Per G. Lindgren

Malignant carcinoid tumors. An analysis of 103 patients with regard to tumor localization, hormone production, and survival.

In a prospective study of 103 patients with carcinoid tumors consecutively referred for medical treatment, the most common sites of the primary tumors were the ileum (73%), bronchi (7%), and jejunum (4%). All patients had local metastases, and 96 (93%) also had liver metastases. The most common initial symptoms were diarrhea (32%), ileus (25%), and flush (23%). The overall frequency of diarrhea was 84% and of flush was 75%. Heart insufficiency caused by cardiac valve disease was seen in 33% of the patients. The carcinoid syndrome, including flush, diarrhea, and elevated urinary 5-hydroxyindole acetic acid (5-HIAA) concentrations, was manifested by 69 patients (67%), 64 of whom (93%) had carcinoid tumors of mid-gut origin. Elevated urinary 5-HIAA was found in 91 patients (88%), of which 89 displayed liver metastases. The plasma concentration of the tachykinin neuropeptide K (NPK) was elevated in 67 patients (66%), 63 of whom had tumors of the mid-gut region. Serum pancreatic polypeptide (PP) and human chorionic gonadotropin % levels were elevated in 43% and 28% of the patients, respectively, and the highest levels were found in patients with metastatic bronchial carcinoid tumors. Thirty-nine of the 103 patients are now dead; 18 died of tumor progression, whereas 14 patients died of heart failure secondary to a carcinoid tricuspidal valve insufficiency. The estimated median survival from the time of histologic diagnosis was 14 years, and from the time of carcinoid syndrome was 8 years.

PERCUTANEOUS ULTRASONOGRAPHY-GUIDED CUTTING BIOPSY FROM LIVER METASTASES OF ENDOCRINE GASTROINTESTINAL TUMORS

Ultrasonography-guided cutting needle biopsy of the liver was performed in 186 instances on 95 different patients with carcinoid and endocrine pancreatic tumors. In 171 cases, biopsy specimens were taken from liver metastases found on ultrasonography, and in 93% of these the obtained material was adequate for a correct diagnosis. In the 7% for which an incorrect diagnosis was made, all but one biopsy specimen contained normal liver tissue, indicating that the needle-guiding technique, and not the sampling technique, is the most critical part of the biopsy procedure. Tumor specimens were examined with silver stains and immunocytochemistry after application of monoclonal serotonin antibodies. The argyrophil silver stain of Grimelius could be applied on all specimens and had positive results in all but one case, demonstrating the neurohormonal endocrine origin of the metastases. The argentaffin reaction and/or serotonin immunoreactivity could be applied in 152 cases and had positive results in 115 of 122 (94%) of the mid-gut carcinoid tumors and negative results in 27 of 28 (96.4%) of the non-mid-gut carcinoid tumors and endocrine pancreatic tumors. Major complications occurred in 1.5%; none was lethal or required surgery. The results show that the technique used for tumor biopsy is very accurate and provides material sufficient for multiple histopathologic and immunocytochemical analyses without exposing the patients to high complication risks. It is further concluded that the staining techniques and immunocytochemical analyses applied on the biopsy specimens are valid for the prediction of the location of the primary endocrine tumor.

Ultrasound guided tumour biopsy in the anterior mediastinum: An alternative to thoracotomy and mediastinoscopy

To evaluate percutaneous ultrasound (US) guided tumour biopsy of the anterior mediastinum all patients scheduled for open mediastinal biopsy were considered for percutaneous biopsy during a 2-year period. US guided biopsy was chosen when CT had shown the tumour to be in contact with the thoracic wall. US guided biopsy was performed in 23 patients on 28 occasions. The procedure was technically successful in all cases and no complications occurred. In 27 of 28 cases the biopsy diagnosis was identical to the final diagnosis. In one patient with a malignant lymphoma a false diagnosis of connective tissue remnant was reached. US guided tumour biopsy of the anterior mediastinum is a safe, cost-effective and reliable method and a good alternative to the traditional biopsy techniques via mediastinoscopy or thoracotomy.

Angiography, Computed Tomography, Magnetic Resonance Imaging and Ultrasonography in Detection of Liver Metastases from Endocrine Gastrointestinal Tumours

Twenty-five patients with endocrine tumours (13 with endocrine pancreatic tumours and 12 with carcinoids) were examined with angiography, computed tomography, magnetic resonance imaging and ultrasonography. Seventeen patients had liver metastases and were followed between 3 and 66 months with serial examinations during treatment with chemotherapeutic agents and interferon. The efficiency of the various techniques to detect metastases was investigated. Analysis of changes in tumour size during treatment was made to see if treatment effects could be monitored with radiologic examinations. Ultrasonography was the best non-invasive method for detection of metastases and is recommended as standard method for imaging in this group of patients. Angiography was even better showing extremely small metastases, less than 5 mm, and is recommended in selected cases. With one exception, no significant change in tumour size was noted in spite of clear laboratory and clinical signs of therapy effect indicating that tumour size determination is not useful for therapy monitoring in this type of disease.

Ultrasound-guided 1.2-mm cutting-needle biopsies of head and neck tumours

Purpose: to establish the role of ultrasound-guided cutting-needle biopsy in the diagnostic work-up of tumours in the head and neck region. Material and Methods: Seventy-two patients (74 biopsies) with tumours in the head and neck were biopsied by means of a biopsy gun fitted with a 1.2-mm biopty needle (midsized-needle biopsy, MNB). Twenty-four biopsies were taken from salivary glands, 29 from lymph nodes, and 21 from miscellaneous locations. Thirty-three of the patients were biopsied by MNB under ultrasound guidance after a blinded fine-needle aspiration biopsy (FNAB) was considered non-diagnostic or non-representative. Results: in 91% of the cases, the MNB diagnosis was identical to the final diagnosis (surgical or radiological/clinical follow-up: at least 6 months), 9% were false-negative/non-representative. in 17/33 patients MNB was considered to provide more diagnostic information than FNAB, the methods had equal accuracy in 12 patients, and in 4 patients the information already gained with FNAB was superior to that provided by MNB. the non-diagnostic sampling rate for FNAB was 25% versus 3% for MNB. in 26 patients with malignant lymphoma, MNB results were diagnostically correct in all but 2 cases. FNAB was correct in 2 of 9 cases. There were no biopsy-related complications. Conclusion: MNB was found to be safe and to possess a high degree of diagnostic accuracy, and could therefore, particularly in patients with lymphoma, be considered a diagnostic alternative to FNAB.

Objective responses after fractionated infusional brachytherapy of unresectable pancreatic adenocarcinomas

The prognosis of unresectable pancreatic adenocarcinoma is poor. Therefore, the treatment potential of an intratumoral infusional brachytherapy using macroaggregated human albumin in combination with radioactive chromic phosphate [32P] was investigated in this group of patients.

Ultrasound guided tumour biopsy in the anterior mediastinum

To evaluate percutaneous ultrasound (US) guided tumour biopsy of the anterior mediastinum all patients scheduled for open mediastinal biopsy were considered for percutaneous biopsy during a 2-year period. US guided biopsy was chosen when CT had shown the tumour to be in contact with the thoracic wall. US guided biopsy was performed in 23 patients on 28 occasions. the procedure was technically successful in all cases and no complications occurred. in 27 of 28 cases the biopsy diagnosis was identical to the final diagnosis. in one patient with a malignant lymphoma a false diagnosis of connective tissue remnant was reached. US guided tumour biopsy of the anterior mediastinum is a safe, cost-effective and reliable method and a good alternative to the traditional biopsy techniques via mediastinoscopy or thoracotomy

Diagnostics of Malignant Lymphomas with Ultrasound Guided 1.2 MM Biopsy-Gun

In a retrospective analysis of 129 ultrasound-guided biopsy-gun biopsies (USGB) from patients with known or suspected malignant lymphoma, a histopathological diagnosis was obtained in 101 (78%) instances and no further procedures for histological verification were required. In the 28 cases with initially non-diagnostic results, 14 new USGBs were performed and a diagnosis was obtained in 11. Thus, a total success rate of 87% was achieved. The correct diagnosis was confirmed with either surgery, autopsy, or radiological or clinical follow-up (median 40 months). The diagnoses were categorised as Hodgkins disease and high-grade or low-grade non-Hodgkins lymphoma. Further subtyping of the lymphoma was possible in a few cases only. Immunohistochemistry was utilised only in a minor proportion of the cases (25/129), but refined the diagnosis in several instances. The biopsy-gun method was safe and minor adverse effects were seen in two patients only.

INTERFERON TREATMENT OF NEUROENDOCRINE TUMOUR XENOGRAFTS AS MONITORED BY MRI

The neuroendocrine-differentiated colonic carcinoma cell line (LCC-18) was transplanted to 29 nude mice (Balb/c). The purpose of the present study was to establish an animal model that would allow monitoring with magnetic resonance imaging (MRI) of changes induced by interferon (IFN) therapy and to evaluate whether the therapeutic response, as expressed by changes in MR signal characteristics and tumour proliferation activity, could be modulated by different IFN dosages. IFN did not seem to have any obvious antiproliferative effect on the LCC-18 tumour cell line transplanted to nude mice and no convincing treatment-related changes in rho values or T1 and T2 relaxation values were observed. The animal model was probably unsuitable for demonstration of IFN effects.

Multiple Real Time Parallel Section Scans

parts of the cardiac cycle. On the basis of these results a time interval of 0.1 s was chosen. The length of a) may also have an impact on the precision of the method. Without investigating this more closely, we have set this interval at 0.0 s. In the second study (3) the short-term reproducibility was estimated by making a second injection after 10 min. The correlation between calculated lumen volume in the two angiographic series was 0.83 (n= 13). The relative volume measurement used is, however, sensitive to differences in film exposure and contrast homogeneity. To obtain a reproducibility over several years, as is demanded in longitudinal studies, we will have to modify our previously described technique by using absolute volumes instead. A method for such an absolute volume determination has been suggested by CRAWFORD et coil. 0).