Carcinoid syndrome: case report
Introduction: Carcinoid tumors are neuroendocrine tumors derived from enterochromaffin or Kulchitsky cells (that secretes serotonin or other chemicals into bloodstream), which are widely distributed in the body, but they are traditionally described as originating from the foregut, midgut, and hindgut. A case of carcinoid syndrome is reported.
Case: A 55-year-old man with medical history of Parkinson disease. Was admitted to internal medicine outpatient clinic for with history of diarrhea, abdominal pain, irregular bowel movements dyspepsia and weight loss, asthenia and anorexia, associated with occasional flushing episodes for 10 months. Physical examination revealed: red facial flush and facial spider-like veins and hepatomegaly.
Laboratory: Complete blood count cells was normal. AST 114 U7L. ALT 118 U/l. Bilirrubin 2.1 mg/dl. GGT 482 U/l. ALP 371 U/l.CA-125 52 U/l. Urinary 5-HIAA: 320 mg/24 h (range<10). Chromogranin A >1200 ng/ml (range<98 ng/ml). Barium enema, filling defect in ileocecal valve. Colonoscopy, suggested lipomatosis of ileocecal valve. Abdominal ultrasound; liver metastases. Abdominal CT. Liver metastases. Tumor in ileum with infiltration of the mesentery and carcinomatous peritonitis. Somatostatin receptor scintigraphy, liver metastasis from a carcinoid tumour. The primary tumour located in the distal ileum.
Echocardiography was normal. The patient was treated with sandostatin Lar 20 mg monthly.
Discussion: The prognosis for patients with metastatic carcinoid tumors has improved during the last decade. Due to longer survival times, follow-up should be focused on monitoring tumor size and extension of metastases by CT scan and nuclear scanning. During follow-up, hormonal activity must be monitored on a regular basis. Routine examinations every 612 months to detect carcinoid-related heart disease at an early stage are important in order to adjust therapy and, hence, improve prognosis. Combining new diagnostic and treatment modalities (somatostatin analogues have also been reported to inhibit tumor growth, hepatic artery embolization, radiofrequency ablation)in metastatic carcinoid patients may result in better quality of life and longer survival times.