Chest
Volume 119, Issue 6, June 2001, Pages 1647-1651
Journal home page for Chest

Clinical Investigations
Cancer
Pulmonary Carcinoid: Presentation, Diagnosis, and Outcome in 142 Cases in Israel and Review of 640 Cases From the Literature

https://doi.org/10.1378/chest.119.6.1647Get rights and content

Objective

To determine the characteristic features and outcome of pulmonary carcinoid tumors in Israel.

Methods

Retrospective analysis of the clinicopathologic data and outcome of patients from four major hospitals in Israel in the last 20 years.

Results

There were 142 cases of pulmonary carcinoid tumors: typical (n = 128) and atypical (n = 14). We calculated an annual incidence of about 2.3 to 2.8 cases per 1 million population. The ratio of female to male patients was 1.6:1. The prevalence of smoking was similar to the general population in patients with typical carcinoids and twice as high in the atypical group. Bronchial obstruction was the cause of most of the presenting symptoms and signs and included obstructive pneumonitis, pleuritic pain, atelectasis, and dyspnea (41%). Carcinoid syndrome was extremely rare and occurred in only one patient with metastatic disease. Most of the tumors (68%) arose in the major bronchi. Diagnosis was made using fiberoptic bronchoscopy in 52% of patients without evidence of endobronchial hemorrhage. Nodal involvement and distant metastases occurred in 57% and 21%, respectively, in the atypical group, and 10% and 3%, respectively, in the typical group. The treatment of choice was surgical: lobectomy (56%) or pneumonectomy (16%). The respective 5-year survival rates for patients with typical and atypical tumors were 89% and 75% (not significant), and the 10-year survival rates were 82% and 56% (p < 0.05). A review of large series from the literature is presented.

Conclusion

Pulmonary carcinoid is an uncommon tumor in the Israeli population. With early diagnosis and aggressive surgical therapy, long-term prognosis is excellent.

Section snippets

Materials and Methods

We reviewed the medical records of 142 patients with carcinoid tumors treated at four major medical centers in Israel over the last 20 years (from 1980 to 1999). Data were collected from Hadassah Medical Center, Jerusalem; Shiba Medical Center, Tel-Aviv; Carmel Medical Center, Haifa; and Rabin Medical Center, Petah-Tiqva. The data analyzed included patients' age and sex, smoking history, presenting symptoms, mode of diagnosis, location and size of tumor, tumor spread, methods of treatment,

Results

The 142 patients consisted of 56 male and 86 female patients aged 12 to 80 years (mean ± SD, 52 ± 16 years). According to the histologic findings, 128 patients (48 male and 80 female patients; age range, 12 to 80 years) had a typical carcinoid tumor, and 14 patients (8 male and 6 female patients; age range, 22 to 75 years) had an atypical carcinoid tumor. The annual incidence is seven cases per year for a population of about 2.5 to 3 million people (the areas of referral for the four major

Discussion

The annual incidence of pulmonary carcinoid in Israel is quite low and is estimated to be 2.5 cases per 1 million people. Our female to male ratio of 1.6:1 contrasts with other studies in the literature, which reported an almost equal sex distribution.8,9 The relative rates of typical and atypical carcinoid tumors are similar to those reported by some authors, although in other series, the prevalence of atypical carcinoids was about 20%.10,11,12

The prevalence of smokers among the typical

Conclusion

Carcinoid tumor is an uncommon tumor in Israel. It is more common in woman and occurs frequently in the central airways, causing obstruction of an airway. Diagnosis can be made easily using bronchoscopy, and surgical removal is the treatment of choice. Long-term results are excellent in the typical form but less favorable in the atypical form.

ACKNOWLEDGMENT

The authors thank Gloria Ginzach and Marian Propp for editorial and secretarial assistance.

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