GI Carcinoid Tumors - USarpel

GI Carcinoid Tumors - USarpel - CarcinoidTumors 10/6/04...

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Carcinoid Tumors 10/6/04 Umut Sarpel
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Case presentation 47M, asymptomatic PMHx: hypertriglyceridemia 1996: Incidental liver lesions seen on U/S
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Case presentation MRI: multiple liver lesions, largest >8cm no other masses seen Fine needle Bx: carcinoid tumor OctreoScan: activity in liver lesions, no other areas of activity Mild Sx: bloating, diarrhea
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Case presentation Unknown primary  1998: Small bowel series, EGD, colonoscopy -  no neoplasm Carcinoid crises: flushing, headaches, itching,  diarrhea, hypo/hypertension Sandostatin - short-acting and depot Systemic chemotherapy - Streptozotocin Chemoembolization x 3
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Case presentation Increasingly frequent and severe crises 2001: Capsule endoscopy to search for  primary tumor: lesion in jejunum CT: new mesenteric mass - tumor and  bulky nodes Referred for cytoreductive surgery
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Case presentation Operative findings: 2.5cm white, hard lesion in jejunum, grossly  invading through wall Similar lesion on adjacent mesentery with  bulky nodes Liver riddled w/ metastases
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Case presentation Small bowel resection including extensive  resection of adjacent mesentery, total resection  of 75cm small bowel Radiofrequency ablation x 2 Liver wedge biopsy Prophylactic cholecystectomy
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Pathology Multiple carcinoid tumors in small bowel Extensive serosal involvement / retraction Angiolymphatic invasion Margins negative for tumor 5 /11 lymph nodes positive for carcinoid Gall bladder with focus of carcinoid on  subserosal aspect Liver Bx: focal carcinoid tumor
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Introduction First described in 1888 Carcinoid = “Cancer-like” thought to be more indolent Most often diagnosed in 5th /6th decade 55% female
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Introduction Cell of origin: Kulchitsky cell, a  neuroendocrine cell found along the primitive GI tract Highly biologically active tumors Secretion of several hormonal mediators
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Introduction Incidence: reported as 3.8 per 100,000 Much higher rate at autopsy: 20-yr study at Mayo Clinic, small bowel only, found  97/14,852 (0.65%) 12-yr study in Sweden found 199/16,294 (1.2%) Maggard MA et al. Ann Surg 2004; 240:117-122.
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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GI Carcinoid Tumors - USarpel - CarcinoidTumors 10/6/04...

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