„Accidental“ recognition of clinically inactive carcinoid tumors in the clinical practice

Introduction: Carcinoid tumors are rare, originates from neuroendocrine cells, with typical hystological characteristics. Despite their common origin, tumors at different locations have different clinical manifestations.

Case study: 1st case: 36 year old woman was investigated because of aneamia. A polyp has been found in the rectum, and has been removed. Histology proved carcinoid tumor (chromogranin A ++, VIP – neg., somatostatin +, serotonin neg., somatostatin receptor neg). The patient had no typical symptoms to carcinoid. The polypectomy was complete. Serum chromogranin A level was 8.5ng/ml (in normal range).

2nd case: 60 year old woman underwent investigations because of anaemia, too. Two solid polyps (4 and 9mm) were detected during gastroscopy. After biopsy, they were proved histologically to carcinoid tumors (chromogranin A ++, p53 neg. COX2 neg., somatostatin neg., insuline neg.). Endosonography proved the intramucosal location of the tumor. Hystology showed lymphatic invasion, therefore, the stomach was resected. Pathology proved lymphatic invasion in the submucosus layer. Serum chromogranin A level was 237.7ng/ml (high).

Discussion: There were no typical symptoms of carcinoid syndrome in either cases. Endosonography and specific immunohystochemistry (chromogranin A, somatostatin, C -kit, serotonin, p53, insuline, VIP) might be helpful planning the therapy. Serum chromogranin A test is recommended in the follow up carcinoid tumors.

Conclusion: After removing small polyps with unusual look, only histology may prove its carcinoid origine. Immunohystochemistry, endosonography and serum chromogranin A level determine the therapy of patients with carcinoid tumors.