October - December 2008, Volume 4, Issue 4

Pais R, Dadoun F, Zota MB, Agoston-Coldea L, Ta?eb D, Barthet M, Dutour-Meyer A, Dumitrascu D

Diagnostic and therapeutic approach to small bowel carcinoid tumor. Case report

Acta Endo (Buc) 2008, 4 (4): 447-453
doi: 10.4183/aeb.2008.447

Detecting the primary tumours in carcinoid malignancies is a critical challenge. We report the case of a 25 year old male patient with a typical clinical carcinoid syndrome. Metastatic carcinoid malignancy was easily diagnosed by very high plasma chromogranin, plasma serotonin and urinary 5-Hydroxy-Indol Acetic Acid levels, and the detection of multiple liver metastases by ultrasound. Somatostatin receptor scintigraphy (SRS) failed to detect the primary lesion, as did upper and lower gastrointestinal (GI) tract endoscopy, bronchoscopy, total body CT, MRI, and GI video tract endoscopy; only F-DOPA PET-scan ascertained and accurately localized the primary ileal tumor. Surgery confirmed the localisation, and pathology revealed a 3 cm highly differentiated carcinoid tumor with low proliferation grade (Ki67<2). The therapy with short and long acting somatostatin analogues was started before surgery and continued after surgical intervention. There was a regression of the clinical carcinoid syndrome and a numerical involution of liver metastases, but the levels of chromogranin A and serotonin remained elevated. Other therapeutical option should be discussed.

Keywords: carcinoid tumors, chromogranin A, somatostatin receptors, F-DOPA PET scan, Small bowel scintigraphy

Correspondence: D. Dumitrascu, MD, 2nd Dpt. of Internal Medicine, &#8220;Iuliu Hatieganu&#8221; University of Medicine and Pharmacy, 4 Clinicilor Str. 400 003 Cluj-Napoca, Romania, Tel +40-722 756475 fax/tel +40 264 593355 Email: dan_dumitrascu@yahoo.de