Pulmonary carcinoid - Presentation, diagnosis, and outcome in 142 cases inIsrael and review of 640 cases from the literature

Objective: To determine the characteristic features and outcome of pulmonar y carcinoid tumors in Israel. Methods: Retrospective analysis of the clinicopathologic data and outcome o f patients from four major hospitals in Israel in the last 20 years. Results: There were 142 cases of pulmonary carcinoid tumors: typical (n = 1 28) and atypical (n = 14). We calculated an annual incidence of about 2.3 t o 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 an d signs and included obstructive pneumonitis, pleuritic pain, atelectasis, and dyspnea (41%). Carcinoid syndrome was extremely rare and occurred in on ly one patient with metastatic disease. Most of the tumors (68%) arose in t he major bronchi, Diagnosis was made using fiberoptic bronchoscopy in 52% o f patients without evidence of endobronchial hemorrhage, Nodal involvement and distant metastases occurred in 57% and 21%, respectively, in the atypic al group, and 10% and 3%, respectively, in the typical group. The treatment of choice was surgical: lobectomy (56%) or pneumonectomy (16%), The respec tive 5-year survival rates for patients with typical and atypical tumors we re 89% and 75% (not significant), and the 10-year survival rates were 82% a nd 56% (p < 0.05). A review of large series from the literature is presente d. Conclusion: Pulmonary carcinoid is an uncommon tumor in the Israeli populat ion. With early diagnosis and aggressive surgical therapy, long-term progno sis is excellent.