Typische und atypische Karzinoide der Lunge: chirurgische Behandlungsstrategie

Zusammenfassung

Pulmonale typische (TC) und atypische Karzinoide (AC) sind Lungentumoren mit neuroendokriner Differenzierung. Der Anteil an pulmonalen Karzinoiden unter den Lungentumoren ist mit < 2 % gering, und die Inzidenz liegt bei 0,5/100 000 Einwohner. Abhängig von Lokalisation und Ausdehnung präsentieren sie sich inzidentell oder symptomatisch mit Husten, Hämoptysen oder postobstruktiven Lungenentzündungen. Weniger als 1 % führen zu hormonassoziierter Symptomatik. TC und AC werden anhand definierter histologischer Kriterien (Mitoserate, Nekrosen) unterschieden. Patienten mit TC haben nach nicht anatomischer Resektion ein exzellentes Langzeitüberleben. AC haben ein deutlich höheres Rezidivrisiko, weshalb anatomische Resektionen erforderlich sind. Bei beiden Karzinoidtumoren sollte eine radikale mediastinale Lymphadenektomie durchgeführt werden. Die chirurgische R0-Resektion ist das entscheidende prognostische Kriterium für einen lokalisierten Karzinoidtumor. Auch bei metastasierten Erkrankungen sollte bei Resektabilität die chirurgische Therapie erwogen werden.

Abstract

Pulmonary typical (TC) and atypical carcinoids (AC) are lung tumors with neuroendocrine differentiation. Pulmonary carcinoids account for < 2 % of all lung cancers and the incidence is around 0,5/100 000. Depending on localization and extension they present incidentally or symptomatically with cough, hemoptysis and postobstructive pneumonia. Less than 1 % are associated with endocrine activity. TC and AC are differentiated by defined histopathologic criteria (mitotic rate, necrosis). Patients with TC have excellent long-term survival after non-anatomical lung resection. AC are associated with higher recurrence rates and anatomical lung resection should be preferred. Radical mediastinal lymph node dissection should be performed for both TC and AC. Complete surgical resection is the most significant prognostic factor for localized carcinoids. Surgical metastasectomy should also be considered in case of resectable metastatic disease.

Key words

typisches Karzinoid - atypisches Karzinoid - Thoraxchirurgie - neuroendokriner Lungentumor - Lungenresektion

Key words

typical carcinoid - atypical carcinoid - thoracic surgery - neuroendocrine lung tumor - lung resection

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