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67-year old man in a good physical condition was admitted to the Clinic to diagnose mediastinal tumor which was noticed on chest radiogram. The patient reported chronic cough, sweats and weight loss (5 kg during 4 months). The elevated number of monocytes was the only abnormality in his laboratory tests. Chest computer tomography confirmed well separated solid tumor without calcifications (with focal necrosis) in anterior mediastinal area. No lymphadenopathy was observed. Radiological image suggested teratoma or other germ stem tumor. Considering undiagnostic bronchial forceps biopsy during bronchofibroscopy we performed percutaneous fine needle aspiration biopsy which suggested carcinoid. Patient was referred to Surgery Clinic to be operated. Histological examination of resected tumor showed atypical carcinoid of probably thymic origin.

The classification, diagnosis, treatment and prognosis of neuroendocrine tumors are presented. Rare case of typical carcinoid of the larynx is described. This was the second primary tumor after squamous lung cancer treatment. The diagnosis was based on routine histological investigation, and then confirmed by immunohistochemical tests with synaptophysin, chromogranin, S-100 protein and cytokeratin markers. The clinical presentation of the patient, age, gender, localization, macroscopic appearance and slow growth dynamic was in accordance with cases described in the literature.

Primary pancreatic carcinoid is an extremely rare pancreatic neoplasm. The most frequently it metastasizes to regional lymph nodes and liver. Carcinoids of the pancreas display various nonspecific imaging features (USG, CT), which can cause diagnostic problems. Authors report a case of late recognition of pancreatic carcinoid, in a woman who complained of abdominal pain and dyspeptic symptoms. The patient underwent pancreatoduodenectomy and dissection of tumor conglomerate in retroperitoneal space. The diagnosis was established by histopathological examination of the specimen after operation. So far the patient has not presented any clinical or radiological evidence of relapse.

Reports on coexistence of the three cancers: a carcinoid of the appendix, myoma of the uterus and adenoma of the uterine cavity occurring in a female patient are exceptionally rare. Such a case may occur with a frequency of 2 every 10,000 hysterectomies. The patient was subjected to hysterectomy, appendectomy and had her obturator and iliac lymph nodes removed. Postoperative treatment comprised radiotherapy. It is estimated that on overall chance of 5 year survival is close to 50%. The overall good state of the patient, 4 years after operation, speaks for recommending this kind of treatment. The authors suggest that the carcinoid does not necessarily must be an inductor of a cancer of the endometrium and they indicate that a cancer of the endometrium is not an inductor of the carcinoid.

Authors present two cases of carcinoid localized in stomach and retroperitoneal space. Diagnosis was based on clinical examination, endoscopy, CT and histopathological evaluation. The case of gastric carcinoid was an early lesion (penetrated only mucose and submucose layer of gastric wall). In opposition, second patient had inoperable large tumor localized in retroperitoneal space with multiple metastases to the liver.

TGF beta 1 commonly produced by normal and neoplastic human cells, has capacity to regulate new blood vessel formation, to establish and maintain the vessel wall integrity; was found to have some significance in the lung cancer prognosis. Tumour angiogenesis is an important factor for tumour growth and metastasis. The purpose of this study was to find, if the immunoexpression of TGF beta 1 has any significance in determination of the histologic subtypes of carcinoids?; to find, if TGF beta 1 has any role and relation to carcinoids angiogenesis?; and to explore TGF beta 1 expression and angiogenesis with respect to metastatic potential of carcinoids. The study was performed on 48 resected broncho-pulmonary carcinoids: 35 typical (TC) and 13 atypical (AC), classified according to the WHO. Semiquantitative analysis for TGF beta 1 was performed. Sections stained using monoclonal antibody against TGF beta 1 were scored in scale from 0 to 4, according to the percentage of positively stained cells (pc) plus percentage of positively stained stroma (ps). The microvessels stained with CD34 monoclonal antibody, were counted in 0.75 mm2 field (microvessel density--MD), using the computerised image analysis system SAMBA 2005 (the morphometric software). The histologic subtype of carcinoids was related to age of the pts (AC occurred in older pts than TC, p = 0.027), to the tumour size (AC were larger than TC: respectively--3.25 cm and 2.4 cm, p = 0.009). Lymph node metastases were significantly more frequent in AC than in TC (38% vs 13%, p = 0.025). 85% carcinoids showed TGF beta 1 expression with various intensity, mainly in the stroma. There was no significant correlation between TGF beta 1 expression and tumour size, the histologic subtype nor the lymph node metastases. The angiogenesis expressed as MD, was not related to histology, nor to the presence of lymph node metastases. There was no correlation between TGF beta 1 expression and angiogenesis. Shown in our study, lack of relation between TGF beta 1 expression and angiogenesis, could support some of the published data indicating indirect action of TGF beta 1 on the angiogenesis. The rich vascularity found in carcinoids morphology could result from TGF beta 1, commonly expressed by the tumoural stroma. The angiogenesis nor TGF beta 1 expression do not determinate the carcinoids histology.

The case of atypical carcinoid was presented. 5 years after resection of mediastinal mass, the tumor in main left bronchus developed and the diagnosis of small cell lung cancer was established. The pathological analysis of previous slides from resected tumour and bronchial biopsy showed the same atypical carcinoid. The patient was successfully treated using chemotherapy.

The case of carcinoid of the larynx is presented. Attention is focused on the difficulties with establishing the diagnosis. The principles of treatment this kind of neoplasm are reported.

A 74-year-old man is reported in whom hormonally inactive gastric carcinoid coexisted with leiomyoma. The patient was operated on with the preoperative diagnosis of gastric cancer. Microscopic postoperative examination made possible correct diagnosis.

Gastric carcinoids are reviewed in respect of epidemiology, histogenesis, localization, hormonal aspects and malignancy. Coexistence of gastric carcinoids and gastric carcinomas is also discussed as well as optimalization of histologic histochemical and ultrastructural diagnosis of gastric carcinoids.