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G. Dimofte,E. Molodoi,Gabriela Lozneanu,D. Negru
Jurnalul de Chirurgie , 2005,
Abstract: We describe an unusual presentation of a highly malignant type III gastric carcinoid tumor, an incidental finding in a 60 years old female admitted for gallstone disease. The case is presented in a historical fashion, with every stage diagnosis described and reasoned. A well confined liver tumor was falsely assumed as a liver haemangioma, while the primary gastric tumor was revealed only after the passage of a naso-gastric tube which triggered an upper gastro-intestinal bleeding episode. Diagnostic endoscopy revealed a small tumor, but histological examination on biopsy specimen suggested a poorly differentiated carcinoma. Standard total gastrectomy with D2 lymphadenectomy was performed, with good tumor clearance but local metastases were confirmed in adjacent lymphnodes. Final pathology proved a type III highly malignant carcinoid tumor, with mixed cellularity. Follow-up 3 months later showed an explosive development of the liver tumors demonstrating not only the metastatic origin but also the aggressiveness the sporadic gastric carcinoid tumor. Although prognosis is very poor we believe that the errors that marked such a difficult diagnosis could bring back in attention the rare condition of a sporadic gastric carcinoid which can represent up to 30% of all carcinoid tumors, but only 1% of all gastric tumors. Unusual aspects of liver metastases should prompt biopsy and histological confirmation.
Carcinoid tumor of the minor papilla in complete pancreas divisum presenting as recurrent abdominal pain
Yong Kim, Tae Kim, Kyeong Kim
BMC Gastroenterology , 2010, DOI: 10.1186/1471-230x-10-17
Abstract: A 56-year-old female patient was referred for evaluation of pancreatic duct dilatation noted on abdominal ultrasonography and computerized tomography. She complained of intermittent epigastric pain for 6 months. A MRCP and ERCP revealed complete pancreas divisum with dilatation of the main pancreatic duct. On duodenoscopy, a small, yellows, subepithelial nodule was visualized at the minor papilla; biopsy of this lesion revealed a carcinoid tumor. She underwent a pylorus-preserving pancreaticoduodenectomy. The histologic evaluation showed a single nodule, 1 cm in diameter, in the submucosa with duodenal and vascular invasion and metastasis to the regional lymph nodes.Although the size of the carcinoid tumor was small and the tumor was hormonally inactive, the concomitant pancreas divisum led to an early diagnosis, the tumor had aggressive behavior. Carcinoid tumors of the minor papilla should be included in the differential diagnosis of recurrent abdominal pain or pancreatitis of unknown cause.Tumors of the minor papilla of the duodenum are very rare; the majority of tumors of the minor papilla of the duodenum are neuroendocrine tumors (NETs), such as somatostatinomas and carcinoid tumors [1-7]. Carcinoid tumors arise from enterochromaffin cells, and gastrointestinal carcinoids are usually located in the appendix, ileum, stomach, and rectum. Carcinoids of the minor papilla are extremely rare; only 8 cases have been reported in the literature [1-8].Pancreas divisum is the most common congenital anomaly of the pancreas, resulting from failure of fusion between the dorsal and ventral pancreatic ducts. Most exocrine secretions of the pancreas drain through the dorsal pancreatic duct and the minor papilla in the pancreas divisum. Patients with pancreas divisum usually have no clinical symptoms, but sometimes have recurrent abdominal pain or pancreatitis when disturbances in drainage of pancreatic secretion through the minor papilla occur.We report a very unusual case of a
Malignant solid pseudopapillary tumor of pancreas causing sinistral portal hypertension  [cached]
Wani Nisar,Lone Tasleem,Shah Asif,Khan Abdul
Indian Journal of Pathology and Microbiology , 2011,
Abstract: Solid pseudopapillary tumor (SPT) of the pancreas is a rare benign or low-grade malignant epithelial tumor that occurs mainly in young females in second to fourth decades of life. Pathologic and imaging findings include a well-defined, encapsulated pancreatic mass with cystic and solid components with evidence of hemorrhage. We report a 23-year-old female who presented with upper abdominal pain of long duration and epigastric mass on palpation. Multidetector-row CT (MDCT) demonstrated a large well-defined heterogeneous attenuation mass, containing hyperdense areas of hemorrhage mixed with solid enhancing and cystic non-enhancing areas, arising from the pancreatic body and tail. Splenic vein thrombosis was present with dilated splenoportal collateral vessels between splenic hilum and portal/superior mesenteric veins, with dilated vessels seen in the gastric wall, with patent portal vein, compatible with sinistral portal hypertension. Typical imaging features and age and sex of the patient suggested a diagnosis of SPT of pancreas complicated by segmental portal hypertension due to splenic vein thrombosis. Histopathology of the biopsy material was confirmatory.
Pseudocyst of ectopic pancreas of the duodenal wall masquerading as malignant cystic tumor of pancreas  [cached]
Sharma Dharamanjai,Agarwal Shaleen,Saran Ravindra,Agarwal Anil
Saudi Journal of Gastroenterology , 2009,
Abstract: We report a patient who underwent pancreaticoduodenectomy for a cystic lesion in the region of the pancreatic head and duodenum. Preoperatively, we had suspected a malignant lesion; however, it turned out to be ectopic pancreatic tissue in the duodenal wall, with the changes of chronic pancreatitis and pseudocyst formation. With this report we seek to highlight the rarity of this particular pathologic combination and the difficulties in its correct preoperative diagnosis and management.
Breast metastasis of ilial carcinoid tumor: Case report and literature review
Chakshu Gupta, Ashok K Malani, Sandeep Rangineni
World Journal of Surgical Oncology , 2006, DOI: 10.1186/1477-7819-4-15
Abstract: We report a case of unilateral breast metastasis from carcinoid tumor of the small intestine in a 52-year-old woman who was successfully treated by lumpectomy and radiation therapy. An extensive review of the literature reveals only a few cases of metastatic carcinoid to the breast from small intestinal primaries.Clinical suspicion for metastasis should be high in a patient with breast mass and history of known carcinoid elsewhere in the body. Lumpectomy alone may be effective in these patients. Mastectomy and especially axillary dissection could be avoided. Their histological appearance may mimic ductal adenocarcinoma of the breast. However, the distinction is important due to differences in management and prognosis.Metastatic tumors to breast represent a mere 1–2% of all breast tumors [1,2]. Common tumors that metastasize to the breast include those from the lung, prostate, thyroid, kidney, hematopoietic system, and malignant melanoma [3-5]. In children, rhabdomyosarcoma is reported to be the most common primary source of metastatic breast lesions [6]. In comparison, metastatic neoplasms from gastrointestinal primaries are rare and include the stomach, pancreas, esophagus, and colon. The majority of these tumors are adenocarcinomas [6]. Small intestinal carcinoids metastasizing to the breast have only sporadically been reported in the literature [7]. Metastatic breast carcinoid can be easily mistaken for primary breast carcinoma. This may potentially be detrimental for the patient, especially if the primary surgery is a mastectomy with axillary lymph node dissection. Many times a primary lesion may not be discovered and breast metastasis may be the presenting feature of an occult carcinoid [8,9]. Primary carcinoid tumors of the breast are also reported in the literature, although this view is no longer accepted [7,10,11]. We report a case of metastatic breast carcinoid in a 52-year-old postmenopausal nun along with a review the literature.A 52-year-old postmenopau
Carcinoid of pancreas: Case report
Radovanovi? Dragan,Stevanovi? Dejan,Pavlovi? Ivan,Mitrovi? Neboj?a
Medicinski Pregled , 2009, DOI: 10.2298/mpns0902083r
Abstract: Introduction. Carcinoid tumors are very common tumors of gastro-intestinal tract even though they are very rare in pancreatic area. A large number of patients with pancreatic carcinoma have non-specific symptoms of disease which is the main cause of late operative treatment of advanced tumors as well as for a low rate of 5-years surviving (28,9%±16%). Case report. A 69-year-old female patient was operated for a 7 cm large carcinoid in pancreatic corpus. Prior to the operation the patient did not have any symptoms of disease. Serotonin and 5-HIAA level was normal before the operation as well as afterwards. In this case distal hemipancreatectomy was done along with celiac, hepatic and lienal lymphadenoctomy. Liver metastasis was not found. The diagnosis of carcinoid was varified by postoperative histopathologic and imunohistochemical analysis. Discussion. According to the experience of other authors, the operative treatment of pancreatic carcinoid is very often undertaken when dimensions of tumor exceed 7 cm. In this stage of disease distant metastases are present in more than 60% of patients. Only 23% of examinated patients have had carcinoid syndrome symptoms. According to this conclusion, the main role of diagnostic procedures is attributed to the computer tomography of abdomen as well as ERCP. The radical resection of pancreas with lympahdenectomy is recommended in order to have a precise histological examination and detect occult lymph node metastases. With radical surgical procedures even at this stage of disease the operation may be curative. Conclusion. Any kind of radical surgical treatment (depending of localizations of tumor, proximal or distal) is the main therapeutic procedure in pancreatic carcinoid.
Heterotopic pancreas in the gastrointestinal tract  [cached]
Zhou Yuan, Jie Chen, Qi Zheng, Xin-Yu Huang, Zhe Yang, Juan Tang
World Journal of Gastroenterology , 2009,
Abstract: Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 60-year-old man with carcinoid syndrome caused by heterotopic pancreatic tissue in the duodenum is described, along with a 62-year-old man with abdominal pain caused by heterotopic pancreatic tissue in the gastric antrum. The difficulty of making an accurate diagnosis is highlighted. The patients remain healthy and symptom-free after follow-up of 1 year. Frozen sections may help in deciding the extent of resection intraoperatively. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of gastrointestinal stromal tumor.
A rare case of metastatic renal carcinoid
Yoshiharu Kato, Kogenta Nakamura, Yoshiaki Yamada, Genya Nishikawa, Takahiko Yoshizawa, Kenji Zennnami, Remi Katsuda, Motoi Tobiume, Shigeyuki Aoki, Tomohiro Taki, Nobuaki Honda
BMC Urology , 2010, DOI: 10.1186/1471-2490-10-22
Abstract: We present our experience of a patient with metastatic renal carcinoid from the gastrointestinal tract.The carcinoid tumor of the kidney in our patient, who had a history of liver metastasis from rectal carcinoid, was considered metastatic based on the pathological findings.Carcinoid tumor was first detected as multiple tumors in the ileum by Lubarsch during autopsy more than 100 years ago [1]. The concept of this disease is an endocrine cell tumor with low-grade atypia, which is generally a low-grade malignant cancer with a good prognosis. About 70% of carcinoid tumors occur in the gastrointestinal tract, including the rectum, appendix, stomach, and ileum. The rest of them arise mainly from neuroendocrine cells in the pancreas, gonads and pulmonary bronchi, and they rarely occur in the kidney. Metastatic renal carcinoid is even rarer, with only one reported case [2]. Here, we present our experience of a patient with metastatic renal carcinoid with a review of the literature.A 56-year-old man underwent resection of a rectal carcinoid twelve years ago, and subsequently underwent resection of liver metastases of rectal carcinoid twice, twelve and ten years ago. Two years ago, he was found to have a 3-cm mass in the left kidney on ultrasonography during a general checkup, and attended our department. Results of routine blood chemical analysis and urinalysis were unremarkable.Ultrasonography revealed a 3-cm relatively well-defined mass in the lower pole of the left kidney, and the interior of the mass was low echoic, unclear of margin, and hypovascular. Contrast-enhanced abdominal CT demonstrated a poorly enhanced, well-defined mass at the above-mentioned site in both the arterial and venous phases (Figure 1A). MRI showed a well-defined mass containing irregular high-signal-intensity areas on T1-weighted images and relatively low-signal-intensity areas on T2-weighted images. Bone scintigraphy did not reveal any obvious bone metastases.Since these findings did not rule o
Primary hepatic carcinoid tumor
Jinbo Gao, Zhijian Hu, Junwei Wu, Lishan Bai, Xinqun Chai
World Journal of Surgical Oncology , 2011, DOI: 10.1186/1477-7819-9-151
Abstract: Carcinoid tumors are neoplasms that originate from the cells of neuroendocrine system, and were first characterized by Oberndorfer in 1907. They are usually low-grade malignant tumors that may cause the carcinoid syndrome by secretion of serotonin and other vasoactive hormones. Most of them occur within the gastrointestinal tract, primarily in the appendix and the terminal ileum [1,2]. Primary hepatic carcinoid tumors (PHCT) are very rare. Here, we report a case of PHCT, and describe the clinical features and treatment of this case.A 53-year-old female presented with right upper quadrant abdominal pain and was admitted to our hospital in May 2007. The patient had no history of jaundice, vomiting, flushing or diarrhea. Her past medical history included hypertension and a cholecystectomy due to gallstones 10 years previously. Physical examination showed no abnormality except for the presence of a scar in the right upper quadrant of abdomen. Laboratory investigations, including liver function test, renal function test, blood routine test and tumor markers (AFP, CEA, CA19-9, CA242, CA125 and CA15-3), were within normal limits. Serum hepatitis B surface antigen and hepatitis C antibody were negative.Computer tomography (CT) revealed a low density nodule in segment 4 of liver. Dynamic CT scans showed enhanced of the nodule in the arterial phase and early washout in the portal phase (Figure 1). Liver ultrasound confirmed the presence of the hypervascular mass. No enlarged lymph nodes were found by CT or ultrasonic. Based on the imaging finding, hepatocelluar carcinoma was highly suspected. A fine-needle aspiration biopsy was performed under ultrasonographic guidance for definite diagnosis. The histological examination of the biopsy specimens suggested the tumor was a carcinoid tumor. The neoplastic cells were round or columnar cells with round nuclei and pale eosinophilic cytoplasm. Immunohistochemistry was positive for pancytokeratin AE1/AE3, synaptophysin and chromorgran
Endocrine tumors of the gastrointestinal tract and pancreas:grading, tumor size and proliferation index do not predict malignant behavior
Borislav A Alexiev, Cinthia B Drachenberg, John C Papadimitriou
Diagnostic Pathology , 2007, DOI: 10.1186/1746-1596-2-28
Abstract: To evaluate prognostic parameters, namely tumor size, tumor grade, and Ki-67 index in relationship to metastatic behavior of GIP ETs.Biopsies and surgical specimens from 38 patients with GIP ETs were selected. The study group comprised 16 males and 22 females (mean age 62.6 years; range 24–91). Formalin-fixed, paraffin-embedded tissue sections were stained with H&E, synaptophysin, chromogranin A, and Ki-67. Ki-67 index was evaluated using ChromaVision Automated Assisted Image Analysis software. Proliferative index was compared to tumor grade, and the degree of associations between tumor size, tumor grade, Ki-67 index and metastatic behavior of GIP ETs were evaluated.Fifteen of the twenty-two (68.18%) surgically staged neoplasms presented with peritoneal dissemination, lymphogeneous, and/or hematogeneous metastases. Nine of the metastatic tumors were G1 (9/13, or 69.23%), 5 were G2 (5/7, or 71.42%), and 1 – G3 (1/2, or 50%). Overall, 10/15 (66.66%) metastatic tumors showed < 2% Ki-67 immunoreactivity. Four ileal ETs had a synchronous malignancy. No significant correlation was found to exist between tumor grade and Ki-67 index as well as between tumor size, tumor grade, Ki-67 index and metastatic behavior.The findings suggest that tumor size, tumor grade and Ki-67 index do not accurately predict malignant behavior of GIP ETs.For many years, tumors of the disseminated endocrine system have been referred as "carcinoids" [1-3]. Oberndorfer coined this term in 1907 for these epithelial tumors in the gut that in general have a relatively monotonous structure and are less aggressive in their behavior than carcinomas [1-6]. Factors that determine the biologic behavior of endocrine tumors are complex and multifaceted. In the WHO classification of 2000, a distinction was made between well-differentiated endocrine tumors (which show benign behavior or uncertain malignant potential), well-differentiated endocrine carcinomas (which are characterized by less aggressive malignant b
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