Multiple liver metastases from a rectal carcinoid tumor - 22/08/11
Doi : 10.1016/j.gie.2009.10.001
Hoon Jai Chun, MD, PhD, Yoon-Tae Jeen, MD, PhD, Sung Chul Park, MD, Bora Keum, MD, PhD, Yeon Seok Seo, MD, PhD, Soon Ho Um, MD, PhD, Chang Duck Kim, MD, PhD, Ho Sang Ryu, MD, PhD
Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
Lawrence J. Brandt, MD, Associate Editor for Focal Points
| Commentary Rectal carcinoid tumors usually are asymptomatic in the absence of advanced disease and most frequently are discovered incidentally during colonoscopy performed for screening or unrelated indications. Also, hindgut carcinoid tumors are not usually metabolically active. They do not usually secrete large amounts of serotonin, nor do patients with these tumors have elevated urinary levels of 5-hydroxyindoleacetic acid, and so carcinoid syndrome is rare with rectal carcinoid tumors, even in the presence of hepatic metastases. The probability of having metastases correlates with the size of the tumor: 60% to 80% with tumors >2 cm and <2% with tumors <1 cm. Therefore, small rectal carcinoid tumors usually can be successfully removed by simple excision, but tumors larger than 2 cm need more extensive surgery that may involve proctectomy. What insights have recent medical advances taught us for management of this particular patient? (1) The positive fecal occult blood test identified the fact that this patient had occult GI bleeding and prompted an evaluation during which the tumor was found; (2) EUS told us this lesion arose from the submucosa, therefore narrowing the differential diagnosis, and it also told us that the tumor involved the serosa, indicating that endoscopic ablation or resection likely would be complicated by perforation; (3) a CT scan revealed metastases indicating the need for chemotherapy; and (4) immunocytochemical staining with synaptophysin helped distinguish this tumor among the varied tumors that present with nests and cribriform patterns of cells, although this staining certainly, by itself, does not make a specific diagnosis. No, we still need to be physicians and clinicians and need to know pathology. I like the Chinese proverb that describes progress: “Be not afraid of going slowly, only of standing still.” Well, we are not standing still, but we do have a long way to go. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2010
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 71 - N° 3
P. 619-620 - mars 2010 Retour au numéro
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