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• The site distribution of gastrointestinal carcinoids differs between races
  Tsuyoshi Konishi
  Published on: 18 April 2016

• Published on: 18 April 2016

  The site distribution of gastrointestinal carcinoids differs between races

  • Tsuyoshi Konishi
  • Other Contributors:
    • Toshiaki Watanabe, Tetsuichiro Muto, Kenjiro Kotake, and Hirokazu Nagawa, on behalf of the Japanese Society for Cancer of the Colon and Rectum

  Dear Editor,

  We read with great interest the guideline for gastroenteropancreatic neuroendocrine (including carcinoid) tumors by Ramage et al.[1] In this excellent guideline, they reported that appendix is the most frequent site of gastrointestinal primary endocrine tumors, consisting 35% of the total tumors, while colon and rectal carcinoids consisted only 7% and 10%, respectively. One important aspect not ment...

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  Dear Editor,

  We read with great interest the guideline for gastroenteropancreatic neuroendocrine (including carcinoid) tumors by Ramage et al.[1] In this excellent guideline, they reported that appendix is the most frequent site of gastrointestinal primary endocrine tumors, consisting 35% of the total tumors, while colon and rectal carcinoids consisted only 7% and 10%, respectively. One important aspect not mentioned, however, is the fact that the site distribution of gastrointestical carcinoids differs among races.

  Modlin et al previously reported a marked predominance of white Caucasians population in carcinoids of the colon and appendix based upon the nationwide surveillance in the United States.[2] In contrast, the incidence of rectal carcinoids was 3- to 4-fold higher in African- Americans than in white Caucasians. Accordingly, the site distribution of colorectal carcinoids markedly differs among these two races.

  Regarding carcinoids in Asian population, there have been few reports based upon a large database. In order to provide such evidence, we analyzed colorectal carcinoids in the Japanese population using the Multi-Institutional Registry of Large Bowel Cancers in Japanh, a nationwide database which covers approximately 10% of the Japanese population, from 1984 to 1998.[3] Among 90,057 cases of colorectal tumors registered during this period, a total of 345 cases of colorectal carciniods were identified. All cases were from the Asian population. The site distribution consisted of the ileum 3 (0.9%), appendix 8 (2.3%), colon 28 (8.2%) and rectum 304 (88.6%). Thus, carcinoids in the Japanese population exhibited much higher distribution in the rectum than in the colon and appendix. This over-representation of rectal carcinoids is compatible with a previous report from Taiwan in which 33 cases (89.2%) out of 37 colorectal carcinoids originated from the rectum.[4]

  The difference in the distribution of colorectal carcinoids among races suggests that race-related genetic factors play an important role in the development of gastrointestinal carcinoids. With acceptance on this point, racial disparity could be a point to consider in the diagnosis of carcinoids, and further investigation using a larger database is needed to clarify these points.

  References

  1. Ramage JK, Davies AH, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 2005;54 Suppl 4:iv1-16.

  2. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97(4):934-59.

  3. Kotake K, Honjo S, Sugihara K, et al. Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer, Japan. Dis Colon Rectum 2003;46(10 Suppl):S32-43.

  4. Weng YJ, Wang SS, Yang WG, et al. Carcinoid tumors of the gastrointestinal tract in Chinese of Taiwan: an analysis of fifty cases. Zhonghua Yi Xue Za Zhi (Taipei) 1996;58(4):254-8.

  Institutions of the authors:
  T. Konishi, T. Watanabe and H. Nagawa, Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
  T. Muto, Department of Surgery, Cancer Institute Hospital, Tokyo, Japan
  K. Kotake,Department of Surgery, Tochigi Cancer Center, Tochigi, Japan

  All Correspondence to:
  Dr. Toshiaki Watanabe
  Department of Surgical Oncology
  University of Tokyo
  7-3-1 Hongo Bunkyo-ku
  Tokyo 113-8655
  Japan
  TEL: +81-3-5800-8653
  FAX: +81-3-3811-6822
  E-mail: toshwatanabe@yahoo.co.jp

  Conflict of interest: none

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  Conflict of Interest:
  None declared.

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