Carcinoid

Classification of Bronchial NET Histological type  Necrosis  Mitotic count  TC  absent  <2/10 HPF  AC  present focal  2–9/10 HPF  LCNEC  present (extensive)  >9/10 HPF  SCLC  >50/10 HPF  TC: typical carcinoid LCNEC: large-cell neuroendocrine carcioma AC: atypical carcinoid SCLC: small-cell carcinoma.

Diagnosis NSE neuron-specific enolase 5HIAA Clinical symptoms bronchial NET   Hemoptysis, cough, recurrent pulmonary infections, wheezing   Carcinoid syndrome  Rare   Cushing's syndrome  Clinical symptoms thymic NET   Chest discomfort, superior vena cava syndrome, stridor, Cushing's syndrome, acromegaly  Pathology   Histopathology   Immunohistochemistry (chromogranin A, synaptophysin, CD56, Ki-67)  Biochemistry (specific)   p-Chromogranin A, p-NSE, u-5HIAA, [au-cortisol, p-ACTH, p-GHRH, IGF-1]  Imaging   Multislice CT scan   111In-DTPA-scintigraphy: (Octreoscan®)  PET: 68Ga-DOTATATE, FDG  Bronchoscopy  Genetic screening   MEN-1 genetic screening when suspected  Diagnosis NSE neuron-specific enolase 5HIAA 5-hydroxy indol acetic acid

Neuroendocrine Tumours (NET) Follow-up After primary surgery: patients with TC and AC at least yearly up to 15 years Biochemical markers e.g. chromogranin A & NSE, should be determined every 3–6 months (in cases with elevated values at baseline) CT should be performed: once a year in atypical carcinoid & every 2 or 3 years in typical carcinoid Patients with metastatic or recurrent disease should be followed during treatment with cytotoxic or biological agents more often, at 3–6-month intervals with imaging, preferably by CT and biological markers to assess possible benefits of the treatment administered