A Patient with Multiple Gastrointestinal Carcinoid Tumours Presenting with Jejunal Intussusception

Carcinoid tumours are neuroendocrine tumours which arise from the enterochromaffin cells in the gastrointestinal and bronchopulmonary systems. The presentation of multiple gastrointestinal carcinoids with jejunal intussusception is rare, and the diagnosis may be challenging. A 49-year-old patient with adult onset bronchial asthma presented with pain around the umbilical region for 1-day duration. Physical examination revealed only mild abdominal tenderness. Abdominal computed tomography revealed small bowel intussusception with two separate highly vascular tumours arising in the small bowel mesentery. Exploratory laparotomy was done, with resection of the tumours arising from the small bowel mesentery and the proximal jejunum causing the intussusception which were excised. Histopathological diagnosis confirmed the presence of a Grade 1 carcinoid tumour of classic type. After surgery, he had an uneventful recovery and was asymptomatic. Carcinoid tumours are a very rare cause of adult intussusception. So far, there have been only two reported cases of jejunal intussusception secondary to carcinoid tumours. These will require a combination of surgical intervention and systemic therapy in selective cases for complete management.

Metastatic carcinoid tumor with severe double valve disease at diagnosis: Case report and review of literature

A 27-year-old woman with a history of anxiety presented with three months of diarrhea. Onphysical examination, she had a grade 3/6 systolic heart murmur at the lower left sternal borderwhich increased with inspiration, a grade 2/6 decrescendo diastolic murmur at the left sternalborder, and lower extremity edema. Stool studies were negative. The abdominal ultrasounddemonstrated multiple complex liver cysts. Transthoracic echocardiogram reported tricuspidvalvular thickening with stenosis and regurgitation, severe pulmonary stenosis, and mild aorticregurgitation with valvular thickening. 5-hydroxyindole acetic acid and chromogranin A levelswere elevated. The patient’s symptoms improved after octreotide therapy, and she underwenttricuspid and pulmonary valve replacement.The incidence of carcinoid tumors is 1.2 to 2.1 per 100,000 people in the general population.Carcinoid heart disease occurs in one-half to two-thirds of patients with carcinoid syndromeand is associated with poorer clinical outcomes. Left side cardiac involvement occurs in lessthan 10% of patients. The presence of both left and right sided valvular disease in the contextof gastrointestinal carcinoid is associated with severe and poorly controlled disease. Up to4% of these cases have metastatic disease on the valves, and 3.8% have direct myocardialinvolvement.

Subtotal Gastrectomy for Atypical Carcinoid of Stomach– A Rare Tumour

The term carcinoid was first employed by Oberndorfer in 1907 to describe a group of tumours of the gastrointestinal tract that had a relatively indolent course and that were considered to be intermediate between adenoma and carcinoma in malignant potential. Gastrointestinal carcinoid tumours are a type of cancer that form in the lining of the gastrointestinal tract originating from entero-chromaffin like (ECL) cells. Gastric carcinoid tumours are rare tumors that develop within the gastric mucosa. They can present as an isolated lesion or there can be multiple lesions. The tumours can invade locally into deeper structures of the gastrointestinal tract (GIT) wall. Solitary gastric carcinoids have a greater chance for the development of malignancy and metastases as compared to multiple gastric carcinoids due to hypergastrinemia. A 60 years old man presented with abdominal pain, vomiting and weight loss and was found to have carcinoid tumour of stomach without classic carcinoid syndrome (CS). Despite advances in the understanding of patho-physiology of carcinoid tumour its complications remain enigmatic. Early, accurate diagnosis and aggressive treatment is recommended. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 145-148