Carcinoid tumour: spontaneous regression following pregnancy
EL Lim1, I Macleod2, D Carr2, D Manas3, R Quinton1 & A James1
Clinical case: An incidental right sided pelvic mass measuring 6 cm×7 cm was found in a 35 year-old nulliparous lady during investigations for secondary infertility. This mass was hard, irregular and white in appearance and biopsy confirmed a carcinoid tumour with a low Ki 67 index of 2.7%. She had no symptoms of flushing, diarrhoea or local discomfort. Endocrine screen showed a non-secretory tumour with normal fasting gut hormones and negative urinary 5H1AAs. Other tumour markers (CEA, CA-125, AFP and calcitonin) were also negative.
Progress and management: The patient became pregnant soon after the diagnosis. Close monitoring during antenatal period was uneventful. She had elective caesarean section and delivered a healthy baby boy at 38 weeks with uncomplicated post-natal period. A repeat CT imaging (10 months from the first scan) did not show any measurable increase in the extent of the pelvic tumour, and no liver metastases were identified. An Indium111 octreotide study showed increased tracer uptake in the lower pelvis, correlating to the tumour on CT as well as a focal increase in the region of the terminal ileum suggestive of a possible primary. A subsequent CT scan four months later however showed that the mass was no longer present and this was confirmed on laparoscopy showing no macroscopic pelvic or abdominal abnormalities.
Discussion: The presence of a non-secretory carcinoid tumour has been demonstrated in our patient with CT imaging, octreoscan and histology. Furthermore, serial imaging has demonstrated spontaneous regression of the carcinoid suggesting that pregnancy did not worsen the course of the disease but may have resulted in tumour regression. Nonetheless, long-term surveillance will be required.