CARCINOID-TUMORS OF THE LUNG - DO ATYPICAL FEATURES REQUIRE AGGRESSIVE MANAGEMENT

Atypical carcinoids are an intermediate form of tumor between low-grad e malignant typical carcinoid and high-grade malignant small cell carc inoma, which represent the two ends of the spectrum of neuroendocrine bronchopulmonary tumors. Between 1983 and 1993, 27 patients with atypi cal carcinoids underwent surgical treatment. The histologic diagnosis of an atypical carcinoid was established if the criteria proposed by A rrigoni and associates were fulfilled. Seven pneumonectomies, 16 lobec tomies, 2 segmentectomies, and 2 wedge resections were performed. Thir teen patients (48.1%) had regional nodal metastases and 6 patients (22 %) had N2 disease at the time of surgical therapy. Distant metastases developed in 5 patients (18.5%) after initial treatment. The 10-year s urvival in patients with an atypical carcinoid was 49%, versus the 84% 10-year survival rate observed in patients with a typical carcinoid. We conclude that the aggressive behavior of atypical carcinoids preclu des the use of limited surgical resection and requires a more aggressi ve approach, with lobectomy and mediastinal lymph node dissection cons tituting a minimal procedure. The same criteria used for well-differen tiated lung carcinoma should apply to this form of neuroendocrine lung tumor. Adjuvant chemotherapy is recommended for patients with stage I II or distant metastases.