• Small intestinal carcinoid: The most common presentation of this disease is the abdominal pain caused by fibrosis of the mesentery, or intestinal obstruction.
• Ectopic adenocorticotropic hormone (ACTH) and Cushing’s disease: These symptoms are observed in foregut carcinoid tumors and must be differentiated with that observed in other tumors. Carcinoid tumors can cause rare acromegaly, which must be differentiated from pituitary tumors.
• Carcinoid crisis: The symptoms such as intense flushing, diarrhea, tachycardia, hyper- or hypotension can happen spontaneously in carcinoid tumors or as a response to chemotherapy or anesthesia.
• Cutaneous flushing: In 94% of the cases, the symptom of carcinoid tumors is cutaneous flushing, which affects the head and neck. Some of the triggers of the flushing are exercise, stress and some food.
• Most of the patients with carcinoid tumor suffer from diarrhea and malabsorption. In these patients, the stool is frothy, watery and bulky.
• Asthma-like syndrome or wheezing is caused by the constriction of the bronchi. There are some tremors which are relatively indolent resulting in chronic symptoms such as cough and shortness of breath.
• Valvular heart lesions, fibrosis of endocardium on the right side is observed in such patients, though pulmonic valve fibrosis is relatively uncommon. Lesion on the cardiac tissues can cause heart failure.
• Often carcinoid tumors occur in association with the genetic disorders such as multiple endocrine neoplasia type I and Peutz-Jeghers syndrome.
• In carcinoid tumor, multicentric tumors in more than one organ have been reported [1] [4].

• Asymptomatic

  Most carcinoids are asymptomatic because most of the hormones they produce are metabolized by the first-pass effect in the liver. [amboss.com]

  In most cases, MD is asymptomatic and the estimated average complication risk of MD carriers, which is inversely proportional to age, ranges between 2% and 4%. [ncbi.nlm.nih.gov]

  They are often asymptomatic, especially those found in the pancreas. [lecturio.com]

• Weight Loss

  Clinical features WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria) Weight loss Abdominal pain, nausea, vomiting Achlorhydria → ↓ iron and B12 absorption → anemia Diagnosis ↑ Serum VIP concentration (> 75 pg/mL) Hypokalemia, hypercalcemia, hyperglycemia [amboss.com]

  Signs and symptoms of GI carcinoid tumors in the jejunum and ileum may include: Abdominal pain Weight loss for no known reason Feeling very tired Feeling bloated Diarrhea Nausea Vomiting Colon Signs and symptoms of GI carcinoid tumors in the colon may [cancer.osu.edu]

  We hereby report a case of a very rare presentation of tuberculosis (TB) in a patient who presented with a dry cough and significant weight loss for 3 months. [ncbi.nlm.nih.gov]

  This can cause diarrhea and weight loss. [cancer.org]

  Typically, carcinoid tumors of the colon present in the sixth to seventh decade of life during evaluation for anorexia, abdominal pain, and unintentional weight loss. [endocrinediseases.org]

• Pathologist

  The first neuroendocrine tumor was recognized by a German pathologist by the name of Siegfried Oberndorfer, who in 1907 coined the term "carcinoid" or "carcimona-like", recognizing the relatively low malignant features of this unusual tumor. [endocrinediseases.org]

  The term carcinoid (Karzinoide) was coined by German pathologist Oberndorfer in 1907. Primary testicular carcinoid tumors (TCT) are rare, constituting 0.23% of all testicular tumors. [ncbi.nlm.nih.gov]

  A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. [dovemed.com]

  […] of the observation.Instead of viewing the case as an instance of a primary hepatoma with a 5-year survival, we should like to suggest that this might have been an instance of a malignant carcinoid of the liver.In our own experience, and that of our pathologist [jamanetwork.com]

• Inflammation

  In the Meckel's diverticulum, ectopic tissue or neoplasms are sometimes found, which may lead to intussusception, hemorrhage, or inflammation. [pure.au.dk]

  Mediastinoscopy and biopsy of these mediastinal lymph nodes showed caseating chronic granulomatous inflammation consistent with TB, which changed the diagnosis to EBTB. [ncbi.nlm.nih.gov]

  Esophagitis is an inflammation of the lining of the esophagus, the tube that carries food from the throat to the stomach. [webmd.com]

  Inflamm Bowel Dis 2007; 13:1129–1134. © 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, [journals.lww.com]

  A complication of GERD is chronic inflammation and tissue damage in the esophagus. Eosinophilic esophagitis Eosinophils (e-o-SIN-o-fils) are white blood cells that play a key role in allergic reactions. [mayoclinic.org]

• Pallor

  On examination, she was well nourished with stable vital signs, and no pallor, jaundice, or significant lymphadenopathy. Abdominal examination revealed no tenderness, organomegaly, or abnormal mass. [wjso.biomedcentral.com]

  Striking color changes range from pallor or erythema to cyanosis. Episodes are often associated with an unpleasant warm feeling, itching, palpitation, upper-body erythema and edema, salivation, diaphoresis, lacrimation, and diarrhea. [emedicine.medscape.com]

• Cough

  Central neoplasms usually give symptoms due to bronchial obstruction (such symptoms can include pneumonia, atelectasis, bronchiectasis, emphysema or even a lung abscess); if airway obstruction is partial, symptoms such as cough, wheezing and recurrent [radiopaedia.org]

  We hereby report a case of a very rare presentation of tuberculosis (TB) in a patient who presented with a dry cough and significant weight loss for 3 months. [ncbi.nlm.nih.gov]

  When symptoms are present, usually there is coughing or wheezing. The cough might produce blood in the phlegm or sputum. If the tumor is large enough to block an air passage, a person might develop an infection called post-obstructive pneumonia. [my.clevelandclinic.org]

  Coughing up blood Wheezing Difficulty breathing Skin flushing, where the skin on the face and upper chest turns pinkish, red, or purple, and feels hot Causes of Carcinoid Tumors As with many cancers, it is unclear exactly what causes carcinoid tumors [bmc.org]

• Pneumonia

  Case report We present a 19-year old male with retro-obstructive pneumonia from a tumor in the right mainstem bronchus. Bronchoscopy showed an obstructive mass confirmed as being a typical carcinoid on biopsy. [ncbi.nlm.nih.gov]

  Central neoplasms usually give symptoms due to bronchial obstruction (such symptoms can include pneumonia, atelectasis, bronchiectasis, emphysema or even a lung abscess); if airway obstruction is partial, symptoms such as cough, wheezing and recurrent [radiopaedia.org]

  […] and neck — 84 percent Diarrhea — 70 percent Heart disease (sudden increase in heart rate and blood pressure) — 3 percent Wheezing — 17 percent Skin changes — 5 percent Depending on the tumor's location, symptoms may also include: Abdominal pain Anemia Pneumonia [upmc.com]

• Dyspnea

  Carcinoid syndrome – characterized by diarrhea, flushing, dyspnea, and wheezing – may occur if a serotonin-producing tumor has metastasized to the liver, bypassing first-pass metabolism. Elevated 5-HIAA in the urine helps to establish the diagnosis. [amboss.com]

  We describe the case of a female patient, 21 years old, complaining of dyspnea attacks and wheezing 2 years ago. Chest radiography showed volume loss in the left lower lobe and ipsilateral retrocardiac triangular basal opacity. [ncbi.nlm.nih.gov]

  Here we report a case of a 79-year-old man who presented with increasing dyspnea and was found to have a septal implantation of a carcinoid tumor. A 79-year-old man with no previous history of cancer presented with exertional dyspnea and cyanosis. [annalsthoracicsurgery.org]

  […] prostaglandins) from a functional neuroendocrine tumor (particularly from the midgut), typically manifesting with increased bowel movements and diarrhea, episodic vasoactive flushes (particularly of the face), hypotension, tachycardia, venous telangiectasia, dyspnea [orpha.net]

• Diarrhea

  In a patient presenting with secretory diarrhea, episodic flushing, wheezing, and cardiac valvular abnormalities, consider a carcinoid tumor! [amboss.com]

  Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms. Carcinoid heart disease. [mayoclinic.org]

  The syndrome causes flushing of the face and upper chest, diarrhea, and trouble breathing. Surgery is the main treatment for carcinoid tumors. If they haven't spread to other parts of the body, surgery can cure the cancer. [nlm.nih.gov]

  These factors cause clinical syndromes characterized by flushing and diarrhea (gastrointestinal) or wheezing and right heart effects (bronchopulmonary). Carcinoid syndromes usually do not occur until tumors metastasize to the liver. [arupconsult.com]

• Abdominal Pain

  References:[3][4][5][1][6][7] Clinical features Asymptomatic Abdominal pain Carcinoid syndrome Diarrhea and abdominal cramps Cutaneous flushing Possible triggers: alcohol consumption, food intake, stress In severe cases, may be accompanied by tachycardia [amboss.com]

  […] include the following: Abdominal pain Weight loss for no known reason Rectum Signs and symptoms of GI carcinoid tumors in the rectum may include: Blood in the stool Pain in the rectum Constipation Carcinoid Syndrome Carcinoid syndrome occurs when gastrointestinal [cancer.osu.edu]

  […] gastrointestinal tract carcinoid can present as vague abdominal pain carcinoid syndrome: in 8% of patients with a carcinoid tumor 9 Location gastrointestinal tract carcinoid (60-85% of all carcinoids) 11,12 small bowel: ~40% of gastrointestinal carcinoids [radiopaedia.org]

  Materials and methods: A 39-year-old white woman presented after incidentally palpating an abdominal mass. She refered abdominal pain on her right iliac fossa. No relevant personal history. [enets.org]

  A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. [ncbi.nlm.nih.gov]

• Constipation

  The patient complained of diarrhea instead of constipation soon after the surgery. [ncbi.nlm.nih.gov]

  Signs and symptoms of GI carcinoid tumors in the duodenum may include: Abdominal pain Constipation Diarrhea Change in stool color Nausea Vomiting Jaundice (yellowing of the skin and whites of the eyes) Heartburn Jejunum The jejunum is the middle part [cancer.osu.edu]

  Patients who do have symptoms typically present with rectal pain, bleeding, or constipation. [endocrinediseases.org]

  Symptoms: Anxiety, Constipation, Diarrhea, Dizziness, Dry Mouth, Fatigue, Headache, Itchy/Dry Skin, Mouth Sores, Nausea, Numbness, Shortage of Breath, etc. [play.google.com]

  Her intermittent mild flushing, constipation and diarrhea were unchanged postoperatively, suggesting that the carcinoid tumor was not the cause of her gastrointestinal symptoms or subjective flushing. [healio.com]

• Chronic Diarrhea

  This may be counterintuitive as the body loses bicarbonate during diarrhea, but if the diarrhea is chronic there are other mechanisms in the body. [lecturio.com]

  Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms. Carcinoid heart disease. [mayoclinic.org]

  Given the chronic diarrhea and the mesenteric mass, carcinoid syndrome was suspected. [karger.com]

  Complications Carcinoid tumors secrete chemicals which can lead to complications such as carcinoid syndrome (skin flushing, chronic diarrhea, problems in breathing), carcinoid heart disease (leaky heart valves, and heart failure) and Cushing syndrome. [symptoma.com]

• Steatorrhea

  Of the possible mechanisms for steatorrhea in this patient, the effect on the intestine of circulating 5-hydroxytryptamine is considered most likely. [amjmed.com]

  Following the procedure, through 1996, he kept suffering from abdominal pain, chronic diarrhea, steatorrhea, tearing, and mild flush (carcinoid-like syndrome). He also developed cholelithiasis, skin pigmentation and exophthalmos. [scielo.isciii.es]

  The NETs of the duodenal ampulla rarely cause functional syndrome associated with the over production of somatostatin, which can trigger diabetes mellitus, gallstones and steatorrhea; in this condition, the NET is named as somatostatinoma [ 11, 23, 24 [pancreas.imedpub.com]

  Stools are watery, frothy, bulky, or in the form of steatorrhea. Diarrhea may or may not be associated with abdominal pain, flushing, and cramps. It may be profuse and often colicky. [emedicine.medscape.com]

• Heart Failure

  The patient was evaluated for valve replacement surgery, but surgery was not performed due to the degree of heart failure. [ncbi.nlm.nih.gov]

  Heart failure management General measures for the treatment of heart failure include salt and water restriction, and monitoring of fluid balance and weight. [doi.org]

  Early recognition and surgical valve replacement before advanced heart failure is established may improve the clinical outcome. [hungary.pure.elsevier.com]

• Tachycardia

  References:[3][4][5][1][6][7] Clinical features Asymptomatic Abdominal pain Carcinoid syndrome Diarrhea and abdominal cramps Cutaneous flushing Possible triggers: alcohol consumption, food intake, stress In severe cases, may be accompanied by tachycardia [amboss.com]

  관련질환명 카테콜라민-유도성 다형성 심실성 빈맥(Catecholamine-Induced Polymorphic Ventricular Tachycardia, CPVT),가족성 다형성 심실성 빈맥(Familial Polymorphic Ventricular Tachycardia, FPVT), 영향부위 체내 : 심장 증상 운동 또는 감정 유발성 실신, 심실 부정맥, 돌연사 원인 RYR2(상염색체 우성유전), CASQ2(상염색체 열성유전), TRDN(상염색체 [carerare.kr]

  […] polypeptides, vasoactive amines, and prostaglandins) from a functional neuroendocrine tumor (particularly from the midgut), typically manifesting with increased bowel movements and diarrhea, episodic vasoactive flushes (particularly of the face), hypotension, tachycardia [orpha.net]

  It is characterized by the sudden onset of prolonged cutaneous flushing, peripheral cyanosis, confusion, dyspnea, and tachycardia. [visualdx.com]

  Bronchospasm, wheezing, tachycardia and hypotension are less common. Up to 50% of patients with carcinoid syndrome develop carcinoid heart disease. [healio.com]

• Hypertension

  Intraoperative handling of tumor Histamine releasing drugs (probably should be avoided in patients with carcinoid tumors, although these drugs have been used frequently in the past without complications) Diagnosis Severe hypotension/hypertension Flushing [openanesthesia.org]

  Serotonin, for example, can lead to tachycardia and hypertensive crisis refractory to conventional treatment. DIAGNOSIS Basic screening with a 12 lead ECG and chest x ray is of limited value. [doi.org]

  This condition may be triggered by stress, chemotherapy, anesthesia, hypothermia, or hypertension, and may even occur without any apparent triggers. [visualdx.com]

  […] for PDX1 (duodenal homeobox factor 1, Am J Surg Pathol 2009;33:626 ) Rarely PAP Electron microscopy description Well formed, membrane bound, dense core secretory granules with dense (osmophilic) cores Board review question #1 A 58 year old man with hypertension [pathologyoutlines.com]

  Foreign body obstruction Pulmonary edema Diarrhea Infections Viral Bacterial Parasitic Autoimmune bowel disease Inflammatory bowel disease Celiac disease Laxative abuse Heart valve disease Rheumatic heart diseases Endocarditis Cardiomyopathy Pulmonary hypertension [arupconsult.com]

• Hypotension

  Nevertheless, the primary treatment for hypotension in patients with carcinoid syndrome should be IV fluids, ocreotide, and phenylephrine (if necessary). [openanesthesia.org]

  Calls for shortness of breath, wheezing, hypotension, profound flushing, or confusion should prompt urgent bedside evaluation as these symptoms may reflect carcinoid crisis. [cancertherapyadvisor.com]

  Bronchospasm, wheezing, tachycardia and hypotension are less common. Up to 50% of patients with carcinoid syndrome develop carcinoid heart disease. [healio.com]

  […] including polypeptides, vasoactive amines, and prostaglandins) from a functional neuroendocrine tumor (particularly from the midgut), typically manifesting with increased bowel movements and diarrhea, episodic vasoactive flushes (particularly of the face), hypotension [orpha.net]

• Palpitations

  […] cramps Cutaneous flushing Possible triggers: alcohol consumption, food intake, stress In severe cases, may be accompanied by tachycardia and fluctuating blood pressure Dyspnea, wheezing (asthma-like attacks) Possible weight loss despite normal appetite Palpitations [amboss.com]

  […] appendectomy Rectum – 1.5 cm abdominoperineal resection Chemoembolization of liver lesions Anesthetic Considerations History Some develop right heart problems due to tricuspid stenosis from serotonin action Other common problems – Asthma, wheezing, palpitations [openanesthesia.org]

  People with carcinoid syndrome may experience: Facial flushing (heat and redness) Diarrhea Intestinal pain and cramping Asthma and wheezing Heart palpitations In order to diagnose your condition, your doctor will review your medical history and perform [mainlinehealth.org]

  Carcinoid syndrome comprises the presence of cutaneous flushing, diarrhea, abdominal pain, wheezing, and palpitations. It is usually seen in the setting of an ileal tumor that has metastasized to the liver. Lung carcinoid may also be responsible. [visualdx.com]

  These symptoms may include: Palpitations ("racing heart") Sweating Flushing (turning red in the face) Diarrhea High blood pressure How are neuroendocrine/carcinoid tumors diagnosed? When you see your physician, you will have a routine examination. [hopkinsmedicine.org]

• Lacrimation

  Imaging studies revealed a large left intraocular tumor, a mass in the left medial rectus muscle, and right lacrimal gland enlargement. The OS was enucleated, and incisional biopsies were performed from the other 2 lesions. [ncbi.nlm.nih.gov]

  Episodes are often associated with an unpleasant warm feeling, itching, palpitation, upper-body erythema and edema, salivation, diaphoresis, lacrimation, and diarrhea. [emedicine.medscape.com]

  Lancet 352 : 799 – 805 32 1982 Metastatic carcinoid unresponsive to radiation therapy presenting as a lacrimal fossa mass. Ophthalmology 89 : 516 – 520 33 1980 Orbital carcinoid tumor metastatic from the colon. [academic.oup.com]

• Arthritis

  He endorsed a 40-pound unintentional weight loss over 2 years and use of NSAIDs for arthritis, but was unable to quantify NSAID use. [karger.com]

  […] chromogranin A levels include the following: chronic atrophic gastritis, liver cirrhosis, chronic hepatitis, pancreatitis, inflammatory bowel disease, heart failure, renal failure, hyperthyroidism, chronic obstructive pulmonary disease (COPD), and rheumatoid arthritis [cancertherapyadvisor.com]

  Skin hyperkeratosis and pigmentation and arthritis are also relatively uncommon. [emedicine.medscape.com]

  Bad news — degenerative disk disease and arthritis. Also, met with oncologist University of Colorado Cancer Center for a second opinion. [cyrilfb.com]

• Flushing

  In a patient presenting with secretory diarrhea, episodic flushing, wheezing, and cardiac valvular abnormalities, consider a carcinoid tumor! [amboss.com]

  Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhea, and difficulty breathing, among other signs and symptoms. Carcinoid heart disease. [mayoclinic.org]

  Cutaneous flushing: In 94% of the cases, the symptom of carcinoid tumors is cutaneous flushing, which affects the head and neck. Some of the triggers of the flushing are exercise, stress and some food. [symptoma.com]

  The syndrome causes flushing of the face and upper chest, diarrhea, and trouble breathing. Surgery is the main treatment for carcinoid tumors. If they haven't spread to other parts of the body, surgery can cure the cancer. [nlm.nih.gov]

• Erythema

  Her physical examination revealed no erythema or swelling of the right shoulder. However, tenderness was noted on the right subacromial bursa and the right acromioclavicular joint. Her drop arm test was positive. [ncbi.nlm.nih.gov]

  According to Wang et al. diagnosis is based on the histopathology when there are no carcinoid symptoms or signs of metastasis [14]. 10% of carcinoid syndrome cases may metastasize to liver or lungs and manifest by erythema on upper torso and face due [hindawi.com]

  With endoscopy, local erythema, edema, white patches, and ulcerations can all be seen. Typically, the distal third of the esophagus is most often affected. Biopsy results reveal mucosal invasion of yeast and pseudohyphae. [cancertherapyadvisor.com]

  Striking color changes range from pallor or erythema to cyanosis. Episodes are often associated with an unpleasant warm feeling, itching, palpitation, upper-body erythema and edema, salivation, diaphoresis, lacrimation, and diarrhea. [emedicine.medscape.com]

• Pruritus

  The treatment depends on its dimensions, presence of metastatic disease and parietal invasion.This article presents a case of a patient of 43 years old with anal pruritus for the last 18 months. [scielo.br]

  Case report We report the case of a 19 years-old woman with history of pruritus, jaundice, weight loss, and anorexia. Physical examination revealed only mild scleral jaundice. [scielo.isciii.es]

  In January 1998, he presented with flushing, pruritus, and watery diarrhea. [bcmj.org]

• Hyperkeratosis

  Skin hyperkeratosis and pigmentation and arthritis are also relatively uncommon. [emedicine.medscape.com]

• Hyperpigmentation

  Thymic carcinoid with cutaneous hyperpigmentation. Arch Intern Med 1985; 145 : 361–363. 32. Lokich JJ, Li F. Carcinoid of the thymus with hereditary hyperparathyroidism. Ann Intern Med 1978; 89 : 364–365. 33. Loon G, Schiby G, Milo S. [nature.com]

• Facial Redness

  redness, abdominal pain and diarrhea). [ncbi.nlm.nih.gov]

• Sexual Dysfunction

  After evaluation of side effects, the patient underwent several medication changes until he was stable with minimal side effects and no reports of sexual dysfunction on a regimen of 10 mg/day of escitalopram and 1 mg of clonazepam twice daily. [healio.com]

• Confusion

  It is characterized by the sudden onset of prolonged cutaneous flushing, peripheral cyanosis, confusion, dyspnea, and tachycardia. [visualdx.com]

  A 65-year-old right-handed man was transferred to this hospital because of the recent onset of confusion and memory loss. MRI scans of the brain showed symmetric abnormalities involving the temporal lobes, left basal forebrain, and insular regions. [content.nejm.org]

  Article Figures/Media A 65-year-old right-handed man was transferred to this hospital because of the recent onset of confusion and memory loss. [doi.org]

  Unfortunately, infectious and inflammatory conditions can also cause increased activity and this may be confusing if the tumor has caused pneumonia and lymph nodes that are reactive to the infection may be misinterpreted as showing evidence of metastasis [endocrinediseases.org]

• Altered Mental Status

  Symptoms may include intense flushing, diarrhea, abdominal pain, tachycardia, hypertension or hypotension, altered mental status, and coma. [emedicine.medscape.com]

Laboratory studies

Diagnosis of carcinoid tumors depends on the characteristic biomarker of the disease. Measuring the biogenic amine (such as serotonin, histamine, and catecholamines) levels as well their metabolites in the plasma is important to diagnose the carcinoid tumor.

• Urinary 5-HIAA levels: The increased levels of 5-HIAA in the urine helps in the assessment of carcinoid tumors. These levels, though, may not help in the detection of tumors at the early stage.
• Fasting plasma 5-HIAA assay: This is a more stable and convenient test.
• CDX2 and TTF-1 are indicative of the GI carcinoid tumors and pulmonary tumors respectively.

Imaging

Imaging techniques that can diagnose carcinoid tumors are as follows:

• Upper and lower gastrointestinal tract radiography
• CT
• MRI
• MIBG (metaiodobenzylguanidine) scan
• PET

Depending on the type and location of the tumor, a combination of either of these can be used. For chest tumors, CT along with scintigraphy is used. Large bowel disease is often diagnosed by colonoscopy. Mesenteric invasion and liver metastasis can be detected by CT scans. For hepatic disease, MRI can be helpful in the diagnosis of the condition. PET scanning is helpful for the diagnosis and follow-up of the tumors. Radionuclide imaging has proven to be the best diagnostic tool for the diagnosis of carcinoid tumors. Somatostatin-receptor scintigraphy (SRS) and CT scanning can help detect localized tumors [1] [5] [6].

• Atelectasis

  Associated airway compression with pulmonary atelectasis may be also seen in some cases. [radiopaedia.org]

  CT scan showed an extensive solid mass with apex protruding into the left main and lower lobar bronchi, causing distal atelectasis. [ncbi.nlm.nih.gov]

  A chest computed tomography showed an atelectasis of the middle lobe (Fig. 1b) and at bronchoscopic examination an endobronchial lesion obliterating the lumen of the middle lobe and infiltrating the intermedius was found. [academic.oup.com]

  Figure 4: CXR showing lobulated carcinoid mass in right lung Figure 5: CT scan showing compressed lung or atelectasis beyond obstruction from bronchial carcinoid The plain chest x-ray (CXR) may reveal atelectasis or collapse of a segment of the lung beyond [endocrinediseases.org]

• Chest X-Ray Abnormal

  Lesions on the lung is a generic term used to describe a finding on a test (in this case your chest x-ray) which is abnormal. [zocdoc.com]

• Hypoglycemia

  The patient’s daughter presented with hypoglycemia due to an insulinoma in 1982 at age 11. In 1983, she had 85% of her pancreas removed. Post-operatively, she continued to have episodes of hypoglycemia. [bcmj.org]

  The clinical features of this tumor are related to the effects of insulin-and thus primarily demonstrate symptoms related to hypoglycemia which are relieved by food intake. [pancreatica.org]

  Furrer J, Hattenschwiler A, Komminoth P et al. (2001) Carcinoid syndrome, acromegaly, and hypoglycemia due to an insulin-secreting neuroendocrine tumor of the liver. J Clin Endocrinol Metab 86: 2227–2230 PubMed CrossRef 15. [springermedizin.de]

Medical care: In case where the surgical excision is not suitable in patients with carcinoid tumor, the following chemotherapy drugs are recommended. Alkylating agents, doxorubicin, actinomycin D, cisplatin, interferon-alfa and streptozocin are some of the drugs that are used to manage the condition. In most of the cases, a combination of the agents is used.

Chemoembolization is one of the strategies for the management of carcinoid tumors. Though octreotide has been found to be very effective in reducing the symptoms, its use in pediatric population is still debated, as it reduces the level of growth factor which is produced impairing growth [7] [8].

Surgical care: The surgical excision as a treatment choice depends on the feasibility of the condition. Surgical technique depends on the location and the stage of the tumor. Simple appendectomy is the treatment option in most of the cases.

Block resection of the tumor (with the adjacent lymph nodes) is a surgical treatment adopted for intestinal carcinoids, while in case of bronchial tumor, surgical resection is opted. In most of the localized tumor, surgical resection works. For managing rectal tumor, endoscopic resection is sufficient. Debulking can provide symptomatic relief in patients when total resection is not possible [9] [10] [11].

Prognosis in the patients with carcinoid tumors depends on some important factors such as the location and size of the tumor, if the tumor has spread to other parts of the body, or if the tumor can be removed completely by surgery or if it recurred or was diagnosed for the first time.

Complications

Carcinoid tumors secrete chemicals which can lead to complications such as carcinoid syndrome (skin flushing, chronic diarrhea, problems in breathing), carcinoid heart disease (leaky heart valves, and heart failure) and Cushing syndrome.

Though the etiology of the carcinoid tumor is not known, genetic abnormalities are often suspected. Changes in the chromosomal abnormalities can be defined as the loss of heterogeneity or numerical alterations of the chromosomes [1].

Carcinoids are the most common neuroendocrine tumors. The true incidence of this type of tumor is still not clear. Though it is estimated to be around 1 every 100,000 individuals, there are some studies that have shown necropsies in approximately 1% of the population [2].

The carcinoid tumors are of neuroendocrine origin. These tumors are derived from the primitive stem cells, giving rise to the multiple cell lineages. These tumors develop in the mucosa of the intestinal tract and grow slowly, extending to the submucosa and mucosal surface, resulting in the formation of small nodules.

The tumors are yellow, or gray-brown in color, due to the accumulation of cholesterol and lipids. Metastases can also occur in the liver, spleen, peritoneum, liver and the ovaries. Five distinct patterns of the carcinoid tumors are observed upon histological examination.

Some of the products of the carcinoid tumors are amylin, dopamine, gastrin, bombesin, catecholamines, motilin, pancreatic polypeptide, prostaglandins, serotonin, somatostatin and substance-P. The carcinoid tumors are found to be argyrophilic and argentaffinic, with somatostatin receptors. There is a high potential for metastasis in carcinoid tumors as these cells produce betacatenin [1] [3].

Though carcinoid tumor has a genetic component, the risk of such tumors can reduce by taking some of the steps:

• Maintaining a healthy bodyweight 
• Regular exercises
• Annual screening of such tumors
• Quit smoking

Carcinoid tumors are derived from primitive stem cells, present in the gut wall, and other organs such as thymus, lungs, liver, ovaries, prostate and kidneys. Among children, carcinoid tumors are seen in the appendix which are benign and asymptomatic.

Most of these tumors are slow-growing and asymptomatic, though some are aggressive and metastatic. Carcinoid tumors can be classified based on the location of the primitive gut giving rise to the tumor such as foregut, midgut and hindgut.

Meckel diverticulum, mesentry and cystic duplications can also lead to the development of carcinoid tumors. These entities have shown distinctive features: clinical, histochemical, and secretory. While both foregut and hindgut carcinoids are argentaffin negative, the midgut carcinoids are argentaffin positive. Foregut tumors can metastasize to the bone and can be associated with acromegaly, Cushing’s disease, and hypertrophy of the skin of the face and the upper neck. In midgut and hindgut carcinoids, the bone metastasis is uncommon, though midgut carcinoid tumors have the rare potential to produce the corticotropic hormone [1].

Carcinoid tumors are derived from primitive stem cells, present in the gut wall, and other organs such as thymus, lungs, liver, ovaries, prostate and kidneys. There are no specific symptoms of the disease, however since there is a genetic component in the pathogenesis of the disease, any family member diagnosed earlier with carcinoid tumor adds to the risk of this disease in the sibling or children. Hence, in such cases, the patient must not neglect any possible signs and symptoms.

1. Maroun J, Kocha W, Kvols L, et al. Guidelines for the diagnosis and management of carcinoid tumors. Part 1: The gastrointestinal tract. A statement from a Canadian National Carcinoid Expert Group. Curr Oncol 2006 13 (2): 67–76.
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