2560 Small Bowel Carcinoid Causing Chronic Anemia

Abstract

INTRODUCTION: Carcinoids are a relatively rare tumor that are often discovered incidentally. If symptoms are present, they may include abdominal pain, carcinoid syndrome, and occasionally bleeding. CASE DESCRIPTION/METHODS: A 59-year-old woman was admitted for bloody bowel movements. Past medical history includes hypertension and morbid obesity. She had chronic microcytic iron deficiency anemia and was evaluated in 2015 with EGD, colonoscopy, and capsule endoscopy. EGD was normal with no bleeding source, colonoscopy showed blood throughout colon without diverticulosis or AVMs, and capsule endoscopy revealed a jejunal ulcer. At presentation, vital signs were stable. Laboratory profile revealed iron deficiency anemia with hemoglobin 7.3 g/dL. Colonoscopy revealed a medium-sized mass in terminal ileum with oozing present and appearance concerning for carcinoid tumor. The mass was tattooed and a clip was placed. CT showed 2.1 cm mass in ileum as well as 1.9 cm enhancing lymph node concerning for metastasis. She underwent laparoscopic small bowel resection with removal of ileal mass and was noted to have multiple lesions along small bowel concerning for metastasis and grossly enlarged mesenteric lymph nodes, which were also removed. Pathology showed well-differentiated grade 1 neuroendocrine tumor with a lymph node positive for metastasis. Patient is scheduled to follow-up with oncology to determine treatment plan. DISCUSSION: Carcinoids are relatively rare with an incidence of 4.7 per 100,000 with rising incidence due to increased detection on endoscopy and imaging as well as increased provider awareness. They can arise in the gastrointestinal tract, lung, and genitourinary tract and are relatively slow growing and less aggressive than other cancers. Within the gastrointestinal tract, most carcinoids are found in the small intestine, rectum, and stomach, while small bowel carcinoids are commonly located in the ileum. Small intestine carcinoid tumors have been characterized as more aggressive in nature and commonly metastasize to lymph nodes or the liver. They require multidisciplinary evaluation with gastroenterologists, oncologists, and surgeons. In our case, the patient had chronic anemia many years prior and had undergone work-up prior to presenting with hematochezia. Previous evaluation showed a jejunal ulcer thought to be due to NSAID use. However, she continued to have iron deficiency anemia. This case illustrates the importance of repeat endoscopic evaluation in cases of persistent iron deficiency anemia.