Endocrine Abstracts

Background: Intracardiac metastasis of carcinoid tumours are rare (incidence 2–4%). Their presence without carcinoid valvulopathy or carcinoid syndrome is unusual.

Case Discussions: A 70 year old male presented with abdominal pain. CT imaging revealed a small intestinal tumor with liver and mesenteric metastasis. Biopsy showed a neuroendocrine tumour (NET). Clinical and biochemical evidence of functionality was absent. He underwent definitive small bowel and liver metastases resection. Histology confirmed a well differentiated NET with Ki 67–5%. Two years later, he developed carcinoid syndrome and was commenced on somatostatin analogues. Subsequent imaging showed multiple liver metastases and a high intensity lesion in the intraventricular septum (IVS). Echocardiogram confirmed the cardiac finding without significant valvulopathy. Cardiac MRI displayed a well-defined mass measuring 2 cm×1.5 cm in the mid IVS with high signal intensity in T2 suggesting metastasis. To date the patient has remained haemodynamically stable.

A 69 year old male presented with a 9 year history of carcinoid syndrome. Imaging revealed a terminal ileal NET with liver metastases. Multiple areas were octreotide avid including a pericardial apical region. Somatostatin analogues were commenced. Two years later he underwent CABG for underlying coronary artery disease. A surprising finding of large firm deposits over both ventricles extending and encasing the aorta was noted.

Discussion: Cardiac metastasis are a rare presenting feature of NETs. The absence of significant valvulopathy was likely to be related to the duration of syndrome. Here the cardiac metastases have been not caused any compromise.