Carcinoid Research Articles

In-depth analysis of immunohistochemistry concordance in biopsy-resection pairs of bronchial carcinoids

Primary diagnosis of bronchial carcinoids (BC) is always made on biopsies and additional immunohistochemistry (IHC) is often necessary. In the present study we investigated the concordance of common diagnostic (synaptophysin, chromogranin, CD56 and INSM-1) and potential prognostic (OTP, CD44, Rb and p16) IHC markers between the preoperative biopsies and resections of in total 64 BCs, 26 typical (41 %) and 38 atypical (59 %) carcinoid tumors. Synaptophysin and chromogranin had 100 % concordance in all resected carcinoids and paired diagnostic biopsies. Synaptophysin was not affected by variable expression in biopsies compared to chromogranin, CD56 and INSM-1. Notably, INSM-1 IHC was false negative in 8 % of biopsies. Of the novel and potential prognostic markers, only CD44 showed 100 % concordance between biopsies and resections, while OTP showed two (4 %) false negative results in paired biopsies. While Rb IHC was false negative in 8 % of biopsies, no strong and diffuse pattern of p16 expression was observed. In this study, most false negative IHC results (85 %, 22/26) were observed in small flexible biopsies. Taken together, our data suggest excellent concordance of synaptophysin and CD44 on the preoperative biopsy samples, while other neuroendocrine markers, Rb and OTP should be interpreted with caution, especially in small biopsies.

Possible Use of Linear Echobronchoscope for Diagnosis of Peripheral Pulmonary Nodules.

Echobronchoscope-guided transbronchial needle aspiration (EBUS-TBNA) is mainly used as the transbronchial approach to hilar/mediastinal lymph nodes or lesions, for diagnostic or staging purposes. Moreover, the role of linear EBUS-TBNA as a diagnostic tool for central intrapulmonary lesions adjacent to the trachea or the major bronchi is also well established. However, since the tip of the ultrasound probe at the distal end of the echobronchoscope is very thin, it can be wedged through smaller peripheral bronchi, reaching the distal parenchyma and allowing for peripheral pulmonary lesion sampling. The main aim of this retrospective study was to evaluate the diagnostic yield and the safety of EBUS-TBNA in the diagnosis of pulmonary peripheral nodules. The database of the Interventional Pulmonology Unit of Azienda Ospedaliero-Universitaria delle Marche (Ancona, Italy) was evaluated to identify peripheral pulmonary nodules approached by EBUS-TBNA. Thirty patients with a single peripheral pulmonary nodule located peripherally to the subsegmental bronchi of the lower lobes and adjacent to a small bronchus greater than 3 mm in diameter were included in this study. The nodule was visible using endoscopic ultrasound in 28 patients and the diagnosis was obtained via EBUS-TBNA in 26 cases (12 adenocarcinoma, 5 typical carcinoid tumors, 4 hamartoma and 5 metastatic lesions). The diagnostic yield was 86.6% for all 30 patients and 92.8% if only the 28 patients in which the lesion was visualized via echobronchoscopy were considered. No relevant adverse events were observed. We conclude that EBUS-TBNA may be an effective and safe option to sample pulmonary peripheral nodules in selected patients with lower lobe peripheral pulmonary lesions adjacent to small bronchi greater than 3 mm in diameter and reachable with the EBUS-TBNA probe.

Lung Sparing Bronchoplasty of Carcinoid Tumors with Single Lumen ETT in a Limited-Resource Hospital Setting

Two patients, who presented with complaints of cough and hemoptysis, were diagnosed as having biopsy proven carcinoid tumor of the airway. Both patients underwent lung sparing surgery and bronchoplasty, with the aid of single lumen ETT in a limited resource, underprivileged hospital setting. This case report underscores the management of resectable tumors of major airways with single lumen ETT.

DOTATOC PET/CT imaging of a typical carcinoid tumor in a human ex-vivo perfused lung lobe.

The use of Isolated lung perfusion (ILP), combined with medical imaging modalities such as positron emission tomography-computed tomography (PET/CT), provides real-time visualization of tumors in ventilated and perfused vital lung tissue. This experiment intends to show the feasibility and benefits of using ILP combined with PET/CT imaging. Following lung surgery on a 49-year-old male, his left lower lobectomy specimen, which held a typical carcinoid tumor, was preserved on normothermic ILP. Gallium-68-Edotreotide ([68Ga]-DOTATOC) was administered into the ILP circuit, and dynamic emission data from PET/CT was acquired. ILP was carried out for 120 minutes. Near physiologic gas exchange and glucose metabolism were preserved throughout the experiment. The time activity curves (TAC) of 5 different volumes of interest (VOI) showed notable differences in tracer uptake over time. The peripheral area of the carcinoid exhibited delayed but high somatostatin receptor agonist uptake compared to the surrounding parenchyma and the intrapulmonary artery. However, the central area of the carcinoid showed very low [68Ga]-DOTATOC uptake. This experiment demonstrates the potential of ILP combined with PET/CT for kinetic modeling in experimental nuclear medicine imaging. By providing visualization of tracer uptake in perfused lung tissue, this model could potentially improve our understanding of tumor physiology and molecular imaging.

Clinical efficacy of thermal ablation for the treatment of pulmonary carcinoid tumor: a propensity-matched analysis

Objective To investigate the clinical efficacy of thermal ablation in the treatment of pulmonary carcinoid (PC) tumor. Methods Data of patients with inoperable PC diagnosed from 2000 to 2019 were obtained from the SEER database and analyzed according to different therapeutic modality: thermal ablation vs non-ablation. Propensity score matching (PSM) was used to reduce intergroup differences. Kaplan–Meier curves and the log-rank test were used to compare intergroup differences of overall survival (OS) and lung cancer-specific survival (LCSS). Cox proportional risk models were used to reveal prognostic factors. Results After PSM, the thermal ablation group had better OS (p < .001) and LCSS (p < .001) than the non-ablation group. Subgroup analysis stratified by age, sex, histologic type and lymph node status subgroups showed similar survival profile. In the subgroup analysis stratified by tumor size, the thermal ablation group showed better OS and LCSS than those of the non-ablation group for tumors ≤3.0 cm, not statistically significant for tumors >3.0 cm. Subgroup analysis by M stage showed that thermal ablation was superior to non-ablation in OS and LCSS for patients with M0 stage, but no significant difference was found in subgroups with distant metastatic disease. Multivariate analysis showed that thermal ablation was an independent prognostic factor for OS (HR: 0.34, 95% CI: 0.25–0.46, p < .001) and LCSS (HR: 0.23, 95%CI: 0.12–0.43, p < .001). Conclusion For patients with inoperable PC, thermal ablation might be a potential treatment option, especially in M0-stage with tumor size ≤3 cm.

Epidemiological Trends of Lung Tumours on Endobronchial Biopsy in Patients Presenting to Tertiary Care Hospital

Objective: To determine the epidemiological trends of lung tumours on endobronchial biopsy in patients presenting to our hospital.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Pulmonology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Jun 2022.&#x0D; Methodology: Two hundred eighty-seven patients who exhibited clinical and/or radiological signs of a lung mass were enrolled in this study. Bronchoscopy was done to identify endobronchial lesions, followed by endobronchial biopsies submitted for histopathology and immunohistochemistry to diagnose the exact type of tumour. Patients who underwent bronchoscopy for some other indication but were found to have an endobronchial mass incidentally were also included in the study.&#x0D; Results: Squamous cell carcinoma was the most common 107(37.3%), followed by small cell carcinoma 76(26.5%). Adenocarcinoma was diagnosed in 75 patients (26.1%). Diagnosis of carcinoid tumour was made in 6 patients (2.09%). There were 5 cases (1.7%) of poorly differentiated carcinoma and metastatic adenocarcinoma each. Large cell carcinoma was present only in 2 cases (0.7%). Strangely, two patients (0.7%) had small and Squamous cells simultaneously, and one had adenosquamous carcinoma. Other tumours, including mantle cell lymphoma, Rhabdomyosarcoma, mucoepidermoid carcinoma, neuroendocrine tumours, spindle cell carcinoma and sarcomatoid carcinoma, were found in 8 cases (2.8%).&#x0D; Conclusion: Squamous cell carcinoma is the most common centrally arising tumour in our population in both genders, followed by small cell carcinoma and adenocarcinoma.Keywords: Epidemiology, Endobronchial mass, Lung cancer, Squamous cell carcinoma.

Expressions of Cushing's syndrome in multiple endocrine neoplasia type 1.

Cushing's syndrome (CS) resulting from endogenous hypercortisolism can be sporadic or can occur in the context of familial disease because of pituitary or extra-pituitary neuroendocrine tumors. Multiple endocrine neoplasia type 1 (MEN1) is unique among familial endocrine tumor syndromes because hypercortisolism in this context can result from pituitary, adrenal, or thymic neuroendocrine tumors and can therefore reflect either ACTH-dependent or ACTH-independent pathophysiologies. The prominent expressions of MEN1 include primary hyperparathyroidism, tumors of the anterior pituitary, gastroenteropancreatic neuroendocrine tumors, and bronchial carcinoid tumors along with several common non-endocrine manifestations such as cutaneous angiofibromas and leiomyomas. Pituitary tumors are present in about 40% of MEN1 patients, and up to 10% of such tumors secrete ACTH that can result in Cushing's disease. Adrenocortical neoplasms occur frequently in MEN1. Although such adrenal tumors are mostly clinically silent, this category can include benign or malignant tumors causing hypercortisolism and CS. Ectopic tumoral ACTH secretion has also been observed in MEN1, almost exclusively originating from thymic neuroendocrine tumors. The range of clinical presentations, etiologies, and diagnostic challenges of CS in MEN1 are reviewed herein with an emphasis on the medical literature since 1997, when the MEN1 gene was identified.

Urgent intraoperative cytological diagnosis of spherical mass lesions in the lungs

Differential diagnosis of pulmonary mass lesions is one of the most difficult tasks not only in pulmonology but also in phthisiology, because clinical manifestations, data from visual and laboratory examinations are undifferentiated in the early stages. In the case of an unclear diagnosis, morphological verification of the process played a crucial role. Urgent intraoperative examination is the most difficult option for morphologic verification of lung lesions, which requires a quick, detailed, and accurate answer.The aim of this study was to evaluate the clinical significance and efficacy of urgent intraoperative cytologic examination in the differential diagnosis between granulomatous (tuberculosis, sarcoidosis), tumor and tumor-like lesions of the lung.Methods. The results of urgent intraoperative cytologic examination of 173 tissue specimens from lung masses were retrospectively analyzed. Cytologic specimens were stained by the May – Grunwald – Giemse and Ziehl – Neelsen methods and then visualized on a Zeiss Lab A1 microscope (Carl Zeiss, Germany). The obtained data are compared with the results of histological examination. To evaluate the effectiveness of intraoperative cytologic examination, the accuracy, sensitivity, and specificity were calculated.Results. Analysis of the results of urgent cytological examinations (n = 173) shows that granulomatosis (tuberculosis/sarcoidosis) was established in 64.7% of cases, malignancy – in 31 cases (cancer – 9.2%, carcinoid tumor – 2.9%, malignant neoplasm of unclear etiology – 4%, suspected malignant lesion – 1.7%); benign process – in 9.2% of cases (hamartoma + chondroma – 5.2%, chronic inflammation – 4%). 1.2% of the cases had no diagnostic material. When comparing the obtained results, there was a discrepancy between the histological picture (2.9% of cases) and the primary clinical diagnosis (5.7% of cases). Sensitivity, specificity, and accuracy of cytologic examination of intraoperative material amounted to 95.9, 71, and 98%, respectively.Conclusion. The high sensitivity and accuracy (&gt; 90%) of urgent cytologic diagnosis of pathologic processes in the lung under intraoperative conditions were demonstrated by the correct assessment of morphologic signs of a given lesion and by their comparison with the clinical picture and the results of additional examinations. Analysis of cytological specimens showed that urgent cytological examination significantly complements the morphological picture of lung lesions and can be considered as the first stage of phenotypic diagnosis.

Late-stage diagnosis of carcinoid heart disease due to lack of access to health care

Carcinoid syndrome (CS) is a unique constellation of symptoms caused by release of vasoactive substances from neuroendocrine tumors (Pandit et al., StatPearls, 2022). Neuroendocrine tumors are rare with an annual incidence of 2 in 100,000 people (Ram et al., 46:21-27, 2019). Up to 50% of patients with these tumors will develop carcinoid syndrome, which is characterized by symptoms caused by elevated levels of serotonin and most commonly include fatigue, flushing, wheezing, and non-specific gastrointestinal symptoms such as diarrhea and malabsorption (Pandit et al., StatPearls, 2022) (Fox et.al., 90:1224-1228, 2004). Over time, patients with carcinoid syndrome can develop carcinoid heart disease (CHD). CHD refers to the cardiac complications that occur when the vasoactive substances, such as serotonin, tachykinins, and prostaglandins, secreted from the carcinoid tumors. These complications most commonly include valvular abnormalities, but can also present as coronary artery damage, arrhythmias or direct myocardial injury (Ram et al., 46:21-27, 2019). While CHD is not typically an initial feature of carcinoid syndrome, it does eventually occur in up to 70% of patients with carcinoid tumors (Ram et al., 46:21-27, 2019) (Jin et.al., 146:65-73, 2021) (Macfie et.al., 224:665-669, 2022). CHD is associated with significant morbidity and mortality due to the risk of progressive heart failure (Bober et.al., 14:1179546820968101, 2020). In this case, we describe a 35-year-old Hispanic woman in South Texas with undiagnosed carcinoid syndrome for over 10 years that eventually progressed to severe CHD. In this patient’s case, we emphasize how lack of access to healthcare resulted in delay of diagnosis, appropriate treatment, and worsened prognosis in this young patient.

Carcinoid tumor of the bronchus and lung: A nationwide cross-sectional study.

e20645 Background: Carcinoid tumor of the lung is a rare neuroendocrine tumor (NET), little is known of the in-hospital characteristics of this tumor. This study aims to describe the characteristics of patients hospitalized with NET of the bronchus and lung. Methods: This is a retrospective descriptive study of patients with lung carcinoid tumors admitted to acute care from 2016 to 2020. Data is derived from the National Inpatient Sample (NIS). The patients were divided into two groups: malignant and benign carcinoid tumors of the bronchus and lung. Patients' characteristics were described, including demographics, hospital length of stay (Los), and total cost. Mortality and common comorbidities were included. Hypothesis testing for categorical variables were tested with Chi-Square. Continuous variables were tested with a Student t-test. Statistical significance was defined as a two-tailed P value of &lt; 0.05. Results: A total of 13,335 admissions were identified over a period of 5 years, but only 1,810 of them met inclusion criteria. The elderly population was the most affected group, with a mean age of 60 years (Malignant 61 versus Benign 52; p 0.001). There was a trend of female predominance, representing 57% vs 42% of males ( p 0.727). White patients constituted the majority of the population (72%), followed by Black (13%) and Hispanics (10%), with a minority of Native Americans and Asian/ Pacific Islanders ( p 0.016). Medicare was the most frequent primary payer (50%, p 0.015). No difference in household distribution ( p 0.138), hospital teaching status ( p 0.743) hospital region ( p 357) or hospital bed size (0.273) were noted. However, the majority of the admissions were to private-non-profit facilities, accounting for 78% ( p 0.003). Mean LoS was 7.4 days ( p 0.021). On subgroup analysis, the malignant carcinoid tumor of the lung was predominant, with 1,490 malignant carcinoid tumors of the lung and bronchus compared to 329 benign carcinoid tumors of the bronchus and lung. Affection by comorbidities like CAD and COPD was significantly associated with a carcinoid tumor of the lung (17% malignant carcinoid tumor of the lung and bronchus and 5% benign carcinoid tumor of the lung and bronchus p 0.003 and 24% malignant carcinoid tumor of the lung and bronchus and 11% benign carcinoid tumor of the lung and bronchus, p 0.008 respectively). All deaths (n = 90) were observed in the malignant carcinoid lung tumor group. Conclusions: In this cross-sectional study of patients with NET of the bronchus and lung admitted to acute care, we found that patients over the age of 50 and Whites were the most affected, with patients with malignant tumors being older. As expected, Medicare was the most frequent primary payer. In addition, COPD and CAD were not uncommon among both groups.

Pediatric carcinoid tumors of the lungs: A descriptive analysis.

e22017 Background: From 1973 to 2012, the prevalence of neuroendocrine tumors in children was found to have increased by approximately 6-fold when using the Surveillance Epidemiology, and End Results. While carcinoid tumors in adults are mostly indolent, pediatric carcinoid tumors tend to carry worse prognoses. Our goal for this study is to describe the population of pediatric patients with pulmonary carcinoid tumors. Methods: We used the National Cancer Database to identify pediatric patients diagnosed with carcinoid tumors of the lungs between 2004-2020. Analysis was conducted with SPSS to determine frequency of cases in different demographics. Survival was assessed using Kaplan-Meier curves with significance set at p &lt; 0.05. Results: Of the 125 patients identified, 55% of the patients were male and 45% female. Pulmonary carcinoid tumor patients were predominately white accounting for 80% of all cases. Black patients accounted for 14% of cases. The ages of diagnosis ranged from 3-17 years of age with the mean being 14.5 years of age. The majority of patients were diagnosed during their teenage years–84% were between the ages of 13 and 17 at diagnosis. Only one case was observed in a patient of age 6 or under. The median survival was 89 months. Univariate analysis revealed no significant difference in survival was seen in sex, race, or insurance groups. Charlson-Deyo score, however, did impact survival, where patients with a score of 2 had lower median survival time (36 months) compared to patients with a score of 1 (121 months) or 0 (87 months). Conclusions: Pediatric pulmonary carcinoid tumors are more commonly seen in white patients with most diagnoses occurring during patients’ teenage years (13-17). Age, sex, and race did not have a significant effect on survival although a Charlson-Deyo score of 2 was indicative of a worse prognosis when compared to a score of 1 or 0.

Cage-Based Metal-Organic Framework as an Artificial Energy Receptor for Highly Sensitive Detection of Serotonin.

Artificial synthetic receptors toward functional biomolecules can serve as models to provide insights into understanding the high binding affinity of biological receptors to biomolecules for revealing their law of life activities. The exploration of serotonin receptors, which can guide drug design or count as diagnostic reagents for patients with carcinoid tumors, is of great value for clinical medicine but is highly challenging due to complex biological analysis. Herein, we report a cage-based metal-organic framework (NKU-67-Eu) as an artificial chemical receptor with well-matched energy levels for serotonin. The energy transfer back from the analyte to the framework enables NKU-67-Eu to recognize serotonin with excellent neurotransmitter selectivity in human plasma and an ultra-low limit of detection of 36 nM. Point-of-care visual detection is further realized by the colorimetry change of NKU-67-Eu toward serotonin with a smartphone camera.

Ileum neuroendocrine tumor: Case report and literature review

Ileal neuroendocrine tumors are rare primary epithelial neoplasm arising from enterochromaffin cells. A 65-year-old male presented with complaints of recurrent abdominal pain of 1 year duration. The pain was more aggravated in last 7 days associated with vomiting, loss of appetite and diarrhea. On radioimaging ultrasonography finding impression of small bowel mass lesion suggestive of ileac carcinoid tumor with ischemic bowel disease was given. Computerized tomograph abdomen pelvis showed a well-defined hypodense, round, hetergenous, enhancing mass measuring 2.6x1.6x1.2 cm., showing arterial enhancement in mesentery in close relation to ileum and metastatic lymph node mass- indicating likeness of neuroendocrine tumor. The surgical resection of ileum with mass and enlarged mesenteric nodes were done. On gross examination ileum specimen on cut open showed multiple, irregular mucosal thickenings with foci of ulceration. The submocosa showed single, circumscribed, round tumor measuring 3 x 2.5x1.5 cm. Cut section of tumor was yellowish, tan, well circumscribed and solid. The mesenteric lymph nodes were enlarged. The microscopic examination ileum showed a tumor composed of uniform, round cells having to oval nuclei with salt and pepper chromatin. Tumor cells were arranged in trabecular, nests, ribbons and in areas pseudo glandular pattern. Increased mitotic activity was noted (4/10 high power field). Mesenteric lymph nodes were involved by tumor. On histopathology reported as Well-differentiated neuroendocrine tumors (NET), G2, intermediate grade of ileum. The immunohistochemical stain were positive for synaptophysin, chromogranin A. The Ki-67 expression was &amp;#60;1%. Herewith we are presenting rare case of well-differentiated neuroendocrine tumor NET, G2, intermediate grade of ileum for its clinical, radio imaging ,pathological features and management.

Intramucosal goblet cell adenocarcinoma: The evil got nipped in the bud

Introduction: Appendiceal goblet cell adenocarcinoma is a rare cancer that usually has histological features of both well-differentiated carcinoid tumors and adenocarcinomas (neuroendocrine cells are not required for the diagnosis). Appendiceal goblet cell adenocarcinoma can present as acute appendicitis, abdominal pain, a mass, or be discovered incidentally following appendectomy. Case Report: A 67-year-old female presented with signs of acute appendicitis and underwent laparoscopic appendectomy. Pathological evaluation showed evidence of both acute appendicitis/periappendicitis and an incidental appendiceal intramucosal well-differentiated adenocarcinoma in the lamina propria of a 12 mm long segment in the middle of the proximal half of the appendix. Conclusion: Appendiceal goblet cell adenocarcinoma can sometimes be an incidental finding. It can be difficult to identify it, especially when it is in the form of only a few cells and clusters of cells limited to lamina propria. This case is the first reported incidence of an intramucosal goblet cell adenocarcinoma that was present in a 12 mm long segment in the middle of the proximal half of the appendix. The location of this tumor provides justification for making submission of an appendix in its entirety for histologic examination as a standard-of-care.

Incidental Detection of Dual Spinal Meningiomas on 68Ga-DOTATATE PET/CT Masquerading as Metastatic Disease in a Patient With Pulmonary Carcinoid Tumor.

Simultaneous occurrence of multiple meningiomas of the spine appearing at different neuroaxial levels is extremely rare event. We present the scintigraphic findings of incidentally detected multiple meningiomas of the spine on 68Ga-DOTATATE PET/CT during the evaluation of a patient with pulmonary carcinoid tumor. These scintigraphic findings could result in a "false-positive" interpretation by exhibiting highly increased uptake similar to that of metastases of neuroendocrine neoplasm. Nuclear medicine physicians should be aware of this potential pitfall in somatostatin receptor imaging to prevent misinterpretation.

O142 The application of robotic surgical approaches in the management of midgut neuroendocrine tumours: a systematic review

Abstract Introduction Robotic-assisted surgery (RAS) promises good outcomes in midgut adenocarcinoma surgery. However, its effectiveness in midgut neuroendocrine tumours (MNETs) is unknown. This study aimed to assess the current use, user interface and any emerging developments of RAS in MNET treatment using the literature available. Methods This review was carried out using PRISMA guidelines. MEDLINE, EMBASE and Web of Science were searched on 22nd October 2022. All studies reporting primary data on robotic surgery in midgut neuroendocrine tumours or carcinoid tumours were included. The midgut was defined to be from the duodenojejunal flexure to the splenic flexure. Methodological quality was assessed using the Joanna Briggs critical appraisal tool. Results According to our systematic review protocol, nineteen studies were selected. A total of twenty-six patients were identified. RAS was used for right colectomy, right hemicolectomy, ileal resection, caecal resection, intracorporeal anastomosis and complete mesocolic excision. It offered an optimal user interface with enhanced visuals, fine dexterity, and ergonomic work position. Innovative developments in tumour-healthy tissue boundary and vasculature visualisation were reported. Conclusion Although the evidence base is limited, RAS for MNETs is safe and feasible. We recommend more extensive prospective-randomised controlled trials comparing it with laparoscopy and open surgery. Developments in contrast dyes and tumour-specific probes are very promising.

Immunotherapeutic Interventions in Carcinoid Tumors

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Post-Synthetic Modification of a Fluorescent Covalent Organic Framework as a Multifunctional Sensor for Efficient Detection of 5-Hydroxytryptamine and Its Metabolite and Latent Fingerprint Identification

In this study, a functionalized vinyl-linked 2D fluorescent covalent organic framework (COF) (TMT-TA-COOH) is constructed by post-synthetic modification (PSM) of a TMT-TA COF, which is composed of trimethyltriazine (TMT) and terephthalaldehyde (TA). The fluorescent COF (TMT-TA) has the characteristics of good crystallization and stability, but the dispersibility in water is poor, which requires further PSM. After PSM, the obtained TMT-TA-COOH not only exhibits good dispersibility in water but also displays stronger binding ability to analytes, which presents high sensitivity for quantitative identification of 5-hydroxytryptamine (5-HT) and its metabolite 5-hydroxyindole-3-acetic acid (5-HIAA) in water. Moreover, TMT-TA-COOH can specifically recognize 5-HT in serum and 5-HIAA in urine with a fast response, good anti-interference performance, and real-time visualization, which enables the TMT-TA-COOH to be a tool for early detection of neurological diseases and biomarkers for carcinoid tumors. In addition, TMT-TA-COOH is also a good candidate for latent fingerprint (LFP) identification, which has the characteristics of high contrast and low background interference. This work not only provides a promising platform for the sensing application of fluorescent COFs in aqueous solution but also opens up a new way for the detection of LFP information.

An unusual association between Burkitt's lymphoma and a Carcinoid tumor in a Syrian boy: a rare case report.

The authors report a case of a 15-year-old Syrian adolescent who was admitted to our hospital due to a persistent, severe generalized abdomen pain accompanied by nausea, vomiting, loss of appetite, and inability to pass stool or gas. An abdominal radiograph revealed dilated intestinal loops with air-fluid levels. The patient underwent emergency surgery through which a retroperitoneal mass was removed as well as part of the ileum and the appendix. The final diagnosis was consistent with intestinal BL associated with an appendiceal carcinoid tumor. The correlation between gastrointestinal carcinoids and other types of tumors was frequently reported. However, there have been few reports of carcinoid tumors being associated with lymphoreticular system cancers. BLs were classified into three variants: endemic, sporadic, and acquired immunodeficiency-associated BL while appendiceal neuroendocrine tumors were classified as the following: well-differentiated neuroendocrine tumors with benign or uncertain malignant potential; well-differentiated neuroendocrine carcinoma with low malignant potential; and mixed exocrine-neuroendocrine carcinoma. Our article demonstrates an unusual association between BL and an appendiceal carcinoid tumor that highlights the significant role of histological and immunohistochemical staining in confirming the diagnosis, as well as the role of surgery in treating the complications of intestinal BLs.

D-43 | The Prognostic Value of Invasive Hemodynamic Monitoring in Patients With Carcinoid Heart Disease Needing Bioprosthetic Valve Replacement

Carcinoid heart disease (CnHD) is a serious cause of morbidity and mortality in patients with carcinoid neuroendocrine tumors. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the utility of invasive hemodynamic evaluation prior to valvular intervention to predict survivorship. We conducted the first known prospective study of CnHD survival by right heart catheterization (RHC) waveform morphology. 50 patients with symptomatic CnHD met inclusion criteria: having RHC within 3 months prior to bioprosthetic valve replacement. They were categorized into 3 morphologic waveform groups: “Preserved A, V wave,” “tall V wave,” and “ventricularized RV wave.” The 3 groups were evaluated for all-cause mortality. Median follow-up was 29 months and median overall survival was 26 months. Compared to the preserved A&V waveform group, ventricularized RV waveform carried a hazard of death ratio by over four-fold in multivariate Cox regression (HR 4.54, 95%CI 1.03-19.96, p=0.046). Median survival was significantly reduced for ventricularized RV compared to A&V (p=0.046), though there was no significant difference for tall V waveform patients (p=0.724). Our data show that a ventricularized RV waveform on RHC is a significant and independent mortality predictor for CnHD. This may provide unique longitudinal evidence that RHC may be a particularly helpful risk stratification tool for symptomatic CnHD patients needing bioprosthetic valve replacement.