Rectal carcinoids often are benign tumors, but some behave in a malignant fashion. Certain features of the tumor can help identify those at greater risk for a more aggressive course.
Primary risk factors in rectal carcinoids:
(1) diameter >= 2 cm
(2) invasion into or through the muscularis propria
(3) severe cytologic atypia, with nuclear pleomorphism and high mitotic rate
Other factors associated with more aggressive growth:
(4) vascular and/or perineural invasion
(5) necrosis
(6) diffusely infiltrating and invasive margin
(7) a ribbon histologic pattern
(8) associated with clinical symptoms
Treatment decisions:
• If the tumor shows none of the risk factors, then complete excision with free margins is sufficient treatment.
• If the tumor has one or more high risk features, then radical excision should be considered.
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