January - March 2018, Volume 14, Issue 1

Zlate AC, Alexandrescu ST, Grigorie RT, Gramaticu IM, Kraft A, Dumitru R, Tomescu D, Popescu I

The Role of Surgery in a Patient with Carcinoid Syndrome, Complicated by Carcinoid Heart Disease

Acta Endo (Buc) 2018, 14 (1): 117-121
doi: 10.4183/aeb.2018.117

A 55-year-old female patient was admitted for flushing and abdominal pain in the right upper quadrant. Her past medical history revealed high blood pressure and a recent echocardiography showed thickened appearance of tricuspid valve with coaptation defect and grade II tricuspid regurgitation. Contrast enhanced abdominal CT scan and MRI were subsequently performed and revealed a large macronodular liver mass, as well as other micronodular lesions disseminated in the liver parenchyma. CT guided biopsy from the main liver mass revealed neuroendocrine tumor of unknown origin (probably GI) with Ki-67 of 8%. Surgical exploration was decided. During laparotomy, the primary tumor was found in the proximal ileum and the patient underwent segmental enterectomy. Non-anatomical hepatectomy was also performed to remove the bulk of the tumor burden (more than 90%). Postoperative course was uneventful and the carcinoid syndrome relieved. At present, 15 months postoperatively, the patient is under treatment with somatostatin analogue for its antiproliferative effect, with good clinical, biochemical and tumoral control and stable heart disease. In patients with neuroendocrine liver metastases from unknown primary, surgical exploration could allow detection (and resection) of the primary tumor and surgical debulking of liver metastases to control carcinoid syndrome and carcinoid heart disease.

Keywords: neuroendocrine tumor, carcinoid heart disease, carcinoid syndrome, liver metastasis, cytoreductive surgery.

Correspondence: Sorin Tiberiu Alexandrescu MD, Fundeni Clinical Hospital, “Dan Setlacec” Centre Of General Surgery And Liver Transplantation, 258 Fundeni Rd, 2nd District, Building A, 3rd floor, Bucharest, 022528, Romania, E-mail: stalexandrescu@yahoo.com