title: The impact of incidental identification on the stage at presentation of lower gastrointestinal carcinoids.
abstract: BACKGROUND
  Over the past 3 decades, there has been a significant increase in the incidence of gastrointestinal carcinoid tumors in the United States. Incidentally discovered carcinoids in the lower gastrointestinal tract have probably contributed to this increase. In this study we aimed to compare the clinicopathologic characteristics of incidentally discovered carcinoids of the small and large bowel with those identified as a result of symptoms.
  
  
  METHODS
  We performed a retrospective review of 58 consecutive patients with nonappendiceal gastrointestinal carcinoids: 30 small bowel and 28 large bowel. We compared asymptomatic patients with lower gastrointestinal tract carcinoids identified by routine colonoscopy with those identified as a result of symptoms.
  
  
  RESULTS
  Twenty-eight (48.3%) incidentally identified carcinoids (15 small bowel and 13 large bowel) were compared with 30 (51.7%) symptomatic carcinoids. Incidental ileal carcinoids were similar in size (mean ± SD, 1.3 ± 0.61 vs 1.7 ± 1.13, p = 0.45) and incidence of lymph node metastases (12 in 15 vs 9 in 15, p = 0.43) to symptomatic ileal carcinoids. However, incidental ileal carcinoids had a lower incidence of distant metastases (1 in 15 vs 7 in 15, p = 0.035) compared with symptomatic ileal carcinoids. There was no difference in tumor size, extent of lymph node metastases, or distant metastases between incidental and symptomatic large bowel carcinoids.
  
  
  CONCLUSIONS
  Ileal carcinoids identified at screening colonoscopy are associated with a significantly decreased incidence of distant metastases compared with those identified after development of symptoms, despite similar size and extent of lymph node metastases. However, incidental large bowel carcinoids appear to have similar staging to those identified as a result of symptoms.
authors: Department of Surgery, Weill Cornell Medical College-NewYork Presbyterian Hospital, New York, NY, USA.
authors: Daniel
authors: D
authors: Buitrago
authors: Koiana
authors: K
authors: Trencheva
authors: Rasa
authors: R
authors: Zarnegar
authors: Brendan
authors: B
authors: Finnerty
authors: Hasan
authors: H
authors: Aldailami
authors: Sang W
authors: SW
authors: Lee
authors: Toyooki
authors: T
authors: Sonoda
authors: Jeffrey W
authors: JW
authors: Milsom
authors: Thomas J
authors: TJ
authors: Fahey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000556:secondary; D003110:Colonic Neoplasms / Q000175:diagnosis; D003113:Colonoscopy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007078:Ileal Neoplasms / Q000175:diagnosis; D033162:Incidental Findings; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000175:diagnosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed