Carcinoid Metastases Research Articles

Carcinoid Metastasis in the Middle Ear: Anaesthetic and Surgical Management

Carcinoid Metastasis in the Middle Ear: Anaesthetic and Surgical Management

A CASE OF CARCINOID TUMOR OF THE DUODENUM WITH DIFFUSE SPLENIC METASTASES SHOWING MULTIPLE HYPERECHOIC NODULES ON ULTRASONOGRAM

Carcinoid tumors arising in the duodenum are relatively uncommon. We reported a case of duodenal carcinoid with diffuse splenic metastases showed a peculiar ultrasonogram. A 75-year-old woman was hospitalized because of left abdominal pain and a weight-loss. Ultrasonogram revealed a hepatosplenomegaly and the spleen filled with many round nodules son the ultrasonogram. In spite of several image examinations and aspiration cytologic examinations with fine needle of the spleen, liver and ascites, final diagnosis was unknwon. After three months from admission she died becaused of hepatorenal failure. Autopsy revealed a carcinoid tumor localized to the duodenal bulb, and metastases in multiple organs such as the liver, pleen, ovary, kidney, lung and lymphnodes. Especially the spleen was severely swelling and filled with multiple metastatic nodules, which showed a good coincidence with the ultrasonographic findings. Hepatic metastasis of carcinoid has been well decribed but splenic metastasis is rare. We think this is the first case in which diffuse splenic metastases of duodenal carcinoid could be visualized by ultrasound.

Identification of zymogen and mature forms of human carboxypeptidase H A processing enzyme for the synthesis of peptide hormones

Carboxypeptidase H (CPH) is one of several processing enzymes required for the conversion of peptide hormone precursors into their smaller active forms. In this study, high levels of CPH activity was found in a liver metastasis of a human ideal carcinoid which expresses β-preprotachykinin mRNA and the tachykinin neuropeptides, substance P and substance K. This human CPH showed properties of a zinc-metallopeptidase that is structurally similar to bovine and rat CPH. Immunoblots of the human ileal carcinoma with anti-bovine CPH showed that CPH activity is represented by two proteins of apparent molecular masses 57 and 55 kDa. Cell-free translation of poly(A) + RNA followed by immunoprecipitation with anti-bovine CPH showed that human CPH mRNA encodes a precursor protein of apparent molecular mass 75 kDa. These data demonstrate that human CPH is synthesized as a zymogen, prepro-CPH, which must be cleaved to form catalytically active CPH.

Neuron-specific enolase in mucosal endocrine cells and carcinoid tumours of the small intestine: A comparative study with neuron-specific enolase immunocytochemistry and silver stains

Endocrine cells of human small intestinal mucosa, small intestinal carcinoids and carcinoid liver metastases were stained with an immunocytochemical technique using an antiserum against neuron-specific enolase (NSE), with the argyrophil technique of Grimelius and with the argentaffin technique of Masson. In the normal mucosa, scattered NSE-immunoreactive cells were seen mainly in the deeper parts of the crypts. These cells, as shown in the same sections, corresponded to the argentaffin and/or argyrophil cells indicating that they were of endocrine type. All intestinal carcinoids (16 cases) displayed NSE immunoreactivity. However, this reaction did not correlate on the cellular level with the silver techniques employed. Thus, many tumour cells were NSE immunoreactive but lacked an argentaffin or argyrophil reaction and vice versa. On the light microscopical level the silver techniques reveal the presence of neurohormonal granules in the tumour cells, while the NSE immunoreactivity appears to disclose neuroendocrine differentiation of the tumour cells irrespective of their hormone and granular content. Out of 13 carcinoid liver metastases, eight displayed strong NSE immunoreactivity, three were weakly stained and two were unreactive. Consecutive or the same tumour sections showed an argentaffin and argyrophil reaction in all carcinoid metastases. Since silver staining provides one type of information and NSE immunocytochemistry another, they provide in combination a good discriminator for neuroendocrine tumours.

Computed Tomography and Angiography in Carcinoid Liver Metastases

Fifteen patients with carcinoid metastases in the liver were examined with computed tomography (CT). In 13 patients, liver metastases were demonstrated, while 2 patients had a normal liver at CT. The attenuation of the metastases was lower than that of the liver parenchyma in 12 patients, higher in one. Angiography was performed on 10 patients, and liver metastases were diagnosed in 9. Eight patients had hypervascular metastases with dense accumulation of contrast medium. In one patient, displacement of the intrahepatic arteries was the only sign of an expansive process. In one patient, previously treated with ligation of the common hepatic artery, no signs of liver metastases could be revealed at angiography but were evident at CT.

Angiographic and computed tomographic appearance of secondary carcinoid of the liver.

Liver angiograms of 27 patients with hepatic carcinoid metastases were analyzed for distribution, size, degree of vascularity, and patterns of tumor staining. Computed tomography (CT) scans were evaluated before and after bolus contrast administration in 13 of the cases. The diagnostic capability of the two procedures was compared. Angiography detected metastases, some less than 1 cm in size in all 13 patients; in 5 of 13 cases (38.5%) CT did not detect any hepatic metastases. In the eight patients in whom CT demonstrated metastases, the patterns of lesions and usefulness of contrast varied. Angiography is essential for evaluation of patients with suspected carcinoid metastases to the liver.

Anaesthesia for the removal of carcinoid metastasis

Anaesthesia for the removal of carcinoid metastasis

Functioning metastatic bronchial carcinoid with elevated levels of serum and cerebrospinal fluid serotonin and pituitary adenoma.

A patient is described who had metastasizing bronchial carcinoid, hyperserotonemia, and an elevated urinary excretion of 5-hydroxy-3-indole acetic acid in the absence of the clinical characteristics of the carcinoid syndrome. During administration of reserpine there was an initial 5-hydroxy-3-indoluria, and excretion remained at levels above normal. A carcinoid metastasis to the choroid of the eye was found at operation, and there was possible metastatic involvement of the brain, based on an elevated level of serotonin in the cerebrospinal fluid. Associated was a pituitary adenoma with clinical evidence of acromegaly. It is suggested that patients with bronchial carcinoid undergo serotonin studies whether the carcinoid syndrome be present or not, and that these cases be scrutinized for additional endocrine adenomas. THE carcinoid syndrome associated with metastasizing bronchial adenoma was recently described by Warner and Southren (1). The present report deals with an additional patient, in whom hyperserotonemia and an increase in the urinary excretion of 5-hydroxy-3-indole acetic acid was found in the absence of the clinical characteristics of the carcinoid syndrome. There was also an elevation of the serotonin content of the cerebrospinal fluid, a finding which suggested metastatic involvement of the brain. A pituitary adenoma with clinical evidence of acromegaly added to the unusual features of this case.