in the first paragraph of 34 cases, the second paragraph of 41 cases, of which 15 cases were located around the ampulla, 2 cases in the 3rd and 4th paragraphs did not record specific parts, 13 cases of tumors For multiple.

2. Pathological morphology:

(1) Gross morphology: Duodenal carcinoid is a yellowish hard-knotted tumor located under the mucosa, and the diameter of the tumor generally does not exceed 2 cm. 99 cases of duodenal carcinoid reported by Burke et al., tumor diameter of O.2 ~ 5.0cm, an average of 1.8cm.

(2) Tissue morphology: Under the microscope, the cancer cells are square, cylindrical, polygonal or round, and the cytoplasm contains eosinophilic particles. The nucleus is small and uniform, and mitosis is rare. Under electron microscopy, the cancerous cells contained large and polymorphic particles. Silver staining reaction was positive. The histological type of duodenal carcinoid is usually a mixture of glandular, substantial, island-like and rare trabecular structures. Most of the carcinoids located in the second paragraph contain a large number of sand bodies (Psammoma Bodies) and are mainly adenoid structures. Immunohistochemical staining often shows that the tumor contains somatostatin, gastrin and other hormones, clinically associated with Zollinger-Ellison syndrome or von Recklinghausen disease.

3. Metastatic route: Duodenal carcinoids are generally low-grade malignant tumors with slow growth and less metastasis. Carcinoids can be metastasized by lymph or blood, or can penetrate the serosa directly into the surrounding tissues. Burke et al reported that 21% of duodenal carcinoid metastases, the common metastatic sites are lymph nodes and liver, and a few metastases to the mesentery and lungs. Tumor infiltration and muscle layer, tumor > 2cm and the presence of schizophrenia, is a dangerous sign of metastasis.

Duodenal carcinoid prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Duodenal carcinoid complications Complications, intestinal obstruction, jaundice

Obstruction is the main complication of this disease. For example, a ring infiltration of the tumor can cause duodenal stenosis, and clinical manifestations of incomplete or complete high intestinal obstruction. In the vicinity of the duodenal papilla, obstructive jaundice can be suppressed in the biliary tract. .

Duodenal cancer symptoms Common symptoms Dehydration, wasting jaundice, diarrhea, edema, black stool

On the one hand, duodenal carcinoids have the common manifestations of duodenal tumors, such as melena, anemia, weight loss, jaundice or duodenal obstruction; on the other hand, due to the secretion of various biologically active substances by cancerous cells Such as 5-HT, vasodilatin, histamine, prostaglandin, somatostatin, glucagon, gastrin, etc., when these biologically active substances enter the blood circulation, especially the carcinoid liver metastasis, these biological activities Substance directly into the systemic circulation, can appear carcinoid syndrome, manifested as paroxysmal face, neck, upper limbs and upper body skin flushing and diarrhea, diarrhea, severe dehydration, malnutrition, asthma, and even edema, right heart failure.

However, it should be noted that patients with individual villus tubular adenomas can also secrete serotonin, which raises 5-HIAA (5-Hyaroxyindoleacetic acid, 5-hydroxyindoleacetic acid), resulting in a midgut type. Carcinoid signs.

Duodenal carcinoid examination

1.24h urine 5-HIAA determination: urine 5-HIAA discharge is one of the important basis for the diagnosis of carcinoid and the determination of postoperative recurrence. The discharge of carcinoid patients is more than 1 to 2 times higher than normal, and the discharge of patients with carcinoid syndrome is more high.

2. Gastrointestinal barium meal: visible polypoid filling defect, but sometimes difficult to distinguish with adenocarcinoma.

3. Fiber duodenoscopy: The location, morphology and extent of the lesion can be observed under direct vision, and biopsy can be taken directly for histopathological examination.

4. B-mode ultrasound and CT examination: mainly used to diagnose the presence or absence of liver or abdominal lymphatic metastases.

Diagnosis and diagnosis of duodenal carcinoid

1.24h urine 5-HIAA determination: urine 5-HIAA discharge is one of the important basis for the diagnosis of carcinoid and the determination of postoperative recurrence. The discharge of carcinoid patients is more than 1 to 2 times higher than normal, and the discharge of patients with carcinoid syndrome is more high.

2. Gastrointestinal barium meal: visible polypoid filling defect, but sometimes difficult to distinguish with adenocarcinoma.

3. Fiber duodenoscopy: The location, morphology and extent of the lesion can be observed under direct vision, and biopsy can be taken directly for histopathological examination.

4. B-mode ultrasound and CT examination: mainly used to diagnose the presence or absence of liver or abdominal lymphatic metastases.

Mainly based on clinical manifestations, and various tests and other comprehensive analysis to confirm the diagnosis.

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