Elong to a category of tumors called apudomas (amine precursor uptake and decarboxylation tumors) because they arise from endocrine amine precursor uptake and decarboxylation cells that can be found throughout the gastrointestinal tract and in other organs such as the pancreas and the lung. The tumor arises in the wall of the bowel as a submucosal mass that may result in scarring and kinking of the surface (fig. 1). Microscopically, carcinoid tumors are made up of small round regular cells containing a round nucleus and clear cytoplasm. A prominent nucleolus is often present [2]. Histologic diagnosis also relies on immunohistochemical stains and electron microscopy. The presence of elevated excretion of 5-hydroxyindoleacetic acid (5-hiaa) is suggestive of a functioning carcinoid tumor [3, 4]. View larger version: in this window in a new window download as powerpoint slide fig. medicaresupplementspecialists.com/pfz-100-mg-generic-viagra-np/ cheapest viagra on the web generic viagra by mail cheap viagra online buy cheap viagra buy generic viagra buy viagra viagra online viagra online buy viagra online overnight shipping 1. —small-bowel carcinoid tumor. Photograph of surgical specimen shows small submucosal mass (arrow) causing kinking of bowel surface. (courtesy of askin f, baltimore, md) distinguishing benign from malignant carcinoid tumors on the basis of histology alone is often impossible. Documented metastases or local spread to adjacent organs establishes the malignant nature of the tumor. However, the likelihood of metastasis is related to tumor size. For example, the incidence of nodal and liver metastases is approximately 20–30% in patients with carcinoid tumors smaller than 1 cm but increases to almost 60–80% for nodal metastases and 20% for liver metastases when tumors are 1–2 cm [5–7]. In patients with primary tumors greater than 2 cm, the incidence of nodal metastases is 80% and of liver metastases is 40–50% [5–7]. Approximately 85% of carcinoid tumors arise in the gastrointestinal tract and can be classified according to their site of origin [8]. Tumors originating from the foregut develop in the stomach, duodenum, and pancreas; those arising in the midgut develop in the small bowel, appendix, and right colon; and those arising from the hindgut develop in the transverse colon, left colon, or rectum [2, 8]. Carcinoid tumors can be hormonally active and can release vasoactive hormones into the systemic circulation, which i.


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