islet cell carcinoid
Introduction
Introduction to islet cell carcinogenesis Islet cell carcinoma (Carcinoid) is a tumor originating from EC cells and has the function of secreting hormones such as serotonin (5-HT) or 5-hydroxytryptophan (5-HTP). Some patients may appear clinically. Carcinoidsyndrome, a malignant tumor with low malignancy and slow growth. As early as 1907, Oberndorfer first proposed carcinoid tumor as a slow-growing intestinal adenocarcinoma and proposed the term carcinoid. Lembeck discovered the presence of serotonin in carcinoid tissues in 1953 and is a bioactive substance that causes carcinoid syndrome. Williams classifies carcinoid tumors into three types: the foregut, the midgut and the hindgut. Secretion of 5-HT, 5-HTP, vasoactive intestinal peptide and peptide hormones, producing atypical carcinoid syndrome; midgut carcinoids such as appendicoids secrete 5-HT, with typical carcinoid syndrome; No function. Islet cell carcinoid is different from midgut carcinoid, and it does not necessarily suggest that the liver has carcinoid metastasis when it produces carcinoid syndrome. basic knowledge The proportion of illness: 0.005%-0.007% Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia
Cause
Islet cell carcinoid cause
Cause:
Islet cell carcinoma (Carcinoid) is a tumor originating from EC cells. EC cells have the characteristics of APUD cells, which are widely distributed in the gastrointestinal tract, pancreas and lung. The cause of this disease is still unknown. Islet cell carcinoma (Carcinoid) is a tumor originating from EC cells and has the function of secreting hormones such as serotonin (5-HT) or 5-hydroxytryptophan (5-HTP). Some patients may appear clinically. Carcinoid syndrome is a malignant tumor with low malignancy and slow growth. As early as 1907, Oberndorfer first proposed carcinoid tumor as a slow-growing intestinal adenocarcinoma and proposed the term carcinoid. Lembeck discovered the presence of serotonin in carcinoid tissues in 1953 and is a biologically active substance that causes carcinoid syndrome. Williams divides carcinoid into three types: the foregut, the midgut and the hindgut. The foregut carcinoid secretes 5-HT, 5-HTP, vasoactive intestinal peptide and peptide hormone, which produces atypical carcinoid syndrome. Cancers such as appendix carcinoids secrete 5-HT, which has typical carcinoid syndrome; while posterior intestinal carcinoids are mostly non-functional. Islet cell carcinoid is different from midgut carcinoid, and it does not necessarily suggest that the liver has carcinoid metastasis when it produces carcinoid syndrome.
Prevention
Islet cell carcinoid prevention
At present, there is no effective preventive measure for this disease, so early detection and early diagnosis are the key to the prevention and treatment of this disease. It is recommended to have a full physical examination every year on a regular basis. If there is a B-ultrasound or CT, MRI found abnormal mass, you need to consider the possibility of this disease. Once the suspiciousness of the disease is suspected, immediate surgical resection and pathological examination are needed to determine the nature of the neoplastic mass. In daily life, we should pay attention to nutrition and rationality. Try to diversify foods as much as possible. Eat high-protein, multi-vitamins, low-fat animal fats, digestible foods, fresh fruits and vegetables, and do not eat old-fashioned or irritating things. Grilled, marinated, fried, salty foods, staple foods and coarse grains to ensure nutritional balance.
Complication
Islet cell carcinoid complications Complications anemia
With islet cell cancer and tumors, there may be other endocrine hormone hyperactivity, such as insulin, glucagon, growth hormone, parathyroid hormone, adrenocorticotropic hormone, etc., generally have corresponding characteristic performance. It can be used to identify, in the late stage of cancer and tumor, there may also be manifestations of wasting, anemia, hypoproteinemia and other dyscrasia.
Symptom
Islet cell type cancer symptoms Common symptoms Abdominal pain, bloating, diarrhea, blood pressure, dyspnea, hypoproteinemia, flushing, smooth muscle, tachycardia, tachycardia
The disease is often asymptomatic or has no specific clinical symptoms in the early stage; when the patient has typical paroxysmal skin flushing, and the reaction is onset, the long-term treatment is unhealed, the possibility of the disease should be thought of, when the patient is flushed with the skin, accompanied by heartbeat Over-speed, blood pressure, asthma, dyspnea, abdominal pain, diarrhea and other carcinoid syndrome manifestations, more support for the diagnosis of this disease.
For patients suspected of being carcinoid syndrome, laboratory tests such as coarse screening test, urinary 5-HIAA determination, 5-HT measurement in tumor tissue, application of B-ultrasound, CTMRCI and ERCP, etc. The surgical plan provides diagnostic information.
Islet cell carcinoids can have typical carcinoid syndrome manifestations: paroxysmal flushing, hypotension, edema around the eyelids and tearing.
1. Intermittent flushing: mainly occurs in the exposed parts of the face, neck and front chest, but also throughout the body. The occurrence of flushing of the skin is mostly paroxysmal, sudden appearance, bright red or Dark red, the duration varies from a few minutes to 1-2 days, but the color change of the skin of patients with black race or dark complexion may not be obvious. If the course of disease is longer, fixed skin changes may occur in the site of frequent attacks. Most of the fine blood vessels dilate and the skin is dark red. The factors that affect the flushing of the skin may include: drinking, pain, mood swings and physical activity can induce skin flushing, adrenaline and norepinephrine can also promote seizures; application of -adrenal gland The ability of the blocker can stop the occurrence of flushing of the skin. In the case of skin flushing, the patient is often accompanied by tachycardia, hypotension, edema around the eyelids, and symptoms of the gastrointestinal and lung.
2. Cardiovascular symptoms: When the patient has skin flushing, it may be accompanied by tachycardia, blood pressure drop or even shock; late heart valve disease or congestive right heart failure may occur.
3. Respiratory symptoms: 20 to 30% of patients with paroxysmal skin flushing may have asthma and dyspnea, similar to bronchial asthma, the mechanism is caused by 5-HT and other substances caused by bronchial smooth muscle spasm.
4. Digestive system symptoms: Patients may have abdominal pain, bloating, diarrhea and other symptoms to varying degrees. The abdominal pain is mostly related to the location of the primary tumor and/or metastatic cancer, and the compression and destruction of the surrounding tissue when the tumor is enlarged. Most of the diarrhea is watery. In severe cases, it can reach 10 to 20 times a day. It should be distinguished from WDHA syndrome.
5. Edema around the eyelids, combined with membrane bleeding, tearing, more often accompanied by skin flushing.
6. Other symptoms: accompanied by islet cell carcinoid, sometimes there are other endocrine hormone hyperactivity, such as insulin, glucagon, growth hormone, parathyroid hormone, adrenocorticotropic hormone, etc., generally have corresponding Characteristic performance can be identified. In the late stage of carcinoid, there may also be manifestations of wasting, anemia, hypoproteinemia and other dyscrasia.
Examine
Islet cell carcinoid examination
Coarse sieve test
A drop of the patient's urine on the filter paper, followed by the addition of azo-P-nitroaniline diazo (P-nitroaniline diazo) as red, suggesting an increase in urinary 5-hydroxyindoleacetic acid (5-HIAA), supporting the disease Diagnosis; if purple, it is a pheochromocytoma.
2. Urine 5-HIAA determination
Since 99% of 5-HT is converted into 5-HIAA in the body and then excreted in the urine, the total amount of 5-HIAA in the urine for 24 hours is determined to help diagnose the disease. The total amount of 5-HIAA in the 24-hour urine of normal people is 10.5 ~ 42.0mol, most patients with urine 5-HIAA greater than 158mol / 24 hours, if greater than 263mol / 24 hours, has a diagnostic value.
3. 5-HT assay in tumor tissues
The 5-HT content in carcinoid tissues was significantly increased, which was more sensitive than the 5-HIAA method in urine.
The use of B-ultrasound, CT, MRI and ERCP examinations can help to understand the location, size and number of islet cell carcinoids, and provide local diagnostic data for the development of surgical plans.
Diagnosis
Diagnosis and diagnosis of islet cell carcinoid
Attention should be paid to the identification of hypoglycemia caused by epilepsy, cerebrovascular accident, rickets, mental disorders and other causes.
