Carcinoid Tumor Presenting Research Articles

Appendiceal carcinoid tumor presenting as perforated appendicitis in pediatric patients: A case series and review of the literature

Appendiceal carcinoid tumor presenting as perforated appendicitis in pediatric patients: A case series and review of the literature

Management and outcome of pituitary metastasis from a bronchial carcinoid tumour presenting with ocular symptoms

Management and outcome of pituitary metastasis from a bronchial carcinoid tumour presenting with ocular symptoms

A CALCIFIED CARCINOID TUMOR

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Pulmonary carcinoid tumor is a neuroendocrine tumor of enterochromaffin cells representing about 1–5% of all lung malignancies. It usually presents in never smokers typically in proximal airways. Patients present with chronic cough, hemoptysis, and bronchial obstruction. These tumors show a low to moderate activity on PET scan. We present a case of a calcified carcinoid tumor. CASE PRESENTATION: A 49-year-old never-smoker male with medical history known for obesity, diabetes mellitus, hypothyroidism and exposure to welding presented complaining from progressive dyspnea with cough, wheezing and a history of mild hemoptysis. A Pulmonary function test (PFT) was performed which showed a FEV1/FVC ratio of 73% (post-bronchodilator), FEV1 77%, TLC 112%, RV 152% and DLCO of 77%. Findings were suggestive of a moderate obstructive lung defect and no significant bronchodilator response associated with decreased diffusion capacity and air trapping. The patient was started on umeclidium-vilanterol and a Chest X-ray was performed that showed atelectasis with prominence of the right hilum suggestive of pulmonary artery enlargement or potentially underlying lymphadenopathy/nodule. Thus, a Chest computer topography (CT) was scheduled. However, the patient developed an episode of hemoptysis and presented to the emergency department (ED) acutely prior to performing the chest CT. Chest CT was performed upon presentation to the ED which showed a calcified right hilar mass. Upon presentation the patient denied having any other complaints. He was started on antibiotics and steroids. A bronchoscopy with endobronchial ultrasound was performed that showed an endobronchial mass at the level of the secondary carina between the right upper lobe and bronchus intermedius bulging into the bronchus intermedius with about 85% obstruction of the bronchus intermedius not allowing the bronchoscope to pass distally with cobblestone mucosa. A transbronchial needle aspiration from the right hilar mass was performed as well as an endobronchial biopsy from right lung mass and lateral wall of the bronchus intermedius. Brushing from the right lung mass in the bronchus intermedius and bronchioalveolar lavage from bronchus intermedius was done. Pathology from the right upper lobe biopsy was positive for a neuroendocrine tumor (carcinoid). BAL, brushing, and lymph nodes were negative. A PET CT scan was done which confirmed the presence of a partially calcified right posterior hilar soft tissue mass with low FDG uptake and no definite metastatic disease. Patient underwent a right pneumonectomy. DISCUSSION: Calcifications has been reported in mesenteric carcinoid tumors, however, no prior cases of pulmonary carcinoid calcification were reported in the literature. This case describes an unusual presentation of pulmonary carcinoid tumor. CONCLUSIONS: This presentation highlights the importance of proper evaluation of a calcified mass. REFERENCE #1: https://pubmed.ncbi.nlm.nih.gov/7839976/ DISCLOSURES: No relevant relationships by Ahmad Albalbissi, source=Web Response No relevant relationships by Girendra Hoskere, source=Web Response No relevant relationships by AYA MASADEH, source=Web Response

Carcinoid Syndrome in a Patient with Duodenal Carcinoid Tumor

Duodenal carcinoid tumors accounts for 5% of all Gastrointestinal Neuroendocrine Tumors (GI-NETs). Only 4% of all duodenal carcinoid tumors present with a full-blown carcinoid syndrome. We report a case of duodenal carcinoid tumor presenting as carcinoid syndrome in a 58 year old man, who presented with upper abdominal discomfort, diarrhoea, hot flushes and occasional wheezing. Histopathology following endoscopic resection of the tumor and 24 hour urinary 5-Hydroxyindolacetic acid (5-HIAA) confirmed the diagnosis. Duodenal carcinoid tumors are one of the rarest tumors of gastrointestinal tract and their association with a typical carcinoid syndrome is not that common. A high level of suspicion is required for an early diagnosis. With proper resection (endoscopic or surgical) of a localized tumor, recurrence and progression of the disease can be halted. Symptoms of carcinoid syndrome should be controlled by antidiarrheal agents, inhaled β-adrenergic agonist bronchodilators and somatostatin analogs (octreotide, lanreotide). Patients should be advised to avoid stress and conditions or substances that precipitate these symptoms. Dietary supplementation with nicotinamide can help in this regard. Patients with hepatic metastases are treated with synthetic analogues of somatostatin (octreotide, lanreotide). Systemic chemotherapy is not recommended in metastatic disease by the current guidelines. Patients should be followed up by monitoring serum chromogranin and urinary 5-HIAA. EUS, CT, MRI & somatostatin receptor scintigraphy can also be used for following up the patients.

Ectopic Cushing’s Syndrome as the Initial Presentation of Pulmonary Carcinoid Tumor Managed by Etomidate: A Case Report

Ectopic increase of adrenocorticotropic hormone (ACTH) or ectopic Cushing syndrome is a rare initial presentation of small cell carcinoma and carcinoid tumor of the lung. Here, we reported a 36-year-old male with atypical symptoms of Cushing syndrome managed by Etomidate that had a central pulmonary nodule, and pathologic evaluation of pulmonary lobectomy revealed the diagnosis of well-differentiated, low-grade typical carcinoids of lung. © 2019Tehran University of Medical Sciences. All rights reserved. Acta MedIran 2019;57(7):464-467.

Anemia as the only clinical presentation of metastatic jejunal carcinoid tumor: A case report with radiological and enteroscopic findings

Anemia as the only clinical presentation of metastatic jejunal carcinoid tumor: A case report with radiological and enteroscopic findings

2663 A Rare Presentation of Duodenal Carcinoid Tumor Complicated by Hemorrhagic Shock

INTRODUCTION: A carcinoid tumor is a tumor that develops from enterochromaffin cells. These cells produce hormones and chemicals that have a profound impact on the circulatory system, gastrointestinal tract, and the lungs. Duodenal carcinoid tumors are rarely encountered in the clinical setting making up only 2–4% of all carcinoid tumors. They are also difficult to diagnose due to their nonspecific clinical presentation which include symptoms such as abdominal pain, jaundice, pancreatitis and weight loss. According to the general guidelines for the treatment of duodenal carcinoid tumors, endoscopic therapy is recommended for tumors measuring less than 1 cm in diameter, whereas surgical resection may be preferable for those measuring 1 cm or more. However, treatment guidelines for duodenal carcinoids are not yet standardized as a result of the lack of consistent data. The most feared complication of carcinoid tumors include carcinoid crisis but milder presentations may include anemia, shortness of breath and diarrhea. CASE DESCRIPTION/METHODS: A 79 year old male with a history of hypertension, hyperlipidemia, spinal stenosis, aortic stenosis and carcinoid tumor at the gastric bulb who previously refused interventional surgery presented to the hospital with a primary complaint of shortness of breath. Initial hemoglobin on presentation was 5.1 and patient noted to be in hemorrhagic shock with vital signs that included heart rate of 116 and blood pressure of 91/52. Patient was subsequently admitted to the intensive care unit and transfused a total of 6 units of packed red blood cells over the course of his 8-day hospital course. An octreotide scan performed during the hospital stay showed a carcinoid tumor at the gastric bulb that was not actively bleeding. This may be explained by the patient’s late presentation to the hospital after the carcinoid tumor bleeding had resolved. The patient at the conclusion of the hospital stay continued to decline any surgical intervention. DISCUSSION: This case highlights an unusual presentation of a patient with a history of carcinoid tumor that presented in hemorrhagic shock secondary to a duodenal carcinoid tumor. Previous research has shown complications of carcinoid tumors that range from diarrhea and shortness of breath to carcinoid crisis. However, hemorrhagic shock has not been demonstrated to be an association with carcinoid tumor. Further large scale retrospective studies may be needed to better evaluate to the full scope of carcinoid tumor complications.

CT detection of primary and metastatic ileal carcinoid tumor: rates of missed findings and associated delay in clinical diagnosis.

To determine the rate of missed CT findings of ileal carcinoid tumor prior to pathologic diagnosis and the resultant diagnostic delay. Initially, 74 patients with abdominal and pelvic CT prior to pathologically-proven diagnosis of ileal carcinoid were identified. Patients were excluded when the original CT study (n = 6) or report (n = 4) was not available, resulting in a final cohort of 64 patients (mean age, 58.3years; 29M/35F); 27 (42%) patients had more than one abdominal CT prior to diagnosis. All available CT studies prior to diagnosis were retrospectively reviewed for the presence of the primary ileal tumor and metastatic disease (mesenteric and hepatic). Primary ileal tumors were prospectively missed on at least one CT scan in 64% (32/50) of patients with retrospectively identifiable disease. CT findings of mesenteric spread were missed at least once in 46% (25/54) of cases where present in retrospect. By the final pre-operative CT, hepatic metastases and bowel wall thickening were present in 55% (35/64) and 52% (33/64) of cases, respectively. In patients with missed ileal and/or mesenteric findings resulting in diagnostic delay, mean delay was 40months (range 4-98months). Initial presentation of ileal carcinoid tumor, even with mesenteric involvement, is often missed prospectively at abdominal CT, leading to delay in diagnosis until bowel or mesenteric findings become more obvious, or hepatic metastatic disease manifests. Radiologists should make a concerted effort to evaluate the bowel and mesentery in patients with long-standing vague abdominal symptoms.

Goblet cell carcinoid of the appendix accompanied by adenomatous polyp with high-grade dysplasia at the cecum.

Goblet cell carcinoid tumor of the appendix is an uncommon neoplasia that shares the histological attributes of both adenocarcinoma and carcinoid tumors. Its prognosis has a more aggressive course than the other known carcinoid tumors. Clinical diagnosis of goblet cell carcinoid is seldom made preoperatively. The most common clinical presentation of goblet cell carcinoid tumor is acute appendicitis. In this study, we report a patient on whom right hemicolectomy was performed because of a cacal sessile polyp with high grade dysplasia; goblet cell carcinoid tumor of the appendix was revealed incidentally during microscopic evaluation of the appendectomy specimen. The patient healed uneventfully and no recurrence was observed after the 12-month follow-up period. Careful microscopic examination of the appendectomy specimen is key for the diagnosis of appendiceal tumors such as goblet cell carcinoid, especially in elderly patients.

A 14-year-old boy with endobronchial carcinoid tumor presenting with asthma

Introduction Bronchial carcinoid tumors seldom occur in children, sometimes mistaken for a minor disease and diagnosed slowly. Materials and Methods: We report on a patient who diagnose tumors slowly because confused with asthma. Results This case describes a 14-year-old boy, presenting with asthma-like symptoms throughout 3 years. He was treated as asthma but wax and wane. Chest x-ray showed an hyperlucent left lung, so we rechecked high resolution computed tomography (HRCT) for unilateral hyperinflation diseases diagnosis. It was found 1×1㎝ nodule in left main bronchus. We did bronchoscopy and discovered a round mass in the left bronchus, 2∼3㎝ away from carina. In the biopsy, it was bronchial carcinoid tumor, so we resected tumor. Discussion Because symptoms of bronchial carcinoid tumors are various, it can often be misdiagnosed firstly. It is confused with asthma, pneumonia and foreign body. An additional examination were necessary when respiratory symptoms persist.

An Atypical Presentation of a Carcinoid Tumor

An Atypical Presentation of a Carcinoid Tumor

Rare Presentation of a Sub-centimeter Carcinoid Tumor in Rectum With Inactive Liver Metastasis

Carcinoid tumors are rare and slow-growing tumors that originate in cells of the neuroendocrine system. Here we discuss a patient with a sub-centimeter rectal carcinoid tumor with inactive liver metastasis. This case highlights the need for awareness of various locations for carcinoid tumor, and given the inactive metastasis, it also prompts a discussion to establish a surveillance strategy in such patients to minimize morbidity and mortality. A 65 year old black male with medical history of Grade III internal hemorrhoids seen on physical exam had a screening colonoscopy done. He had no significant family history and was a former smoker. On colonoscopy, a diminutive sessile polyp at the hepatic flexure, two sessile polyps in the sigmoid colon and a sub-centimeter sessile polyp in the rectum were seen. These were successfully removed during procedure. Biopsy of polyps was unremarkable, except for the rectal polyp, which showed nests of neuroendocrine cells in the lamina propria and submucosa. No mitosis or necrosis was present. Cells were positive for Synaptophysin with few scattered cells positive for Chromogranin. The diagnosis was carcinoid tumor. For staging purposes, a CT Thorax/Abdomen/Pelvis done showed multiple liver lesions. Chromogranin level was 3 nmol/L (ref. 0-5) and total urine 5-Hydroxyindoleacetic acid (5-HIAA) was 4.9 mg/24hrs (ref. 0-14.9). Interestingly, a PET scan did not show any hypermetabolic areas and an MRI Abdomen with liver protocol 3 months later showed stable lesions with no new changes. Follow-up colonoscopy 6 months later was negative for malignancy. Patient's repeat chromogranin levels and 5-HIAA were lower and he denied any symptoms. Patient was placed on a surveillance schedule with imaging every 6 months. Carcinoid tumor is commonly found in the small intestine in 28.5% of cases, while rectal carcinoids comprise only 14% of cases. Furthermore, patients who develop active liver metastasis have a 5-year survival rate of 27%, if not treated. Currently, there are no clear guidelines for management and surveillance to address inactive liver metastasis for carcinoid tumors. While surgical resection is the best treatment for cure in carcinoid tumor, active liver metastasis can be treated with cryoablation, radiofrequency ablation or chemoembolization if surgery is not an option. However, timely treatment is possible if awareness and surveillance guidelines are available, the need for which is highlighted by this case.Figure: Rectal Polyp.Figure: Internal Hemorrhoids.

Death resulting from low-grade midgut carcinoid tumor: Autopsy findings and review of the literature

Well-differentiated neuroendocrine tumors of the midgut are generally known as midgut carcinoids. These endocrine tumors have characteristic clinicopathological features with majority elaborating serotonin, present at an advanced age, and are frequently associated with carcinoid syndrome. We report an autopsy case of low-grade (G1) midgut carcinoid tumor presenting as carcinoid syndrome in a 64-year-old patient who presented with abdominal distension, diarrhea, body pain, and vomiting. Autopsy findings show a yellow tan tumor in the distal ileum measuring 0.5 × 0.5 × 0.1 cm. Histology shows tumor to be carcinoid and strongly positive for immunohistochemical markers chromogranin and cytokeratin and negative for S-100 protein.

Metastatic Carcinoid Tumor Presenting as a Breast Mass: A Case Report and Review of the Literature

Carcinoid tumors are indolent neoplasms derived from the enterochromaffin cells which have a wide anatomic distribution. Most common primary sites include gastrointestinal tract and bronchopulmonary system. Despite their slow growing nature, carcinoid tumors possess metastatic potential, and breast is a rare but known site of metastasis. We report a case of breast metastasis from carcinoid tumor of the terminal ileum in a 53 year old woman who initially presented with a breast mass detected by screening mammography. A review of literature was performed for this rare presentation of breast as the initial site of detection of metastatic carcinoid tumor.

A case of uncontrolled severe asthma patient with coexisting carcinoid tumor presenting as pneumomediastinum

Introduction: Patients with inadequately controlled or uncontrolled asthma are at a greater risk of attacks for asthma requiring emergency room visits or hospital admissions. There is a significant correlation between the severity of the disease and the severity of exacerbations. Patients with poorly controlled asthma are at a higher risk for complications. Case study: We present a 24-year-old aspirin-intolerant, uncontrolled asthma patient with the complication of pneumomediastinum. Results: Severe symptoms persisted after the resolution of the pneumomediastinum despite intense anti-inflammatory and anti-obstructive therapy. A bronchoscopy revealed an endobronchial lesion and she was diagnosed with a carcinoid tumor. Conclusion: This case is an example of the importance of re-evaluating asthma patients who do not respond to standard medical treatment. Clinicians should be aware of the complications associated with asthma attacks such as pneumomediastinum and the possibility of a differential diagnosis that worsen asthma symptoms such as a carcinoid tumor.

58-Year-Old Woman With Melena

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (T.G.C., B.A.-B.); Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (C.G.L.). A 58-year-old woman presented to the emergency department with a 3-day history of passing dark, tarry stools. Her medical history was notable for symptomatic hemophilia A carrier state, gastroesophageal reflux disease, internal hemorrhoids, papillary thyroid cancer treated with thyroidectomy and radioactive iodine for nodal metastasis with secondary hypothyroidism, and obesity with a recent intentional 22.5-kg weight loss. She reported a 3-day history of passing black, tarry stools, averaging 3 stools per day. She did not have light-headedness on standing, any previous episodes, abdominal pain, vomiting, hematochezia, hematemesis, or history of liver or renal disease or alcohol abuse. She was not taking nonsteroidal anti-inflammatory drugs, iron, bismuth subsalicylate, or antiplatelet or anticoagulant medications. Her family history was notable for adenomatous colonic polyposis (at age 17 years, her son was diagnosed as having adenomatous colonic polyps that necessitated a subtotal colectomy). The patient’s last colonoscopy was 4 years before the current presentation and was negative for masses or polyps. On presentation, she had sinus tachycardia at 110 beats/min with a blood pressure of 111/ 51 mmHg. Examination findings were remarkable for conjunctival pallor and positive results on a fecal occult blood test with melenic stool noted on rectal examination. Examination revealed no abdominal tenderness or stigmata of chronic liver disease. Laboratory testing revealed the following notable results (reference ranges provided parenthetically): hemoglobin, 5.5 g/dL (12.015.5 g/dL); platelets, 179 10/L (150450 10/L); international normalized ratio, 1.0 (0.8-1.2); activated partial thromboplastin time, 27 seconds (28-38 seconds); factor VIII activity, 86% (55%-200%); sodium, 139 mmol/L (135-145 mmol/L); potassium, 4.2 mmol/L (3.6-5.2 mmol/L); serum urea nitrogen, 28 mg/dL (6-21 mg/dL); and creatinine, 0.7 mg/dL (0.6-1.1 mg/dL).

異所性ACTH産生肺カルチノイドの1例

異所性ACTH産生肺カルチノイドの1例

Carcinoid Tumor Presenting as Organizing Pneumonia: Resolution With Partial Relief of Endobronchial Obstruction

Carcinoid Tumor Presenting as Organizing Pneumonia: Resolution With Partial Relief of Endobronchial Obstruction

Recurrent bronchial carcinoid tumour presenting as a thyroid nodule

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Carcinoid Tumor Presenting as Acute Coronary Syndrome: A Case Report

Pulmonary carcinoid tumors are neuroendocrine tumors that have an incidence of 1.2-2.1/100,000 among general population. Forty percent of patients with disseminated disease experience cardiac involvement, whither due to carcinoid heart disease or due to the vasospastic effect of secreted serotonin. Acute coronary syndrome is one of the rare entities that carinoid patients can present with. Few cases are reported in literature with similar presentation. Herein we are reporting a case of a 45-year-old Yamani male patient presented to the emergency department of our hospital with chest pain for 12 hours duration. He also reported a history of watery diarrhea for the last four months. He was diagnosed to have acute coronary syndrome. Further radiological investigations showed numerous enlarged mediastinal lymph nodes. Biopsy showed moderately differentiated neuroendocrine tumor consistent with atypical carcinoid. J Med Cases. 2013;4(9):641-643 doi: http://dx.doi.org/10.4021/jmc1216w