vasoactive-intestinal-peptide and Bronchial-Neoplasms

Gut peptide secreting tumours originate most commonly from the pancreatic Islets of Langerhans. Tumours at a variety of other sites have also been shown to synthesize and release these peptides, reflecting the wide distribution of the peptide secreting cells of the diffuse neuroendocrine system. Tumours such as the glucagonomas, insulinomas, VIPomas and gastrinomas are associated with characteristic clinical syndromes resulting from the effects of the peptide they secrete. The majority of the islet cell tumours in fact secrete a number of different peptides and many of these are present in several molecular forms, some of which may not be biologically active. This may explain the lack of clinical sequelae in association with tumours such as the somatostatinomas. The clinical features, methods of diagnosis, localisation and treatment of these tumours will be discussed.

Topics: Adenoma, Islet Cell; Bombesin; Bronchial Neoplasms; C-Peptide; Carcinoma, Small Cell; Diagnosis, Differential; Endocrine System Diseases; Erythema; Gastrointestinal Hormones; Glucagon; Glucagonoma; Humans; Insulin; Insulin Secretion; Insulinoma; Male; Neoplasms; Neurotensin; Pancreatic Hormones; Pancreatic Neoplasms; Pancreatic Polypeptide; Somatostatinoma; Vasoactive Intestinal Peptide; Zollinger-Ellison Syndrome

We have attempted to characterize a group of bronchopulmonary neoplasms that share certain structural features with true carcinoids but appear distinctly more pleomorphic and behave far more aggressively. In reviewing our files from 1973 to 1982, 11 such neoplasms were identified; the original diagnoses were "atypical bronchial carcinoid" (3 cases), "malignant carcinoid" (1 case), "bronchial carcinoid" (3 cases), "peripheral carcinoid" (2 cases), and "peripheral oat cell carcinoma" (2 cases). Of the 11 neoplasms, 5 were central and 6 were peripherally located. At presentation, 7 patients had lymph node metastases and 1 had a distant metastasis. No patient had a conventionally defined hormonal syndrome; however, 2 patients had a history of episodic flushing, one of which was associated with diarrhea. All cases were studied by light microscopy and light microscopic immunohistochemistry for NSE (neuron-specific enolase), serotonin, and broad-spectrum neuropeptides. Five cases were studied by electron microscopy. By light microscopy, the tumors were composed of solid clusters of polygonal to fusiform cells in an evident organoid arrangement. Foci of glandular and/or squamous differentiation were seen in 7 cases. Pleomorphism was moderate and mitoses were readily found. Focal necrosis was seen. By immunohistochemistry, 10 cases expressed NSE immunoreactivity. All cases demonstrated hormonal immunoreactivity; in 9 cases, immunoreactivity for more than one hormone was observed. The hormones most frequently expressed were serotonin, bombesin, gastrin, leu-enkephalin, and ACTH. By electron microscopy, all cases studied contained heterogeneous populations of neurosecretory granules; the latter, however, were not abundant and tended to aggregate either in the basal pole of the cells or, more frequently, interlacing "dendritelike" cytoplasmic processes. Aggregates of intermediate filaments were frequently seen. Basal lamina deposition was seen but gaps and larger areas of discontinuity were frequent. We believe that these neoplasms constitute a distinct pathologic entity for which the term "well-differentiated neuroendocrine carcinoma" has been proposed. Clinically, these tumors merit special attention since they are demonstrably more aggressive than true carcinoids but are distinctly less malignant than the intermediate or small cell variants of neuroendocrine carcinoma.

Topics: Adult; Aged; Bombesin; Bronchial Neoplasms; Carcinoid Tumor; Carcinoma, Adenoid Cystic; Chorionic Gonadotropin; Cytoplasmic Granules; Enkephalin, Leucine; Female; Humans; Immunoenzyme Techniques; Lung Neoplasms; Male; Microscopy, Electron; Middle Aged; Serotonin; Somatostatin; Staining and Labeling; Vasoactive Intestinal Peptide

A series of 25 apudomas of the gastrointestinal tract (22 cases), bronchus (2 cases), and thymus (1 case) were subjected to staining with silver impregnation (Masson-Fontana and Grimelius) techniques and with the commercial immunoperoxidase kits for the peptide hormones adrenocorticotropin, calcitonin, gastrin, glucagon, growth hormone, human chorionic gonadotropin (hCG), insulin, somatostatin, and vasoactive intestinal peptide. Of the tumors studied, 16 were regarded as malignant, and 5 of the patients showed clinical symptoms due to inappropriate hormone secretion. A total of 16 tumors contained cells positive for 1 or more (6 were multihormonal) of the hormones studied. One bronchial carcinoid stained for hCG, which has not been previously reported. In addition, one of the rectal carcinoids contained somatostatin-positive cells, only once described previously. The thymic tumor proved frankly malignant, most probably identical to the oat-cell carcinoma recently described. The findings also substantiate the recent suggestion that gastrointestinal carcinoids cannot be adequately classified on the basis of silver stains only and strongly advocate the use of the immunoperoxidase kits in routine assessments of all the endocrinologically active tumors, whatever their localization might be.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Apudoma; Bronchial Neoplasms; Calcitonin; Chorionic Gonadotropin; Female; Gastrins; Gastrointestinal Neoplasms; Glucagon; Growth Hormone; Humans; Immunoenzyme Techniques; Male; Middle Aged; Peptides; Somatostatin; Thymus Neoplasms; Vasoactive Intestinal Peptide