Malignant Carcinoid Syndrome
A symptom complex associated with CARCINOID TUMOR and characterized by attacks of severe flushing of the skin, diarrheal watery stools, bronchoconstriction, sudden drops in blood pressure, edema, and ascites. The carcinoid tumors are usually located in the gastrointestinal tract and metastasize to the liver. Symptoms are caused by tumor secretion of serotonin, prostaglandins, and other biologically active substances. Cardiac manifestations constitute CARCINOID HEART DISEASE. (Dorland, 27th ed; Stedman, 25th ed)
Carcinoid Tumor
A usually small, slow-growing neoplasm composed of islands of rounded, oxyphilic, or spindle-shaped cells of medium size, with moderately small vesicular nuclei, and covered by intact mucosa with a yellow cut surface. The tumor can occur anywhere in the gastrointestinal tract (and in the lungs and other sites); approximately 90% arise in the appendix. It is now established that these tumors are of neuroendocrine origin and derive from a primitive stem cell. (From Stedman, 25th ed & Holland et al., Cancer Medicine, 3d ed, p1182)
Hydroxyindoleacetic Acid
Carcinoid Heart Disease
Cardiac manifestation of gastrointestinal CARCINOID TUMOR that metastasizes to the liver. Substances secreted by the tumor cells, including SEROTONIN, promote fibrous plaque formation in ENDOCARDIUM and its underlying layers. These deposits cause distortion of the TRICUSPID VALVE and the PULMONARY VALVE eventually leading to STENOSIS and valve regurgitation.
Octreotide
Flushing
Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. (1/72)
PURPOSE: Subcutaneous (SC) octreotide acetate effectively relieves the diarrhea and flushing associated with carcinoid syndrome but requires long-term multiple injections daily. A microencapsulated long-acting formulation (LAR) of octreotide acetate has been developed for once-monthly intramuscular dosing. PATIENTS AND METHODS: A randomized trial compared double-blinded octreotide LAR at 10, 20, and 30 mg every 4 weeks with open-label SC octreotide every 8 hours for the treatment of carcinoid syndrome. Seventy-nine patients controlled with treatment of SC octreotide 0.3 to 0.9 mg/d whose symptoms returned during a washout period and who returned for at least the week 20 evaluation constituted the efficacy-assessable population. RESULTS: Complete or partial treatment success was comparable in each of the four arms of the study (SC, 58.3%; 10 mg, 66.7%; 20 mg, 71.4%; 30 mg, 61.9%; P> or =.72 for all pairwise comparisons). Control of stool frequency was similar in all treatment groups. Flushing episodes were best controlled in the 20-mg LAR and SC groups; the 10-mg LAR treatment was least effective in the control of flushing. Treatment was well tolerated by patients in all four groups. CONCLUSION: Once octreotide steady-state concentrations are achieved, octreotide LAR controls the symptoms of carcinoid syndrome at least as well as SC octreotide. A starting dose of 20 mg of octreotide LAR is recommended. Supplemental SC octreotide is needed for approximately 2 weeks after initiation of octreotide LAR treatment. Occasional rescue SC injections may be required for possibly 2 to 3 months until steady-state octreotide levels from the LAR formulation are achieved. (+info)Prognosis and survival in patients with gastrointestinal tract carcinoid tumors. (2/72)
OBJECTIVE: To determine the impact of clinical presentation variables on the management and survival of patients with gastrointestinal (GI) tract carcinoid tumors. METHODS: A 20-year (1975-1995) retrospective analysis of 150 patients with GI tract carcinoid tumors at the Massachusetts General Hospital was conducted. Median follow-up was 66 months (range 1-378). Survival estimates for prognostic factors were calculated using Kaplan-Meier product limit estimators, with death from carcinoid as the outcome. Univariate analyses for each factor were obtained using a log-rank test, and multivariate survival analysis was performed. RESULTS: All but two patients underwent surgical intervention with the intent to cure (90%) or debulk the tumor (9%). Mean age at presentation was 55 +/- 18 years (range 11-90). There was a slight female/male predominance (80:70). Symptoms were nonspecific; the most common were abdominal pain (40%), nausea and vomiting (29%), weight loss (19%), and GI blood loss (15%). Incidental carcinoids, discovered at the time of another procedure, occurred in 40% of patients and were noted at multiple sites throughout the GI tract. The distribution of tumors was ileojejunum (37%), appendix (31 %), colon (13%), rectum (12%), stomach (4%), duodenum (1.3%), and Meckel's diverticulum (1.3%). Of the 27 patients with documented liver metastases, carcinoid syndrome developed in only 13 patients (48%), manifested by watery diarrhea (100%), upper body flushing (70%), asthma (38%), and tricuspid regurgitation (23%). All 13 patients with carcinoid syndrome had elevated levels of 5-HIAA, but the absolute levels did not correlate with the severity of symptoms. An additional 11 patients, 3 without liver metastases, had elevated levels of 5-HIAA without any evidence of carcinoid syndrome. Multicentric carcinoid tumors occurred in 15 patients (10%), and all but one of these tumors were centered around the ileocecal valve. There was no difference in the incidence of liver metastases between solitary (18%) and multicentric carcinoids (20%). Synchronous noncarcinoid tumors were present in 33 patients (22%), and metachronous tumors developed in an additional 14 patients (10%) in follow-up. Age and tumor size, depth, and location were significant predictors of metastases. By multivariate analysis, age > or = 50 years, metastases, and male gender were statistically significant predictors of death. CONCLUSIONS: Gastrointestinal tract carcinoid tumors have a nonspecific clinical presentation, except in the case of the carcinoid syndrome. Surgical resection is the treatment of choice for improving survival. Surgically treated patients with carcinoid tumor have an overall favorable 83% 5-year survival rate. (+info)Carcinoid constrictive pericarditis. (3/72)
A 78 year old man presented with diarrhoea, anorexia, and progressive lower limb oedema. He was in atrial fibrillation and had a right pleural effusion and ascites. Ultrasound of the abdomen and 24 hour urinary hydroxyindoleacetic acid output indicated metastatic carcinoid syndrome. Cardiac catheterisation revealed pericardial constriction, and pericardial exploration showed a greatly thickened pericardium with no evidence of tumour invasion. The patient died within 24 hours of surgery. Necropsy findings were consistent with a diagnosis of constrictive pericarditis secondary to metastatic carcinoid syndrome. (+info)Gastrointestinal carcinoids: characterization by site of origin and hormone production. (4/72)
OBJECTIVE: To describe a large series of patients with carcinoid tumors in terms of presenting symptoms, hormonal data, stage at diagnosis, pathologic features, and survival. SUMMARY BACKGROUND DATA: Published series have described significant prognostic features of carcinoid tumors as site of origin, age, sex, stage at diagnosis, presence of high hormone levels, and increased T stage. Of these, stage at diagnosis and T stage seem to emerge most often as independent predictors of survival in multivariate analyses. Of carcinoid tumors, those arising from a midgut location have higher levels of serotonin and serotonin breakdown products, as well as more frequent metastatic disease at presentation, than those arising from either foregut or hindgut locations. METHODS: A prospective database of carcinoid patients seen at Duke University Medical Center was kept from 1970 to the present. Retrospective medical record review was performed on this database to record presenting symptoms, hormonal data, pathologic features, and survival. Statistical methods included analysis of variance, Kaplan-Meier analysis, and Mantel-Cox proportional hazard survival analysis, with P <.05 considered significant for all tests. RESULTS: Carcinoids arising in different locations had different presentations: rectal carcinoids presented significantly more often with gastrointestinal bleeding, and midgut carcinoids presented significantly more often with flushing, diarrhea, and the carcinoid syndrome. Patients with midgut tumors had significantly higher levels of serotonin and serotonin breakdown products, corresponding to higher metastatic tumor burdens. Although age, stage, region of origin, and urinary level of 5-hydroxyindoleacetic acid predicted survival by univariate analysis, only the latter three were independent predictors of survival by multivariate analysis. Of the patients with metastatic disease at diagnosis, those with midgut tumors had better survival than those with foregut or hindgut tumors. CONCLUSIONS: Although region of origin is certainly an important factor in determination of prognosis, stage of disease at presentation is more predictive of survival. Pancreatic and midgut carcinoids are metastatic at diagnosis more often than those arising in other locations, leading to a worse overall prognosis. Among patients with distant metastases, patients with midgut primary tumors have improved survival despite increased hormone production compared with patients with tumors arising in other primary sites. (+info)Occurrence and effects of octreotide antibodies during nasal, subcutaneous and slow release intramuscular treatment. (5/72)
OBJECTIVE: Previous studies have indicated that antibody formation against octreotide is extremely rare. We examined the occurrence of octreotide antibody formation after treatment with three administration forms in large populations of patients with acromegaly or carcinoid syndrome. DESIGN: (i) Nasally administered octreotide: 70 previously untreated patients and 81 previously s.c. octreotide-treated patients participated. (ii) Subcutaneously administered octreotide: 172 acromegalic patients and 59 patients with carcinoid syndrome treated for up to 12 years participated. (iii) Intramuscularly administered depot octreotide (Sandostatin LAR): 62 acromegalic patients participated. METHODS: Presence of antibodies is defined as increased precipitation by polyethylene glycol of (125)I-octreotide after incubation with serum; this was also used for screening of cross-reaction with somatostatin and lanreotide (Somatuline). RESULTS: In patients who received nasal octreotide for at least 9 and up to 12 months (n=42), the occurrence of octreotide antibodies was 77% and 81% for previously untreated and treated patients respectively. In subcutaneously treated patients it was 63/231 (27%) after a mean exposure of 3 years. In patients treated for more than 5 years (n=53) it was 57% and after 8 years (n=18) 72%. In contrast, no patient could with certainty be identified to be antibody-positive after a mean of 2.5 years intramuscular Sandostatin LAR treatment (n=47). In all populations, the antibody-positive patients were as well controlled as the antibody-negative patients. Octreotide antibodies did not cross-react with native somatostatin (n=141), while about 25% of the antibody-positive sera did cross-react with the somatostatin analogue, lanreotide (Somatuline, Ipstyl, Angiopeptin). CONCLUSIONS: Antibody formation against octreotide is much more frequent than previously believed. It depends primarily on drug exposure time and route of administration. It does not alter the GH/IGF-I status in treated acromegalic patients and induces only mild local reactions in some patients. (+info)Hepatic artery ligation in treatment of carcinoid syndrome. (6/72)
SUMMARY: In a patient with malignant carcinoid syndrome with metastasis to the liver, cardiac lesions, pulmonary hypertension, pellagra-like skin lesions and depression developed. Her disability progressed despite medical therapy and two courses of chemotherapy. The primary tumour had been resected but the metastatic mass in the liver could not be resected because of its anatomic position. The dramatic improvement after hepatic artery ligation was correlated with urinary 5-hydroxyindole acetic acid excretion. (+info)Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours. (7/72)
Patients with metastatic carcinoid tumours often undergo surgical procedures to reduce the tumour burden and associated debilitating symptoms. These procedures and anaesthesia can precipitate a life-threatening carcinoid crisis. To assess perioperative outcomes, we studied retrospectively the medical records of adult patients from 1983 to 1996 who underwent abdominal surgery for metastatic carcinoid tumours. Preoperative risk factors, intraoperative complications and complications occurring in the 30 days after surgery were recorded. Perioperative complications or death occurred in 15 of 119 patients (12.6%, exact confidence interval 7.2-19.9). None of the 45 patients who received octreotide intraoperatively experienced intraoperative complications compared with eight of the 73 patients (11.0%) who did not receive octreotide (P=0.023). The presence of carcinoid heart disease and high urinary output of 5-hydroxyindoleacetic acid preoperatively were statistically significant risk factors for perioperative complications. (+info)Carcinoid heart disease: successful tricuspid valve replacement. (8/72)
A woman aged 46 was found to have severe tricuspid valve disease 14 years after the diagnosis of a malignant carcinoid tumour of the ileum and 33 years after the onset of symptoms attributable to the disease. Increasing ascites requiring repeated paracentesis had not responded to chemotherapy including infusion of 5-fluorouracil and vincristine into the coeliac artery. The tricuspid valve was replaced by a Bjork-Shiley prosthesis. After operation there was no recurrence of ascites or oedema. She remains well one year and 11 months later. It is suggested that valve replacement surgery should be considered more often in patients with carcinoid heart disease. Hepatomegaly and ascites sould not be attributed too readily to advancing malignant disease without careful consideration of the role of right-sided valvar lesions in the production of these signs. (+info)Malignant Carcinoid Syndrome is a complex of symptoms including flushing, diarrhea, heart disease and various other manifestations, caused by the release of vasoactive substances, especially serotonin, from neuroendocrine tumors, typically occurring in the gastrointestinal tract.
Malignant carcinoid syndrome is a complex of symptoms that occur in some people with malignant tumors (carcinoids) that secrete large amounts of hormone-like substances, particularly serotonin. These symptoms can include flushing of the face and upper body, diarrhea, rapid heartbeat, difficulty breathing, and abdominal pain and distention. In addition, these individuals may have chronic inflammation of the heart valves (endocarditis) leading to heart failure. It is important to note that not all people with carcinoid tumors will develop malignant carcinoid syndrome, but those who do require specific treatment for their symptoms and hormonal imbalances.
A carcinoid tumor is a slow-growing neuroendocrine neoplasm, often originating from enterochromaffin cells in the gastrointestinal tract or lungs, characterized by the excessive production and release of hormones and vasoactive substances, which can lead to various paraneoplastic syndromes.
A carcinoid tumor is a type of slow-growing neuroendocrine tumor that usually originates in the digestive tract, particularly in the small intestine. These tumors can also arise in other areas such as the lungs, appendix, and rarely in other organs. Carcinoid tumors develop from cells of the diffuse endocrine system (also known as the neuroendocrine system) that are capable of producing hormones or biologically active amines.
Carcinoid tumors can produce and release various hormones and bioactive substances, such as serotonin, histamine, bradykinins, prostaglandins, and tachykinins, which can lead to a variety of symptoms. The most common syndrome associated with carcinoid tumors is the carcinoid syndrome, characterized by flushing, diarrhea, abdominal cramping, and wheezing or difficulty breathing.
Carcinoid tumors are typically classified as functional or nonfunctional based on whether they produce and secrete hormones that cause symptoms. Functional carcinoid tumors account for approximately 30% of cases and can lead to the development of carcinoid syndrome, while nonfunctional tumors do not produce significant amounts of hormones and are often asymptomatic until they grow large enough to cause local or distant complications.
Treatment options for carcinoid tumors depend on the location, size, and extent of the tumor, as well as whether it is functional or nonfunctional. Treatment may include surgery, medications (such as somatostatin analogs, chemotherapy, or targeted therapies), and radiation therapy. Regular follow-up with imaging studies and biochemical tests is essential to monitor for recurrence and assess treatment response.
Hydroxyindoleacetic acid (5HIAA) is a major metabolite of serotonin, a neurotransmitter, formed by the action of monoamine oxidase and aldehyde dehydrogenase, and its measurement in urine is often used as a biomarker for serotonin synthesis in clinical and research settings.
Hydroxyindoleacetic acid (5HIAA) is a major metabolite of the neurotransmitter serotonin, formed in the body through the enzymatic degradation of serotonin by monoamine oxidase and aldehyde dehydrogenase. 5HIAA is primarily excreted in the urine and its measurement can be used as a biomarker for serotonin synthesis and metabolism in the body.
Increased levels of 5HIAA in the cerebrospinal fluid or urine may indicate conditions associated with excessive serotonin production, such as carcinoid syndrome, while decreased levels may be seen in certain neurodegenerative disorders, such as Parkinson's disease. Therefore, measuring 5HIAA levels can have diagnostic and therapeutic implications for these conditions.
Carcinoid heart disease is a rare but serious complication of carcinoid syndrome, characterized by fibrous plaque buildup and right-sided valvular dysfunction due to the release of vasoactive substances from neuroendocrine tumors, most commonly occurring in the ileum or appendix.
Carcinoid heart disease is a rare complication that occurs in some people with carcinoid tumors, which are slow-growing tumors that typically originate in the digestive tract. These tumors can release hormones and other substances into the bloodstream, which can cause various symptoms. In carcinoid heart disease, these substances cause fibrous plaques to form on the heart valves, leading to thickening and stiffening of the valve leaflets. This can result in leakage or obstruction of the heart valves, causing symptoms such as shortness of breath, fatigue, and fluid retention. Carcinoid heart disease is most commonly affects the tricuspid and pulmonary valves, which are located on the right side of the heart. If left untreated, carcinoid heart disease can lead to serious complications, including heart failure. Treatment typically involves a combination of medications to manage symptoms and control the growth of the tumor, as well as surgery to repair or replace damaged heart valves.
Octreotide is a synthetic analogue of the natural hormone somatostatin, used medically to suppress the release of various hormones and inhibit related symptoms, often administered in treatments for gastrointestinal disorders, acromegaly, and certain tumors like carcinoid and vasoactive intestinal peptide (VIPomas).
Octreotide is a synthetic analogue of the natural hormone somatostatin, which is used in medical treatment. It is a octapeptide with similar effects to somatostatin, but with a longer duration of action. Octreotide is primarily used in the management of acromegaly, gastroenteropancreatic neuroendocrine tumors (GEP-NETs), and diarrhea and flushing associated with carcinoid syndrome.
It works by inhibiting the release of several hormones, including growth hormone, insulin, glucagon, and gastrin. This results in a decrease in symptoms caused by excessive hormone secretion, such as reduced growth hormone levels in acromegaly, decreased tumor size in some GEP-NETs, and improved diarrhea and flushing in carcinoid syndrome.
Octreotide is available in several forms, including short-acting subcutaneous injections (Sandostatin®), long-acting depot intramuscular injections (Sandostatin LAR®), and a slow-release formulation for the treatment of diarrhea associated with AIDS (Mycapssa™).
The medical definition of Octreotide is:
A synthetic octapeptide analogue of somatostatin, used in the management of acromegaly, gastroenteropancreatic neuroendocrine tumors (GEP-NETs), and diarrhea and flushing associated with carcinoid syndrome. Octreotide inhibits the release of several hormones, including growth hormone, insulin, glucagon, and gastrin, leading to symptomatic improvement in these conditions. It is available as short-acting subcutaneous injections, long-acting depot intramuscular injections, and a slow-release formulation for diarrhea associated with AIDS.
'Flushing' in a medical context is a transient erythema, often involving the face and upper chest, usually caused by dilatation of peripheral blood vessels and increased blood flow, which can be a physiological response to emotions, physical activity, or certain medications, or a symptom of various medical conditions.
"Flushing" is a medical term that refers to a sudden, temporary reddening of the skin, often accompanied by feelings of warmth. This occurs when the blood vessels beneath the skin dilate or expand, allowing more blood to flow through them. Flushing can be caused by various factors such as emotional stress, alcohol consumption, spicy foods, certain medications, or medical conditions like carcinoid syndrome or menopause. It is generally harmless but can sometimes indicate an underlying issue that requires medical attention.
'Ileal Neoplasms' are defined as abnormal growths or malignancies occurring in the ileum, which is the final portion of the small intestine, and can include a range of tumor types such as adenocarcinomas, lymphomas, carcinoids, and gastrointestinal stromal tumors (GISTs).
Ileal neoplasms refer to abnormal growths in the ileum, which is the final portion of the small intestine. These growths can be benign or malignant (cancerous). Common types of ileal neoplasms include:
1. Adenomas: These are benign tumors that can develop in the ileum and have the potential to become cancerous over time if not removed.
2. Carcinoids: These are slow-growing neuroendocrine tumors that typically start in the ileum. They can produce hormones that cause symptoms such as diarrhea, flushing, and heart problems.
3. Adenocarcinomas: These are malignant tumors that develop from the glandular cells lining the ileum. They are relatively rare but can be aggressive and require prompt treatment.
4. Lymphomas: These are cancers that start in the immune system cells found in the ileum's lining. They can cause symptoms such as abdominal pain, diarrhea, and weight loss.
5. Gastrointestinal stromal tumors (GISTs): These are rare tumors that develop from the connective tissue of the ileum's wall. While most GISTs are benign, some can be malignant and require treatment.
It is important to note that early detection and treatment of ileal neoplasms can significantly improve outcomes and prognosis. Regular screenings and check-ups with a healthcare provider are recommended for individuals at higher risk for developing these growths.
Neuroendocrine tumor
In malignant carcinoid tumors with carcinoid syndrome, the median survival has improved from two years to more than eight years ... "Carcinoid Tumors and the Carcinoid Syndrome: What's New in the Therapeutic Pipeline". Carcinoid Symposium 2002. The Carcinoid ... There may be associated atypical carcinoid syndrome, acromegaly, Cushing disease, other endocrine disorders, telangiectasia, or ... Many carcinoids are asymptomatic and are discovered only upon surgery for unrelated causes. These coincidental carcinoids are ...
Octreotide scan
medicinenet.com > Carcinoid Syndrome (cont.) By Dennis Lee and Jay Marks. Retrieved Mars 2011 Briganti V, Cuccurullo V, Berti V ... and in other Malignant and Benign Pulmonary Diseases)". Current Radiopharmaceuticals. 13 (3): 166-176. doi:10.2174/ ... An octreotide scan is a type of SPECT scintigraphy used to find carcinoid, pancreatic neuroendocrine tumors, and to localize ...
Mitral stenosis
Other rare causes include mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic ...
Adenoma
They may cause carcinoid syndrome, a type of paraneoplastic syndrome. A sebaceous adenoma is a cutaneous condition ... They are removed because of their tendency to become malignant and to lead to colon cancer. Ashkenazi Jews have a 6% higher ... About one in 10,000 is malignant. Thus, a biopsy is rarely called for, especially if the lesion is homogeneous and smaller than ... If the appendix has ruptured and a tumor is present, this presents challenges, especially if malignant cells have formed and ...
List of MeSH codes (C04)
... malignant carcinoid syndrome MeSH C04.557.465.625.650.200.500.205 - carcinoid heart disease MeSH C04.557.465.625.650.240 - ... malignant carcinoid syndrome MeSH C04.557.470.200.025.200.500.205 - carcinoid heart disease MeSH C04.557.470.200.025.215 - ... malignant carcinoid syndrome MeSH C04.557.580.625.650.200.500.205 - carcinoid heart disease MeSH C04.557.580.625.650.240 - ... denys-drash syndrome MeSH C04.557.435.595.950 - wagr syndrome MeSH C04.557.435.600 - nephroma, mesoblastic MeSH C04.557.435.675 ...
Mitral valve replacement
... malignant carcinoid syndrome, neoplasm, left atrial appendage thrombus, endocarditic vegetations, certain inherited metabolic ...
Carcinoid
... resulting in a syndrome of clinical signs and symptoms. Carcinoid tumors are the most common malignant tumor of the appendix, ... Carcinoid tumors are also found in the lungs. Metastasis of carcinoid can lead to carcinoid syndrome. This is due to the over- ... so-called coincidental carcinoids), all carcinoids are considered to have malignant potential. About 10% of carcinoids secrete ... are associated with carcinoid syndrome. Sometimes, carcinoids cause paraneoplastic syndromes, which involve discharge of ...
Chromogranin A
It is used as an indicator for pancreas and prostate cancer and in carcinoid syndrome. It might play a role in early neoplasic ... it can be used to identify a range of neuroendocrine tumours and is highly specific for both benign and malignant cells of this ... 2005). "Current diagnosis and treatment of gastrointestinal carcinoids in a series of 101 patients: the significance of serum ... from a human midgut carcinoid tumour". FEBS Letters. 301 (3): 319-21. doi:10.1016/0014-5793(92)80266-J. PMID 1577173. S2CID ...
Computed tomography enterography
... diarrhea Small Bowel masses Malignant Adenocarcinoma Carcinoid Lymphoma Gastrointestinal stromal tumor Non-malignant ... Hyperplastic polyps Hamartomatous polyps sencondary to Peutz-Jeghers syndrome Adenomas Lipomas Hemangiomas Ectopic gastric or ...
Mediastinal tumors
Masses in this area are more likely to be malignant than those in other compartments. Masses in the posterior portion of the ... Invasive tumors can produce compression effects such as superior vena cava syndrome. Thymomas are diagnosed with CT or MRI ... Tonofibrils seen under electron microscopy can differentiate thymoma from other tumors such as carcinoid, Hodgkin's, and ... Superior vena cava syndrome, pleural effusions. Diagnosis usually by CT showing lobulated mass. Confirmation done by tissue ...
List of cancer types
Similarly, a cancer arising from malignant fat cells would be termed a liposarcoma. For some common cancers, the English organ ... Multiple endocrine neoplasia syndrome Pancreatic Cancer Parathyroid cancer Pheochromocytoma Thyroid cancer Merkel cell ... cancer Gastrointestinal carcinoid tumor Gastrointestinal stromal tumor (GIST) Hepatocellular cancer Pancreatic cancer, islet ... For example, the most common cancer of the liver parenchyma ("hepato-" = liver), arising from malignant epithelial cells (" ...
Pulmonary valve stenosis
... it may also be due to a malignant carcinoid tumor. Both stenosis of the pulmonary artery and pulmonary valve stenosis are forms ... PVS was the key finding that led Jacqueline Noonan to identify the syndrome now called Noonan syndrome. Among some of the ...
Serotonin syndrome
The condition most often confused with serotonin syndrome is neuroleptic malignant syndrome (NMS). The clinical features of ... Carcinoid syndrome Ferri, Fred F. (2016). Ferri's Clinical Advisor 2017: 5 Books in 1. Elsevier Health Sciences. pp. 1154-1155 ... Nisijima K, Shioda K, Iwamura T (2007). "Neuroleptic malignant syndrome and serotonin syndrome". Neurobiology of Hyperthermia. ... Christensen V, Glenthøj B (2001). "[Malignant neuroleptic syndrome or serotonergic syndrome]". Ugeskrift for Lægerer. 163 (3): ...
Small intestine cancer
Carcinoid tumors of the midgut-This is a type of neuroendocrine tumor (NET). They tend to be slow growing and are the most ... Peutz-Jeghers syndrome Cholecystectomy, which alters the flow of bile to the small intestine, increases the risk of small ... Malignant Neoplasms of the Small Intestine. eMedicine.com. URL: http://www.emedicine.com/MED/topic2651.htm. Accessed on: June 2 ... The survival rate for later stages is much lower at 4%. Early-stage carcinoid tumors have a five-year survival rate of 95%, ...
Gastrointestinal disease
Tumours of the small intestine include gastrointestinal stromal tumours, lipomas, hamartomas and carcinoid syndromes.: 879-887 ... describes the specific malignant conditions of the gastrointestinal tract. In general, a significant factor in the etiology of ... Peutz-Jeghers syndrome can cause dark spots on the oral mucosa or on the lips or the skin around the mouth. Several GI diseases ... Gardner's syndrome can be associated with failure of tooth eruption, supernumerary teeth, and dentigerous cysts. ...
Hereditary cancer syndrome
Genetic testing should be considered with adrenocortical carcinoma; carcinoid tumors; diffuse gastric cancer; fallopian tube/ ... autosomal dominant genetic condition that predisposes individuals to benign and malignant tumors. The most common tumors in Von ... A hereditary cancer syndrome (familial/family cancer syndrome, inherited cancer syndrome, cancer predisposition syndrome, ... Lynch syndrome), Howel-Evans syndrome of esophageal cancer with tylosis, juvenile polyposis syndrome, Li-Fraumeni syndrome, ...
Paraganglioma
There is no test that determines benign from malignant tumors; long-term follow-up is therefore recommended for all individuals ... GeneReviews/NCBI/NIH/UW entry on Hereditary Paraganglioma-Pheochromocytoma Syndromes k (Articles with short description, Short ... such as carcinoid tumor, neuroendocrine carcinoma, and medullary carcinoma of the thyroid.[citation needed] With ... Kairi-Vassilatou E, Argeitis J, Nika H, Grapsa D, Smyrniotis V, Kondi-Pafiti A (2007). "Malignant paraganglioma of the urinary ...
Octreotide
... diarrhea and flushing episodes associated with carcinoid syndrome, and diarrhea in people with vasoactive intestinal peptide- ... It has been used in the treatment of malignant bowel obstruction. Octreotide may be used in conjunction with midodrine to ... and albumin improves survival in patients with type 1 and type 2 hepatorenal syndrome". Journal of Clinical Gastroenterology. ... in terminally ill Japanese cancer patients with malignant bowel obstruction". Japanese Journal of Clinical Oncology. 38 (5): ...
List of diseases (C)
Carbohydrate deficient glycoprotein syndrome Carbon baby syndrome Carbonic anhydrase II deficiency Carcinoid syndrome Carcinoma ... malignant) Chondrysplasia punctata, humero-metacarpal type Chordoma Chorea Chorea acanthocytosis Chorea familial benign Chorea ... CCA syndrome Ccge syndrome CCHS CDG syndrome CDG syndrome type 1A CDG syndrome type 1B CDG syndrome type 1C CDG syndrome type 2 ... syndrome Coffin-Siris syndrome COFS syndrome Cogan-Reese syndrome Cogan syndrome Cohen-Gibson syndrome Cohen-Hayden syndrome ...
Endocrine disease
Multiple endocrine neoplasia MEN type 1 MEN type 2a MEN type 2b Carcinoid syndrome Autoimmune polyendocrine syndromes ... benign or malignant) of endocrine glands Endocrine disorders are often quite complex, involving a mixed picture of ... disorders Kallmann syndrome Klinefelter syndrome Turner syndrome Acquired disorders Ovarian failure (also known as Premature ... myopathy Hypothyroidism Hypothyroid myopathies Kocher-Debre-Semelaigne syndrome Hoffmann syndrome Myasthenic syndrome Atrophic ...
Multiple endocrine neoplasia type 1
About 30% of tumors are malignant and have local or distant metastases. About 10-15% of islet cell tumors originate from a β- ... Carcinoid tumors, particularly those derived from the embryologic foregut (lungs, thymus), occur in isolated cases. Multiple ... Among patients presenting with Zollinger-Ellison syndrome, 20 to 60% have MEN 1. A severe secretory diarrhea can develop and ... In a diagnostic workup individuals with a combination of endocrine neoplasias suggestive of the MEN1 syndrome are recommended ...
VIPoma
"Carcinoid Tumors and Syndrome". The Lecturio Medical Concept Library. Retrieved 5 July 2021. Sandhu S, Jialal I. "ViPoma". ... They are sometimes associated with multiple endocrine neoplasia type 1. Roughly 50-75% of VIPomas are malignant, but even when ... This syndrome is called Verner-Morrison syndrome (VMS), WDHA syndrome (from watery diarrhea-hypokalemia-achlorhydria), or ... During attacks of diarrhea, flushing similar to the carcinoid syndrome occur rarely. Besides the clinical picture, fasting VIP ...
Ovarian cancer
Gonadoblastomas in people with Swyer or Turner syndrome become malignant in approximately 40% of cases. However, in general, ... The most common malignancy is squamous cell carcinoma, but adenocarcinoma, basal-cell carcinoma, carcinoid tumor, ... Some family cancer syndromes such as hereditary nonpolyposis colon cancer and Peutz-Jeghers syndrome also increase the risk of ... Ovarian borderline tumors, sometimes called low malignant potential (LMP) ovarian tumors, have some benign and some malignant ...
List of skin conditions
... epidermal necrosis Limb-mammary syndrome Lowry-MacLean syndrome Macrocheilia Macrocystic lymphatic malformation Malignant ... Buschke-Ollendorff syndrome (dermatofibrosis lenticularis disseminata) Capillary aneurysms Carcinoid Cellular angiofibroma ... Turner syndrome Ulnar-mammary syndrome Van Der Woude syndrome Von Hippel-Lindau syndrome Watson syndrome Werner syndrome (adult ... Freeman-Sheldon syndrome, Windmill-Vane-Hand syndrome) Wilson-Turner syndrome Wolf-Hirschhorn syndrome (4p- syndrome) X-linked ...
Respiratory disease
Infant respiratory distress syndrome most commonly occurs in less than six hours after birth in about 1% of all births in the ... Malignant tumors of the respiratory system, particularly primary carcinomas of the lung, are a major health problem responsible ... carcinoid, Kaposi's sarcoma, melanoma) Lymphoma Head and neck cancer Pleural mesothelioma, almost always caused by exposure to ... Meconium Aspiration Syndrome occurs in full term or post-term infants who aspirate meconium. Risk factors include a diabetic ...
List of syndromes
Cantú syndrome Capgras delusion Capgras syndrome Capillary leak syndrome Caplan's syndrome Carcinoid syndrome Cardiac syndrome ... syndrome Neu-Laxova syndrome Neuro-cardio-facial-cutaneous syndromes Neurofibromatosis type I Neuroleptic malignant syndrome ... syndrome Wende-Bauckus syndrome Werner syndrome Wernicke-Korsakoff syndrome West syndrome Westerhof syndrome Wet lung syndrome ... syndrome Shone's syndrome Short anagen syndrome Short bowel syndrome short limb syndrome Short man syndrome Short QT syndrome ...
Pheochromocytoma
Multiple organ dysfunction syndrome (MODS): Caused by an elevated inflammatory response, multiple organ dysfunction is a severe ... In 2019, a consortium of almost twenty European medical centers looked at the prognosis of malignant pheochromocytoma and the ... "Neuroendocrine Cancer Survivor Featured on Discovery Fit & Health TV Show". Carcinoid Cancer Foundation. 2012-07-08. Retrieved ... May 2013). "New syndrome of paraganglioma and somatostatinoma associated with polycythemia". Journal of Clinical Oncology. 31 ( ...
Fetal adenocarcinoma
Other presenting symptoms described have included: flu-like syndrome with cough and fever, Due to its rarity, little is known ... A case of combined small cell lung carcinoma featuring components of FA and cells resembling those from carcinoid tumor has ... Although it is not normally considered a fast-growing malignant neoplasm, FA can exhibit high uptake on FDG-PET scanning. ... Adenocarcinomas are most often highly heterogeneous peripheral tumors, and are thought to arise from malignant transformation ...
Index of oncology articles
... malabsorption syndrome - malignancy - malignant - malignant ascites - malignant fibrous cytoma - malignant fibrous histiocytoma ... carcinoid - carcinoid syndrome - carcinoma - carcinoma in situ - carcinomatosis - carcinosarcoma - carcinosis - carcinostatic ... malignant meningioma - malignant mesothelioma - malignant mixed Müllerian tumor - malignant peripheral nerve sheath tumor - ... FAMMM syndrome - Fanconi anemia - Fanconi syndrome - FAP - fatty-replaced breast tissue - fazarabine - fecal occult blood test ...
Gastrointestinal cancer
The five-year survival rate with the latter procedure is above 70%.: 580 A gastrointestinal carcinoid tumor is a rare, slow- ... If a younger person gets such a cancer, it is often associated with hereditary syndromes like Peutz-Jegher's, hereditary ... Gastrointestinal cancer refers to malignant conditions of the gastrointestinal tract (GI tract) and accessory organs of ... "Gastrointestinal Carcinoid Tumor". National Cancer Institute at the National Institutes of Health. 1980-01-01. Retrieved 15 ...
Malignant Carcinoid Syndrome: Practice Essentials, Background, Pathophysiology
This syndrome is characterized by hot, red flushing of the face; severe and debilitating diarrhea; and asthma attacks. ... Malignant carcinoid syndrome is the constellation of symptoms typically exhibited by patients with metastases from carcinoid ... encoded search term (Malignant Carcinoid Syndrome) and Malignant Carcinoid Syndrome What to Read Next on Medscape ... Carcinoids do not produce the malignant carcinoid syndrome until they are no longer confined to the small bowel or mesentery, ...
Malignant Carcinoid Syndrome | Harvard Catalyst Profiles | Harvard Catalyst
"Malignant Carcinoid Syndrome" by people in Harvard Catalyst Profiles by year, and whether "Malignant Carcinoid Syndrome" was a ... carcinoid syndrome symptoms and healthcare resource utilization in patients with carcinoid syndrome. BMC Cancer. 2019 Mar 28; ... "Malignant Carcinoid Syndrome" is a descriptor in the National Library of Medicines controlled vocabulary thesaurus, MeSH ( ... Malignant Carcinoid Syndrome*Malignant Carcinoid Syndrome. *Carcinoid Syndrome, Malignant. *Carcinoid Syndromes, Malignant ...
Malignant Carcinoid Syndrome: Practice Essentials, Background, Pathophysiology
This syndrome is characterized by hot, red flushing of the face; severe and debilitating diarrhea; and asthma attacks. ... Malignant carcinoid syndrome is the constellation of symptoms typically exhibited by patients with metastases from carcinoid ... encoded search term (Malignant Carcinoid Syndrome) and Malignant Carcinoid Syndrome What to Read Next on Medscape ... Carcinoids do not produce the malignant carcinoid syndrome until they are no longer confined to the small bowel or mesentery, ...
Malignant Carcinoid Syndrome: Background, Pathophysiology, Epidemiology
This syndrome is characterized by hot, red flushing of the face; severe and debilitating diarrhea; and asthma attacks. ... Malignant carcinoid syndrome is the constellation of symptoms typically exhibited by patients with metastases from carcinoid ... encoded search term (Malignant Carcinoid Syndrome) and Malignant Carcinoid Syndrome What to Read Next on Medscape ... Carcinoids do not produce the malignant carcinoid syndrome until they are no longer confined to the small bowel or mesentery, ...
Malignant Carcinoid Syndrome: Background, Pathophysiology, Epidemiology
This syndrome is characterized by hot, red flushing of the face; severe and debilitating diarrhea; and asthma attacks. ... Malignant carcinoid syndrome is the constellation of symptoms typically exhibited by patients with metastases from carcinoid ... encoded search term (Malignant Carcinoid Syndrome) and Malignant Carcinoid Syndrome What to Read Next on Medscape ... Carcinoids do not produce the malignant carcinoid syndrome until they are no longer confined to the small bowel or mesentery, ...
Carcinoid syndrome due to a malignant somatostatinoma.
Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide. ... Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue. N Engl J Med. 1986 Sep 11;315 ... Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide.. ... Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide. ...
Paraneoplastic Syndromes: Practice Essentials, Pathophysiology, Etiology
They are defined as clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease. ... Paraneoplastic syndromes are rare disorders that are triggered by an altered immune system response to a neoplasm. ... These syndromes vary from dermatomyositis-polymyositis to Cushing syndrome [6] to the malignant carcinoid syndrome. ... Cyclical Cushings syndrome due to an atypical thymic carcinoid. Neth J Med. 2006 Jan. 64(1):23-7. [QxMD MEDLINE Link]. ...
urofacial syndrome - Ontology Browser - Rat Genome Database
Malabsorption Syndromes + Malignant Carcinoid Syndrome + Mallory-Weiss Syndrome Malocclusion and Short Stature ... urofacial syndrome + A syndrome that is characterized by inverted facial expressions in association with a severe and early- ... Cerebellar Vermis Aplasia with Associated Features suggesting Smith-Lemli-Opitz Syndrome and Meckel Syndrome ... urofacial syndrome (DOID:0050816). Annotations: Rat: (2) Mouse: (2) Human: (2) Chinchilla: (2) Bonobo: (2) Dog: (2) Squirrel: ( ...
Autonomic dysreflexia: MedlinePlus Medical Encyclopedia
Neuroleptic malignant syndrome (a condition caused by some medicines that leads to muscle stiffness, high fever, and drowsiness ... Carcinoid syndrome (tumors of the small intestine, colon, appendix, and bronchial tubes in the lungs) ... Serotonin syndrome (drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells) ... Guillain-Barré syndrome (disorder in which the bodys immune system mistakenly attacks part of the nervous system) ...
Abstract Search
Neuroendocrine tumor - Wikipedia
In malignant carcinoid tumors with carcinoid syndrome, the median survival has improved from two years to more than eight years ... "Carcinoid Tumors and the Carcinoid Syndrome: Whats New in the Therapeutic Pipeline". Carcinoid Symposium 2002. The Carcinoid ... There may be associated atypical carcinoid syndrome, acromegaly, Cushing disease, other endocrine disorders, telangiectasia, or ... Many carcinoids are asymptomatic and are discovered only upon surgery for unrelated causes. These coincidental carcinoids are ...
IntronA | European Medicines Agency
... carcinoid syndrome.. Malignant melanoma. As adjuvant therapy in patients who are free of disease after surgery but are at high ... Carcinoid tumour. Treatment of carcinoid tumours with lymph node or liver metastases and with ... major organ obstruction or compression syndrome, orbital or epidural involvement, serous effusion, or leukaemia. ...
Cancer Insurance, Heart Attack, Stroke Insurance
Cancer Insurance, Heart Attack, Stroke Insurance
Medifocus Guidebook on Carcinoid Tumors
... and can cause carcinoid syndrome. Most carcinoid tumors are now known to be slow growing malignant tumors that have their own ... The management of symptoms associated with carcinoid tumors and carcinoid syndrome with biological agents such as somatostatin ... The relationship between carcinoid syndrome and carcinoid heart disease - a condition that affects the heart valves and results ... Carcinoid syndrome describes a combination of symptoms that result from hormones or hormone-like substances, (e.g., serotonin, ...
Carcinoid Syndrome - Endocrine and Metabolic Disorders - MSD Manual Professional Edition
Carcinoid Syndrome - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the MSD Manuals - Medical ... including carcinoid syndrome. Carcinoid syndrome is usually due to endocrinologically active malignant tumors that develop from ... Carcinoid syndrome develops in some people with carcinoid tumors Overview of Carcinoid Tumors Carcinoid tumors develop from ... Symptoms and Signs of Carcinoid Syndrome The most common (and often earliest) sign of carcinoid syndrome is ...
Sandostatin LAR Depot - Drug Information from Guideline Central
14.2 Carcinoid Syndrome A 6-month clinical trial of malignant carcinoid syndrome was performed in 93 patients who had ... Table 7. Average Number of Daily Stools and Flushing Episodes in Patients With Malignant Carcinoid Syndrome Treatment Daily ... Seventy-eight (78) patients with malignant carcinoid syndrome who had participated in this 6-month trial subsequently ... Electrocardiograms were performed only in carcinoid patients receiving SANDOSTATIN LAR DEPOT. In carcinoid syndrome patients, ...
Carcinoid Heart Disease: Pathophysiology, Pathology, Clinical Manifestations, and Management | Cardiology | Karger Publishers
Carcinoid tumors of midgut origin usually present as classic carcinoid syndrome, whereas the syndrome is rare in tumors of ... are malignant [3, 5, 6]. The incidence of carcinoid tumors in the general population is approximately 1-5/100,000 persons [1, 3 ... midgut carcinoid), bronchus (foregut carcinoid), and genitourinary tract (hindgut carcinoid) [3, 7]. The term "carcinoid" was ... Carcinoid syndrome is a rare endocrine disorder related to the effects of vasoactive substances produced by carcinoid tumors, ...
Liver and Other Neoplasms - Treatment Approaches - Medical Clinical Policy Bulletins | Aetna
The most common such tumor is the carcinoid tumor whose hormone production is associated with the carcinoid syndrome, ... Secondary carcinoid tumors of liver. C78.7. Secondary malignant neoplasm of liver and intrahepatic bile duct [not covered for ... carcinoid tumors in persons who have failed systemic therapy with octreotide to control carcinoid syndrome (e.g., debilitating ... Malignant carcinoid tumors [functional neuroendocrine cancers in persons who have failed systemic therapy with octreotide to ...
Carcinoid syndrome - wikidoc
Functioning carcinoid; Functioning argentaffinoma; Neuroendocrine tumor carcinoid type; Malignant carcinoid syndrome ... Synonyms and keywords: Thorson-Bioerck syndrome; argentaffinoma syndrome; Cassidy-Scholte syndrome; flush syndrome; Carcinoid ... Differentiating Carcinoid Syndrome from other Diseases. Epidemiology and Demographics. Risk Factors. Screening. Natural History ... Retrieved from "https://www.wikidoc.org/index.php?title=Carcinoid_syndrome&oldid=1510048" ...
The Quizzes about Endocrinology disease - Part 1 (20 test) - MedQuizzes
C) malignant melanoma. (D) carcinoid syndrome. (E) disseminated carcinomatosis. 19. A 25-year-old woman presents with symptoms ... Carcinoid syndrome is characterized by increased levels of 5-hydroxyindolacetic acid. The syndrome occurs in relation to ... E) malignant hypertension. 3. Which of the following is the most common presentation of anterior pituitary hyposecretion in a ... Androgen insensitivity syndrome is caused by a mutation in the androgen receptor, and it affects 1 in 100,000 chromosomal males ...
Men and Women React Differently to Acute Stress
Clinical Trials - Global Genes
This is a Phase 2, randomized, open-label, parallel-group, multi-center study for patients with documented carcinoid syndrome ... Study to Evaluate the Safety, PK, and Dose Response of Paltusotine in Subjects With Carcinoid Syndrome. ... STARLIGHT: A Phase III Study of JR-141 in Patients With Mucopolysaccharidosis II (Hunter Syndrome) ... Mucopolysaccharidosis type 2 (Hunter syndrome, Iduronate 2-sulfatase deficiency, MPS2, MPSII, Mucopolysaccharidosis type II) ...
1678711379 - Passmed UK
... often associated with malignant carcinoid syndrome.. - Cutaneous flushing: Early and frequent (94%) symptom; typically affects ... Carcinoid crisis can be the most serious symptom of the carcinoid tumours and life-threatening. It can occur suddenly or after ... Radial tunnel syndrome is a set of symptoms that include fatigue or a dull, aching pain at the top of the forearm with use. ... Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the "funny bone" ...
Paraneoplastic Syndrome
The first report of Paraneoplastic syndrome is attributed to a French physician, M Auche, who described the involvement in a ... Other clinical symptoms may be benign but syndromes could be varied; from a malignant carcinoid syndrome to Cushing syndrome. ... Rheumatologic syndrome includes polyarthritis, particularly in patients with myelomas, lymphomas, acute leukemia, malignant ... Types of Paraneoplastic Syndrome. Due to the complexity of this syndrome, its clinical presentations may vary greatly. Hence, ...
Edward C. McCarron, MD| Surgical Oncology | MedStar Health
DeCS 2020 - June 23, 2020 version
Malignant Brenner Tumor use Brenner Tumor Malignant Carcinoid Syndrome Malignant Carcinoid Syndromes use Malignant Carcinoid ... Malignant Fibrous Histiocytoma use Histiocytoma, Malignant Fibrous Malignant Fibrous Histiocytomas use Histiocytoma, Malignant ... Malignant Histiocytic Disorder use Histiocytic Disorders, Malignant Malignant Histiocytic Disorders use Histiocytic Disorders, ... Malignant Fibrohistiocytic Tumor use Histiocytoma, Malignant Fibrous Malignant Fibrohistiocytic Tumors use Histiocytoma, ...
DeCS 2018 - July 31, 2018 version
Malignant Brenner Tumor use Brenner Tumor Malignant Carcinoid Syndrome Malignant Carcinoid Syndromes use Malignant Carcinoid ... Malignant Fibrous Histiocytoma use Histiocytoma, Malignant Fibrous Malignant Fibrous Histiocytomas use Histiocytoma, Malignant ... Malignant Histiocytic Disorder use Histiocytic Disorders, Malignant Malignant Histiocytic Disorders use Histiocytic Disorders, ... Malignant Fibrohistiocytic Tumor use Histiocytoma, Malignant Fibrous Malignant Fibrohistiocytic Tumors use Histiocytoma, ...
DeCS 2018 - July 31, 2018 version
Malignant Brenner Tumor use Brenner Tumor Malignant Carcinoid Syndrome Malignant Carcinoid Syndromes use Malignant Carcinoid ... Malignant Fibrous Histiocytoma use Histiocytoma, Malignant Fibrous Malignant Fibrous Histiocytomas use Histiocytoma, Malignant ... Malignant Histiocytic Disorder use Histiocytic Disorders, Malignant Malignant Histiocytic Disorders use Histiocytic Disorders, ... Malignant Fibrohistiocytic Tumor use Histiocytoma, Malignant Fibrous Malignant Fibrohistiocytic Tumors use Histiocytoma, ...
DeCS 2017 - July 04, 2017 version
Malignant Brenner Tumor use Brenner Tumor Malignant Carcinoid Syndrome Malignant Carcinoid Syndromes use Malignant Carcinoid ... Malignant Fibrous Histiocytoma use Histiocytoma, Malignant Fibrous Malignant Fibrous Histiocytomas use Histiocytoma, Malignant ... Malignant Histiocytic Disorder use Histiocytic Disorders, Malignant Malignant Histiocytic Disorders use Histiocytic Disorders, ... Malignant Fibrohistiocytic Tumor use Histiocytoma, Malignant Fibrous Malignant Fibrohistiocytic Tumors use Histiocytoma, ...