Bronchial Carcinoid

by Carlo Raj, MD

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    00:00 A couple more now with non-small cells and these really are not your bronchogenic at all.

    00:07 Carcinoid, well, let's take a look. Location - well, as far as the lung is concerned, no. Okay. Carcinoid will always begin in intestine. Really? Alright, are you picturing that? So, our discussion is long, it begins in intestine. Correct. And you can produce a lot of serotonin and a bunch of other, 40 other different metabolites. Histamine and catecholamines, I mean, the list goes on and on and on. But, of all of them, the one that you’re paying attention to by far is going to be the serotonin. Okay.

    00:42 Now, bronchial carcinoid, let's take a look at the characteristics. Excellent prognosis, rarely metastasises. Symptoms due to mass effect, which we’ll come to in a little bit, that’s big for us. Number 1, flushing, you must find. Now, we said that serotonin that causes vasodilation, but there’s something with carcinoid that you have to find. Majority of your patient with carcinoid will have flushing. What’s that mean? Increased redness, that means vasodilation. Also, up in the lungs look for the patient that has bronchospasms.

    01:17 Okay? Number 2, and then, because this is in intestines, you’re going to have diarrhoea.

    01:21 What are you going to check for in your stool? Do you see that stuff coming out of your butt in the toilet, check it out. What do you find? You find 5-HIAA. 5-hydroxyindoleacetic acid.

    01:34 We had that discussion during diarrhoea, secretory. And you have right sided valvular disease.

    01:39 Now, as a whole with carcinoid syndrome, these are things that you’re paying attention to. And do this for me.

    01:46 I want you to now talk about carcinoid syndrome, which means that you began in the intestine.

    01:51 In the intestine also secreting serotonin metabolite 5-HIAA, diarrhoea, number 1.

    01:59 Number 2, syndrome, not tumour. This means that it metastasised to the liver. The liver can’t handle all of the metabolites. Out comes serotonin and company. Once you leave the liver, because you can’t properly detoxify because the tumour, that had the serotonin, maybe diarrhoea, but the liver is able to handle everything else, coming from the portal vein. But if you metastasised to liver, then you grow a colony, you secrete these substances into the inferior vena cava. Up it comes. All through the inferior vena cava, what do you enter? Right atrium. What’s your next structure? Take a look. Right sided-valvular disease. You might have tricuspid regurgitation, stenosis. You might have pulmonic regurgitation, pulmonic stenosis.

    02:55 So for a diarrhoea, right sided-valvular.

    02:57 Next, you’re going to lung. Now I want you to think of this behaving like histamine.

    03:03 ReLLY? With histamine, what does it do to your bronchi? Oh yes, bronchospasm. You have bronchospasm here. Tell me what kind of effect does histamine have on your blood vessels? You remember that movie Hitch with Will Smith? What happened to him? He had an anaphylactic reaction. Why I am talking like that? Angioedema. What caused that increased vascular permeability and dilation? Oh, that was also histamine.

    03:35 But this is carcinoid. Now, what he did? He took a bunch of antihistamine, remember that Benadryl and, anyhow. So, he took antihistamine, that’s gonna combat that, that’s acquired angioedema. My point is, you’re going to have vasodilation and flushing. So, have a little bit of fun with this and this is bronchial carcinoid. Prognosis, excellent. Syndrome, I just walked you through. The most important feature is the flushing.

    About the Lecture

    The lecture Bronchial Carcinoid by Carlo Raj, MD is from the course Lung Cancer .

    Included Quiz Questions

    1. Intestines
    2. Lung
    3. Breast
    4. Stomach
    5. Liver
    1. 5-HIAA in the urine
    2. Elevated serum ACTH
    3. Elevated serum IgE
    4. Responsiveness to anti-histamines
    5. Hypercalcemia
    1. Aortic regurgitation
    2. Flushing
    3. Increased vascular permeability
    4. Bronchospasms
    5. Angioedema

    Author of lecture Bronchial Carcinoid

     Carlo Raj, MD

    Carlo Raj, MD

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