Angiographic findings in two ileal carcinoid tumors.

Abstract

Angiography may be the best method for diagnosing small-bowel carcinoid tumors preoperatively. The routine roentgen findings are usually nonspecific. At barium examination, carcinomas, benign intramural or polypoid tumors, pancreatic rests, and regional enteritis may all mimic carcinoids (2, 4). Multiple lesions or kinking of the bowel associated with a small asymmetric filling defect are the most reliable signs of carcinoid at the small-bowel study (2, 4, 6). The most common symptoms produced by small-bowel carcinoids are secondary to obstruction, either by tumor encirclement of the bowel or by intussusception of intraluminal polypoid masses (1). The clinical and chemical findings are specific in this disease only in the presence of liver metastases (7). The possibility of using angiography in the diagnosis of small-bowel carcinoids should, therefore, be evaluated. Two patients with ileal carcinoid tumors have been examined angiographically at the Roentgendiagnostic Department, University of Lund. The vascular patterns of the two tumors were strikingly similar and different from other intestinal tumors that we have seen. Case Reports Case I: A 58-year-old male was admitted because of a six-month history of intermittent, non-radiating midabdominal pain, at first coming only after meals, but later occurring at any time. In the last three months abdominal swelling had accompanied the attacks, and for the last three weeks he had had diarrhea. No other signs of the carcinoid syndrome were noted. The patient had lost 10 kg over the six-month period. The findings on physical examination were normal. Small-Bowel Series (Fig. 1, A): The loops of the terminal ileum were markedly thickened and separated and showed an irregular mucosal pattern. Selective Superior Mesenteric Angiography (Fig. 1, B): The terminal portion of the superior mesenteric artery and the ileocolic artery and their branches to the ileum were smoothly narrowed within the mesentery. The right colic artery was also narrowed near its origin. A hypervascular lesion was seen in the distal ileum. The terminal arcades and vasa recta in the mesentery along this segment of bowel margin were dilated and irregular, and the vasa recta within the intestinal wall were dilated and stretched. These vessels formed a stellate pattern. Accumulation of contrast medium by the lesion was minimal, and no veins were seen. Surgery: At laparotomy the loops of terminal ileum were markedly thickened and matted together. The small bowel was dilated proximal to a tumor 2 cm in diameter, which obstructed its lumen. The mesentery was infiltrated directly from the tumor and was thickened, foreshortened, and wrinkled. The liver was filled with metastases. A biopsy specimen was taken from the tumor, and the lesion was bypassed with an entero-enterostomy. Microscopic Examination of the Biopsy Specimen: Carcinoid.