A NEW INCOME IN PEDIATRIC PATHOLOGY: GASTROENTERO‐ PANCREATIC NEUROENDOCRINE TUMORS. II: CARCINOID TUMORS

Carcinoid tumors are classified according to their embryologic origin, that might be the foregut (stomach, duodenum, biliary tree and also lung, thymus, thyroid), the midgut (ileum, right colon) and the hindgut (left colon and rectum). The clinical picture of these lesions is varia‐ ble, evidencing completely asymptomatic cases, symptoms due to complications (acute appendicitis, peritonitis, obstructions or hemorrhages) or sudden apparition of car‐ cinoid syndromes. The diagnosis includes urinary 5 – HIAA, chromogranine A dosage and Ki‐67 expression, as well as localising studies, such as echoendoscopy, video‐ capsule and enteroscopy, CT, MRI, selective abdominal angiography, somatostatin‐receptor‐scintigraphy (Octre‐ oscan, SRI). Coronal contrast‐enhanced CT or MRI angio‐ gram can evaluate the mesenteric vessels spread before surgery. Upper endoscopy or/and colonoscopy can be performed to detect foregut or hindgut lesions. The treat‐ ment is based on surgery and other removal techniques, such as cryoablation and radiofrequency ablation, tradi‐ tional drugs: streptozocin, 5‐fluorouracyl, doxorubicin, cyclophos phamide, mitomicycin, metrotrexate together with somatostatin analogs; the future belongs to radionu‐ clide‐radiopeptide therapy.