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DOI: 10.1055/s-0029-1214985
© Georg Thieme Verlag KG Stuttgart · New York
A case of multiple carcinoid tumors of the small intestine
R. Yanaru-Fujisawa
Department of Medicine and Clinical Science
Graduate
School of Medical Sciences
Kyushu University
Maidashi 3-1-1
Higashi-ku
Fukuoka
812-8582
Japan
Fax: +81-92-642-5273
Email: yritsuko@intmed2.med.kyushu-u.ac.jp
Publication History
Publication Date:
06 November 2009 (online)
A 56-year-old man was referred to our institution with hematochezia and general fatigue. Esophagogastroduodenoscopy, total colonoscopy, and angiography failed to identify the source of bleeding. We then examined the patient with capsule endoscopy, which revealed multiple elevated lesions in the middle of the small intestine ([Fig. 1]). The tumors were yellowish in color and were covered with mucosa of normal appearance.
Intraoperative enteroscopy carried out during a laparotomy also revealed numerous protrusions ([Fig. 2]). A 97-cm segment of the middle part of the small intestine was resected. On macroscopic examination, 111 protrusions were noted in the resected segment ([Fig. 3]). The size of the tumors ranged from 1 mm to 13 mm. Microscopically, the tumors were composed of uniform cells, with a round to oval nucleus and eosinophilic cytoplasm, proliferating in a solid, trabecular, or glandular fashion. Two tumors had invaded the muscularis propria and the serosa ([Fig. 4]). The patient has been metastasis-free for 4 years since the surgery.
Approximately 30 % of carcinoid tumors of the small bowel occur as multiple tumors [1] [2]. However, there have been few reports of more than 10 carcinoid tumors of the small intestine in one patient. Yantiss et al. [3] reported that patients with multiple carcinoid tumors were usually younger, had more frequent vascular invasion, and had a poorer prognosis than patients with a single tumor.
With the widespread use of capsule endoscopy and double-balloon endoscopy, enteroscopic findings of gastrointestinal polyposis have become clearer [4] [5]. On the basis on our experience, we recommend considering multiple carcinoids as a possible diagnosis in patients with numerous polypoid lesions in the small intestine.
Endoscopy_UCTN_Code_CCL_1AC_2AC
#References
- 1 Peck J J, Shields A B, Boyden A M. et al . Carcinoid tumors of the ileum. Am J Surg. 1983; 146 124-132
- 2 Butkr A P, Thomas R M, Elsayed A M. et al . Carcinoids of the jejunum and ileum. Cancer. 1997; 79 1086-1093
- 3 Yantiss R K, Odze R D, Farraye F A. et al . Solitary versus multiple carcinoid tumors of the ileum. Am J Surg Pathol. 2003; 27 811-817
- 4 Cobrin G M, Pittman R H, Lewis B S. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer. 2006; 107 22-27
- 5 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004; 2 1010-1016
R. Yanaru-Fujisawa
Department of Medicine and Clinical Science
Graduate
School of Medical Sciences
Kyushu University
Maidashi 3-1-1
Higashi-ku
Fukuoka
812-8582
Japan
Fax: +81-92-642-5273
Email: yritsuko@intmed2.med.kyushu-u.ac.jp
References
- 1 Peck J J, Shields A B, Boyden A M. et al . Carcinoid tumors of the ileum. Am J Surg. 1983; 146 124-132
- 2 Butkr A P, Thomas R M, Elsayed A M. et al . Carcinoids of the jejunum and ileum. Cancer. 1997; 79 1086-1093
- 3 Yantiss R K, Odze R D, Farraye F A. et al . Solitary versus multiple carcinoid tumors of the ileum. Am J Surg Pathol. 2003; 27 811-817
- 4 Cobrin G M, Pittman R H, Lewis B S. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer. 2006; 107 22-27
- 5 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004; 2 1010-1016
R. Yanaru-Fujisawa
Department of Medicine and Clinical Science
Graduate
School of Medical Sciences
Kyushu University
Maidashi 3-1-1
Higashi-ku
Fukuoka
812-8582
Japan
Fax: +81-92-642-5273
Email: yritsuko@intmed2.med.kyushu-u.ac.jp