Carcinoid tumours have been considered a tumour type in a spectrum of Kulchitsky cell or neuroendocrine neoplasms, which range from typical carcinoid through atypical carcinoid and, finally, SCLC . Typical carcinoids have low malignant potential, with less than 5% incidence of lymph node metastases and greater than 80% cure rates with surgery . Atypical carcinoids have an incidence of lymphatic me-tastases in up to 70%, with a 10-year survival of less than 50% . Clinical evidence of carcinoid syndrome implies atypical features, a large lesion or metastases, with rare exceptions . The most recent authoritative classification of neuroendocrine neoplasms adds a tumour type called large cell neuroendocrine carcinoma . This is ahigh grade carcinoma that fits in the spectrum somewhere between atypical carcinoid and SCLC, with a prognosis approaching that of SCLC.
Surgery is still the primary mode of treatment, but accurate intraoperative staging may confirm lymphatic metasta-ses, which may indicate a role for adjuvant therapy . Resection can be considered for pulmonary metastases from extrathoracic malignancies under certain circumstances (Table 8). Some lesions (breast, thyroid, renal cell, melanoma and colon) may be associated with endobronchial me-tastases, necessitating bronchoscopy. If the primary lesion is associated with lymphatic metastases and there is evidence of mediastinal adenopathy, these potential N2 nodes should be biopsied . Your drugs could cost a lot less money and take less time to get: antibiotic levaquin to find out what it feels like to be able to start your treatment without thinking about prescriptions and other factors like that.
Table 8. Requirements for resection of metastatic pulmonary lesions