Metastatic Carcinoid Tumor to the Heart, A Dreadful Complication of Neuroendocrine Tumors Yet Under Estimated: About an Observation

Cardiac metastases are uncommon in neuroendocrine tumors (NET). Features of patients with metastatic carcinoid tumor involving the heart have not been well described. Although carcinoid tumors have been described in almost every organ, few reported cases of confirmed cardiac involvement. The overall incidence of myocardial carcinoid metastases among patients with metastatic carcinoid disease is about 4%. There is limited knowledge on the prevalence, clinical presentation, and management of heart metastasis. The availability and increasing use of modern imaging techniques leads to more frequent discovery of rare metastatic sites. Our aim is to further clarify the clinical manifestations of heart metastasis, to increase the knowledge of rare localizations of NET metastasis and insist on the systematic screening of metastatic carcinoid heart disease as an integral part of the echocardiographic evaluation in patients with carcinoid syndrome. We report the case of a 67-year-old male with history of a low differentiated neuroendocrine tumor, presenting with palpitations and dyspnea and which investigations have led to diagnose myocardial metastasis signing the progression of the NETs.

Primary strumal carcinoid tumor of the ovary arising from a heterochronous struma ovarii in young female patient

Primary ovarian carcinoid tumors are extremely rare. Ovarian strumal carcinoid is usually derived from mature cystic teratoma, an ovarian germ cell tumor composed of two distinctive components characteristic thyroid tissue intermixed with a carcinoid tumor. The incidence of stromal carcinoid tumor is accounting for 0.3-1% of all ovarian tumors and 3% of all mature teratomas. Herein, we report a 25-year-old female presented with severe abdominal pain. She had right struma ovarii after Laparoscopic-Assisted Ovarian Cystectomy (LAOC) procedure one year ago. The sonography of abdomen images study demonstrated a well capsulated cystic mass measured up to 11 cm in dimension. The mature cystic teratoma was the first diagnostic possibility. She underwent the laparoscopy-assisted left ovarian cystectomy. Histopathological and immunohistochemical examinations confirmed strumal Carcinoid Tumor of the Ovary (SCTO) arising from strum ovarii in the left ovary. She was recovered well and was still asymptomatic after two years follow-up. In conclusion, we first describe the primary SCTO arising from a heterochronous struma ovarii. The symptoms of SCTO are usually non-specific and misleading. Therefore, it is important to fully understand the characteristics, diagnosis and management of SCTO. Diagnosis should be confirmed by pathology and immunohistochemistry, and clinically metastatic carcinoid should be excluded.

Inferior Vena Cava Syndrome as a Manifestation of Metastatic Carcinoid Tumor

Small bowel-origin carcinoid tumor is indolent but may metastasize relentlessly to various sites, including the liver. Over the past 9 years, we have treated a 69-year-old woman who has undergone 5 percutaneous liver ablations, 5 hepatic intra-arterial chemoembolizations, an ovarian cryoablation, and a trans-ventral hernia mesenteric cryoablation. These interventions are all related to her inoperable carcinoid malignancy. After the patient presented with swelling of the abdomen and both lower extremities, computed tomography (CT) angiography was performed, revealing a circumferential hepatic metastatic mass encasing the intrahepatic inferior vena cava (IVC) and extensive third spacing of fluids specific to the IVC distribution below the diaphragm. A venogram of the intrahepatic IVC revealed extrinsic compression causing 95% narrowing of the vessel. A balloon was advanced to the level of the lesion and inflated, increasing the caliber of the vessel. Subsequently, 2 covered aortic stent graft cuffs were deployed in an overlapping fashion within the lumen of the IVC, traversing the area of narrowing. Next, an open-cell aortic dissection stent was placed across both overlapping aortic stents from the renal veins to the hepatic veins. Following this, three 17-gauge cryoablation probes were inserted into the segment 1 intrahepatic lesions encasing the newly stented IVC via an anterior percutaneous approach. Two 10-min freeze cycles were performed with intraoperative CT imaging, demonstrating circumferential coverage of the lesions. Posttreatment venogram revealed patent stent grafts within the intrahepatic IVC, and restoration of vessel patency. No immediate postoperative complications were noted. The patient’s abdominal and lower extremity swelling resolved completely within 1 week after procedure. Two-month follow-up CT demonstrated markedly decreased size of the metastatic lesions and no adverse effects. Six- and 9-month PET-CT scans demonstrated maintained patency of the IVC stent. This palliative procedure allowed the patient to maintain good performance status and alleviated her symptoms of IVC syndrome. The radial force generated by the multiple aortic stents will ostensibly maintain the patency of the intrahepatic IVC. Cryoablation of the encasing metastatic lesion was performed with markedly decreased size of the tumor on the 2-month follow-up.

Palpable Breast Findings in High-risk Patients: Are Self- and Clinical Breast Exams Worthwhile?

Objective To assess breast imaging findings, biopsy rates, and malignancy rates in areas of palpable concern in women at high risk for breast cancer. Methods An IRB–approved retrospective review of a tertiary cancer center’s breast imaging database was performed. Breast imaging and electronic medical records of high-risk women with palpable findings detected on self- or clinical breast examination from January 1, 2010, to January 1, 2016, were reviewed. Descriptive statistical analyses were conducted. Results Imaging correlates for 322 palpable findings in 238 high-risk women included 55/203 (27.1%) on mammography, 183/302 (60.6%) on US, and 20/47 (42.6%) on MRI. Biopsies were performed for 104/322 (32.3%) palpable findings: 95/104 (91.3%) under imaging guidance and 9/104 (8.7%) under palpation after negative imaging. Of 322 palpable findings, 16 (5.0%) were malignant in 16/238 (6.7%) women, yielding a positive predictive value of biopsy of 16.8% (95% CI: 9.2%–24%). Women diagnosed with cancer had 16/16 (100%) sonographic, 9/14 (64.3%) mammographic, and 7/7 (100%) MRI correlates. Cancer histopathology included 12 invasive ductal carcinomas, 1 ductal carcinoma in situ, 1 invasive lobular carcinoma, 1 malignant phyllodes tumor, and 1 metastatic carcinoid tumor. Over two years of follow-up imaging in 183/238 (76.9%) women were reviewed; 7/183 (3.8%) were diagnosed with breast cancer at least one year after presenting with a palpable concern in a different location. Conclusion High-risk women with palpable findings exhibit a 6.7% malignancy rate, indicating the value of imaging workup in this population. In our cohort, imaging demonstrated a high negative predictive value.

Case Report: Neuroendocrine Tumor With Cardiac Metastasis

Neuroendocrine tumors (NETs), also known as carcinoid tumors, are a heterogeneous group of neoplasms that arise from cells throughout the neuroendocrine system, most commonly arising from the gastrointestinal (GI) tract, lungs, and bronchi. Myocardial carcinoid metastasis is rare with an incidence among metastatic carcinoid patients of 4%. They are generally asymptomatic and detected incidentally. Infiltrative myocardial metastasis secondary to carcinoid tumor is exceedingly rare with only single-digit cases reported in the literature. We report the case of a 65-years-old female with a newly diagnosed ileal neuroendocrine tumor as well as heart failure due to infiltrative myocardial metastasis.