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Unifying concept of non‐pituitary acth‐secreting tumors. Evidence of common origin of neural‐crest tumors, carcinoids, and oat‐cell carcinomas
Author(s) -
Skrabanek Petr,
Powell David
Publication year - 1978
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(197809)42:3<1263::aid-cncr2820420335>3.0.co;2-o
Subject(s) - neural crest , pheochromocytoma , pathology , paraganglioma , thyroid , medicine , carcinoid tumors , multiple endocrine neoplasia , cell type , pituitary tumors , neuroblastoma , cell , endocrinology , biology , cell culture , embryo , biochemistry , genetics , gene , microbiology and biotechnology
ACTH‐secreting tumors can be reclassified into two overlapping groups on the basis of light and electron microscopic findings and histochemical properties: 1) carcinoid‐oat cell group, and 2) pheochromocytoma‐neuroblastoma group. In the first group, carcinoids are less malignant forms and oat‐cell tumors less differentiated, more malignant forms of the same spectrum. A similar spectrum exists in the second group. These morphological continua may be reflected functionally: the more “oat cell‐like” the tumor appears, the more likely it is to cause Cushing's syndrome instead of the carcinoid syndrome. In the thyroid, ovary, and other organs, mixed or transitional forms between the two groups are encountered, such as ovarian carcinoids with neural or ganglionic elements, or paraganglioma‐like nonamyloid medullary carcinoma of the thyroid. The common endocrine characteristics of the two groups, the existence of transitional or mixed forms in both morphological and biochemical aspects, and the presence of Kultschitzky‐like cells in organs where ACTH‐secreting tumors can occur provide functional and morphological support for the concept that both carcinoid and oat cell tumors are of common embryologic origin as are the pheochromocytoma and related tumors. The concept that only specific tumor‐cell types are associated with ACTH production is not consistent with the theories of totipotentiality of all malignant cells or of genetic random derepression as general mechanisms of “ectopic” hormone production.