Right and Left-sided Valve Disease: A Case of Subclinical Intrapulmonary Shunt in an Adult with Malignant Carcinoid

Carcinoid tumors are highly differentiated neuroendocrine tumors (NET) that most commonly originate from the gastrointestinal tract. Liver metastases bypass first-pass metabolism and liberate vasoactive hormones into systemic circulation, causing flushing and diarrhea. Prolonged levels of circulating serotonin may adversely affect the heart by creating fibrotic endocardial deposits on native valves. The remaining serotonin is metabolized in the pulmonary circuit that leads to pathognomonic valvular disease isolated to the right side of the heart. We present a case of an adult male with known carcinoid syndrome who presented with involvement of right, as well as left-sided valves. He was found to have an intrapulmonary shunt on transesophageal echocardiogram (TEE) with bubble study. Intrapulmonary shunt should be considered, in conjunction with right-to-left shunt, lung involvement, and high levels of serotonin, for carcinoid patients with right and left-sided valve disease.

A clinical and echocardiographic case report of carcinoid-related valvular heart disease

Background Carcinoid syndrome is a rare disease caused by malignant neuroendocrine neoplasms. When vasoactive substances enter the systemic circulation, the triad of cutaneous flushing, bronchospasm, and diarrhoea often characterize carcinoid syndrome. Rarely, carcinoid syndrome can progress to involve the cardiac system, a condition known as carcinoid heart disease, often affecting right-sided valvular structures. Case summary Here, we present a case of malignant carcinoid syndrome with associated carcinoid heart disease in a 63-year-old female. The diagnosis of her dual regurgitant and stenotic valvular disease is detailed, with accompanying two- and three-dimensional echocardiographic images demonstrating the patient’s complex tricuspid dysfunction. Discussion Carcinoid heart disease encompasses a rare but important subset of valvular dysfunction caused by circulating vasoactive substances. Diagnosis utilizing serum studies, computed tomography scans, and echocardiography can help expedite the diagnosis and treatment of such rare conditions, and assist in the avoidance of complications. Despite its relatively well-recognized clinical presentation, carcinoid syndrome and its associated heart disease still remains a challenging condition to manage and treat, often requiring the input of several subspecialties to treat the condition appropriately.

Carcinoid of the uncinate process of the pancreas in a child: An unusual case

Carcinoid of the pancreas is rare among children. We treated a debilitating child who complained about post-prandial pain with a mass in upper abdomen, vomiting and weakness for a period of six months. Abdominal examination revealed an immobile, mildly tender, solid mass in the right lumbar region. Ultrasonography of abdomen demonstrated a tumour of head of the pancreas and ultrasonography-guided fine needle aspiration cytology of the mass suggested a malignant small round cell tumour. With Computed Tomogram an enhancing compact big mass was found at the head of the pancreas compressing the duodenum without invasion and metastasis. At exploratory laparotomy, we also detected a well-defined, rounded, big solid mass arising from uncinate process of the pancreas with no metastasis. After the excision of the mass along with a healthy portion of uncinate process, the patient recovered successfully. Histopathology evaluation showed a neoplasm composed of small nests and sheets of a dense cluster of malignant round cells with hyperchromatic nuclei, sometimes forming acini with stromal invasion. Diagnosis was malignant carcinoid of the pancreas, T2 N0 M0. At follow-up of three and a half years, the patient was found symptom-free and there was no evidence of recurrence. Mediscope Vol. 7, No. 1: Jan 2020, Page 58-62

Role of fused PET/CT compared to the standard contrast-enhanced CT in the follow-up assessment of the treated gastric malignancy

Background To investigate the use of fused positron emission tomography/computed tomography (PET/CT) compared to contrast-enhanced computed tomography (CECT) in the follow-up of treated gastric malignancies, all data were collected and analyzed retrospectively, enrolling 68 patients (18 females and 50 males) (their age range = 34–73 years). The patients had been referred to a private imaging center for their assessment by PET/CT. Results Adenocarcinoma was present in 73.5%, lymphoma was present in 23.5%, and malignant carcinoid was found in 3% of cases. All patients had received at least one treatment method including endoscopic/surgical resection, chemotherapy, and radiotherapy. By PET/CT, gastric recurrence/residual was depicted in 30 patients (47.0%) compared 46 patients (67.5%) as detected by CECT, and this was statistically significant (P value = 0.006), nodal metastasis was present in 18 patients (26.5%) compared to 26 patients (38%) as detected by CECT (P value = 0.143), and distant metastasis was present in 18 patients (26.5%) compared to 24 patients (35%) as depicted by CECT (P value = 0.265). Conclusion PET/CT offered a useful diagnostic modality as compared to CECT for follow-up evaluation of cases with treated gastric malignancies through a precise detection of the gastric lesions but it had rather comparable results in the detection of nodal and distant metastases.

The Understated Malignancy Potential of Nonoperative Acute Appendicitis

Cancer of the appendix is rare and is most commonly found incidentally on pathology after an appendectomy for uncomplicated appendicitis (UA). The medical management alternative with antibiotics and observation remains an ongoing debate. The purpose of our study was to develop modern epidemiological data for adult patients completing an appendectomy for UA secondary to an appendiceal neoplasm (AN). ACS-NSQIP database was queried (2005–2016) to identify patients completing an appendectomy. Cohorts of patients who were diagnosed with UA and an AN were included in the study. Relevant perioperative clinical and outcomes data were collected. Type of AN, surgical procedure, and mortality were analyzed. A total of 239,615 UA patients were identified, of whom 2,773 (1.2%) met the inclusion criteria of AN. Patients with AN were predominantly white (79.5%), with a mean age of 54.5 ± 15.9 years, and 54.6 per cent were females. AN pathology findings included malignant neoplasm (64.5%), malignant carcinoid (17.3%), benign carcinoid (9.3%), and benign neoplasm (8.8%). The overall reported incidence was 1.2 per cent and the mortality rate was 0.7 per cent. Our study emphasizes surgical intervention in adult UA maintains a 1 per cent incidence of AN, and treatment with antibiotics alone will presumably lead to a delay in surgical treatment and progression of disease.

The Role of 5-HT1A Receptor in Cancer as a New Opportunity in Medicinal Chemistry

The 5-HT1A receptor is a pharmacologically well characterized serotonin receptor subtype and it has long been investigated because of its involvement in several physiopathological mechanisms and treatment of neurological diseases like ansia and depression. Serotonin (5-HT) also shows many non-neural functions such as essential hypertension, embryogenesis, follicle maturation and behavior. Moreover, it exerts a growth factor function on different types of non-tumoral cells, and it was also found to be related to oncogenes. In fact, growth-stimulatory activity of serotonin in different human tumor cells has been reported. Recently, new chemical molecules binding the 5-HT1A receptor have been described as novel therapeutic entities useful in neuroprotection, cognitive impairment, Parkinson’s Disease, pain treatment, malignant carcinoid syndrome and cancer. It was widely demonstrated that 5-HT1A receptor is involved in the carcinogenesis and consequently in many human tumor types, such as prostate, bladder, small cell lung, colonrectal and cholangiocarcinoma. Furthermore, depending on the tumor type, 5-HT1A receptor antagonists were shown to be capable of blocking the 5HT-induced increase in tumor growth. In this review, we have focused our attention on each tumor type where the 5-HT1A receptor is involved, investigating the role of this molecular target and the different classes of compounds that have shown the capability to modulate it. The analyzed aspects could represent a hint for the medical chemists to develop novel molecules as selective 5-HT1A agents are useful in further elucidating the role of this therapeutic target.