HETEROGENEITY OF BRONCHIAL CARCINOID-TUMO RS - PLACE OF ATYPICAL FORMS

Atypical carcinoid is an intermediate form between low grade malignant typical carcinoid and high grade malignant small cell carcinoma which are the two ends of the spectrum of neuroendocrine bronchopulmonary t umors. Between 1983 and 1993, twenty-three atypical carcinoids underwe nt surgical treatment. Histologic diagnosis of atypical carcinoid was established if the criteria proposed by Arrigoni et al, were fullfiled . Diagnosis was most frequently based on screening chest roentgenogram (56 %). CT-scan findings showed a nodular peripheral mass in 65 % of patients and central mass or atelectasis in 35 % of patients. Four pne umonectomies, 15 lobectomies, 2 segmentectomies and 2 wedge resections were performed. Nine patients (39 %) had regional nodal metastases an d 4 patients (17 %) had metiastinal nodal metastases (N2 discase) at t he time of surgery. There were 4 death related to recurrence of the di sase with distant metastasis in 3 patients (14 %). Ten-year survival i n atypical form was 59 % contrasting with the 90 % ten-year survival r ate in patient with typical form operated on the same period. Because of their aggressive behavior, atypical carcinoids were comparable to w ell differentiated carcinoma of the lung and require an aggressive app roach with lobectomy and mediastinal lymph node dissection being a min imum procedure.