Background: Experience of thoracal (bronchial and thymic) carcinoid tumors is discussed to add some remarkable diagnostic and therapeutic details for their treatment, based on a retrospective clinico-pathological analysis of 152 consecutive patients operated on at the Thoracic Surgery unit in Budapest between 1974 and 1988.
Methods: Prior to surgery 70 patients were symptom free, obstructive symptoms dominated in 65 patients, and hemoptysis occurred in 23 cases. In 68 patients a peripheral coin lesion was visible in radiographs and in 81 cases the tumor could be seen by bronchoscopy. In 3 patients the neoplasm appeared as mediastinal thymic-carcinoid. Pathological confirmation was based on routine light-microscopic sections, Grimelius technique, and immunohistochemical stainings for NSE and chromogranin. Bronchoplastic procedures were performed in 28 patients and limited (wedge or segmental) resection in 21 cases.
Results: Atypical carcinoids were diagnosed in 18 cases, microscopic vascular invasion could be seen in 70 tumors (46%), and 12 patients had a single hilar lymph-node metastasis. Immunostaining for NSE was evident in all carcinoids and 82% of the tumors presented positive reaction for chromogranin staining. Hospital mortality was 1.3%. The 5-year-survival rate amounted to 93% and the 10-year-survival rate to 83% (126/ 152). The early postoperative deaths were among 49 patients operated on by parenchyma-sparing methods; the rest of these 49 are alive and free of symptoms. Local recurrence occurred after a lobectomy and following removal of a mediastinal carcinoid. The tumors of 23 of the 26 dead patients showed vascular invasion, but 19 neoplasms among them had neither atypia nor regional lymph-node involvement. In the group of patients having tumors with signs of microscopic vascular invasion the 10-year-survival rate was 67%, while in the others it amounted to 96%.
Conclusions: Bronchial carcinoids require anatomic resection with lymph-node dissection. On the other hand, however, parenchyma-sparing methods have to be encouraged because of excellent late results. In our experience, immunohistochemistry for chromogranin can give some help in separation on the neuroendocrine tumor scale, and the presence of microscopic vascular invasivity is the main prognostic factor.