Early Stage Carcinoid Tumors of the Rectosigmoid: Presentation, Management and Pathologic Evaluation
Abstracts
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Objective: To review the presentation, pathology and management of early stage carcinoid tumors of the rectosigmoid evaluated at a single institution. Methods: All cases of early stage (<2cm) rectosigmoid carcinoids identified through the Tumor Registry at Roswell Park Cancer Institute (RPCI) between January 1, 1970 and March 30, 2001 were identified. All patients diagnosed, treated or followed at RPCI were included in the study. Results: There were 7 males and 5 females with a mean age at diagnosis of 52 years (range 34-85 years). Clinical presentation included diarrhea and/or change in bowel habits in 5 patients (42%), rectal bleeding in 4 patients (33%), and abdominal pain in 1 patient (8%). Three patients (25%) were diagnosed during screening/surveillance endoscopy. Urinary 5-hydroxyindolacetic acid (5-HIAA) was measured and was normal in 4 patients (33%). Eight patients (67%) were diagnosed elsewhere and referred to RPCI for further evaluation and management. Lesions were located a mean of 9.6 cm from the anal verge (range 1-20 cm), and were an average of 7 mm in size (range 3-16 mm). Treatement consisted of endoscopic and/or transanal excision/fulguration in all patients. All biopsies showed typical histology without pleomorphism, mitotic activity or necrosis. Patients were followed clinically with periodic endoscopic surveillance for a mean of 7.4 years (range 3 months-22 years). No one has been lost to follow-up and there have been no documented recurrences. Conclusions: Carcinoid tumors of the rectosigmoid are rare. Symptoms in patients with early carcinoid tumors (<2 cm) are non-specific and carcinoid syndrome is not seen. Diagnosis and successful treatment of carcinoids with typical histology can be achieved by transanal approaches. The treatment of carcinoids with atypical histology (pleomorphism, mitotic activity or necrosis) cannot be outlined by the results of this study. Follow-up should consist solely of clinical examination and judicious endoscopic surveillance. |
