Atypical pulmonary carcinoid tumor with abnormal elevation of serum gastrin-releasing peptide precursor: report of a case

We report a rare case of atypical pulmonary carcinoid tumor accompanied by elevation of serum gastrin-releasing peptide precursor (ProGRP). A 55-year-old male presented to our hospital with a history of bloody sputum. The level of serum ProGRP was elevated to 781 pg/ml (normal < 46 pg/ml). Chest computed tomography (CT) revealed a solitary pulmonary tumor in the left lower lobe with sub-carinal lymph node enlargement. Transbronchial lung biopsy showed a pulmonary carcinoid, therefore left lower lobectomy with mediastinal lymph node dissection was performed. ProGRP decreased to normal level 1 month after operation. Histopathological diagnosis showed an atypical pulmonary carcinoid tumor.     

Thymic carcinoid with lymph node metastases; report of a case

A 71-year-old man was admitted to our hospital because of the detection of an anterior mediastinal tumor. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal accumulations in the tumor and the hilar and the supra-clavicular lymph nodes. Preoperatively, percutaneous needle biopsy of the tumor revealed thymic carcinoid. Tumor resection and thymectomy with mediastinal and supra-clavicular lymph nodes dissection were performed because of suspecting metastasis to the lymph nodes from FDG-PET. Postoperative pathological diagnosis revealed atypical carcinoid and metastases to the mediastinal and supra-clavicular lymph nodes. In our case, FDG-PET was useful in detecting the thymic carcinoid and lymph node metastasis. It is desirable to perform clinical research by many facilities for the assessment of FDG-PET as a diagnostic tool and postoperative chemo-radiation therapy for thymic carcinoid.     

Thymic carcinoid—A case report and review of the literature

We report herein a case of a patient with thymic carcinoid who was operated on twice and has been followed for 9 years. In 1979, the original tumor was removed through an emergency left thoracotomy incision done for a hemothorax caused by an anterior mediastinal biopsy. Tumor recurrence was found 6 years later and removal carried out through a median sternotomy. The patient has been working and enjoying life following radiation and chemotherapy for a total of 9 years after his first operation. Recurrent thymic carcinoid has been thought to carry a poor prognosis, but this successfully treated case has been followed up for a long time after the removal of his recurrent tumor. We present this case and discuss other such cases reported in the Japanese literature.     

Severe secretory diarrhea with elevated gastrin-releasing peptide controlled by somatostatin analogue: a case report

Gastrin-releasing peptide immunoreactivity has been seen in functioning endocrine tumours which are recognized as a major cause of secretory diarrhea. The authors describe a case of a 52-year-old woman who had secretory diarrhea (5 L/d) with markedly elevated gastrin-releasing peptide levels associated with islet cell hyperplasia. No tumour could be identified. The diarrhea was controlled by somatostatin analogue.     

Gastleman病合并血小板升高1例

患者　女 ,14岁。因面色苍白伴低热、心悸、气促 2年余 ,乏力 1年于 2 0 0 0年 5月 17日入院。曾住院 ,按“贫血”治疗 ,停药后上述症状加重。体检 :脉搏 12 0次 /ｍｉｎ ,血压 95 / 6 5ｍｍＨｇ。贫血貌。颈部两侧均可触及肿大淋巴结 ,质软 ,无压痛 ,可活动。左下腹可触及一 4ｃｍ×4ｃｍ圆形包块 ,质韧 ,压痛 ,表面较光滑 ,左右活动度大。红细胞 2 72×10 12 /Ｌ ,血红蛋白 5 9ｇ/Ｌ ;白细胞 8 8×10 9/Ｌ ,中性 0 6 9;血小板 5 45× 10 9/Ｌ。血沉 132ｍｍ /ｈ。血清白蛋白2 3 9ｇ/Ｌ ,球蛋白 70 8ｇ/Ｌ。血清ＩｇＧ 31.9ｇ/Ｌ(正常值 …     

Gallbladder carcinoid: a case report

Carcinoids are neuroendocrine tumours that rarely originate in the biliary tract. We report a case of gallbladder carcinoid associated with cholelithiasis extending to hepatic segments IV and V. The mass was detected by ultrasound in a 71-year-old-man investigated for recurrent right upper quadrant pain irradiating to the back and associated with dyspepsia. Cholecystectomy, locoregional lymphadenectomy and 4th and 5th hepatic segment resection were performed. The patient underwent chemotherapy and was also treated with somatostatin analogues. Despite this, he died after 12 months. We stress the rarity and aggressive behaviour of gallbladder carcinoid.     

Management of a lung tumor accompanied by aortic dissection; report of a case

During an annual health check-up, a 75-year-old man was admitted to our hospital due to an abnormal shadow in the left upper lung field. A computed tomography (CT) scan taken at his 1st hospital visit showed a calcified nodule in the left upper lobe and Stanford type A aortic dissection. We could not perform bronchofiberscopy due to the risk associated with the aortic dissection and could not make a diagnosis prior to surgery. Because of the possibility of lung cancer, surgery for the lung tumor and aortic dissection was performed. The pathological diagnosis of the lung tumor was a hematoma. In a case of suspicion of lung cancer along with cardiovascular disease, a surgical diagnosis might be considered.     

Metastatic thymic carcinoid: a case report

Thymic neuroendocrine carcinomas (carcinoid) are rare tumors. They have malignant potential, the capacity for distant metastasis, and often present with associated endocrinopathies. This report describes a patient who was diagnosed with thymic carcinoid and Cushing syndrome at age 19 that, despite complete surgical excision of his tumor, developed local recurrence with distant metastases to his brain, lungs, and bone. We discuss the evolution of this patient's illness as well as the therapies used in his care. Due to the nature of these tumors to recur both locally and distant, the importance of aggressive surgical management is emphasized. We also discuss the role of adjuvant therapy, which in our case consisted of chemotherapy, radiotherapy, and several new therapies including an antiangiogenesis agent and a tyrosine kinase inhibitor.     

Renal carcinoid tumor: a case report

A right renal tumor was incidentally found in a 38-year-old woman by annual medical check up. She visited our hospital for further examination and treatment. She did not show typical symptoms of carcinoid. A computed tomography (CT) revealed a calcified solid tumor in the upper portion of the right kidney. The tumor was 6.0 cm in diameter and was not enhanced in either early or late phase. There was no evidence of extrarenal invasion or distant metastasis. Based on a clinical diagnosis of stage 1 renal cell carcinoma, laparoscopic nephrectomy was performed. The pathological diagnosis was renal carcinoid tumor. The tumor had trabecular and ribbon-like structures with a thin fibrovascular stroma. Immunohistochemicaliy, the tumor cells stained positive for chromogranin A, synaptophisin and CD56. The cell proliferation rate was estimated to be under 1% with Ki67 staining. To find the primary lesion, we performed upper and lower gastric endoscopy and chest computed tomography, but could not find any/other carcinoid tumors. At 1-year follow up, she had no evidence of local recurrence or metastasis.     

Thymic large cell neuroendocrine carcinoma: report of a resected case - a case report

Thymic large cell neuroendocrine carcinomas (LCNECs) are very rare. We here describe a case in which the tumor could be completely resected. A 55-year-old male was admitted to our hospital for treatment of an anterior mediastinal tumor found at a regular health check-up. The patient underwent an extended thymectomy of an invasive thymoma of Masaoka's stage II that had been suspected preoperatively. The tumor was located in the right lobe of the thymus and was completely resected. Final pathological diagnosis of the surgical specimen was thymic LCNEC. The patient underwent adjuvant chemotherapy with irinotecan and cisplatin in accordance with the diagnosis of a lung LCNEC, and is alive without recurrence or metastasis 16 months after surgery.     

A case of typical carcinoid accompanied with left atrium myxoma

A 78-year-old female was admitted to Shizuoka red cross hospital because of an abnormal shadow at the right upper lung field on chest X-ray film. A left atrium myxoma was detected at chest CT scan after admission. Though the lung tumor was well defined and hilar and mediastinal lymph nodes were not swollen at CT scan, the tumor was suspected a small cell carcinoma at the result of trans-bronchoscopic biopsy. Firstly we performed removal of the left atrium myxoma, and two months later, we performed thoracotomy and partial resection of the right upper lobe. The lung tumor was finally diagnosed as a typical carcinoid. We have followed the patient for about 32 months after the operation and there is no evidence of tumor recurrence.     

Primary testicular carcinoid tumor: a case report

This report describes a primary testicular carcinoid. A 41-year-old male was hospitalized with an asymptomatic right testicular mass. A high inguinal orchiectomy was done after the diagnosis of the testicular tumor. Pathologically, the tumor showed the typical appearance of a carcinoid tumor. A computed tomographic scan and other studies could not demonstrate any metastasis elsewhere. He has remained well and without any evidence of recurrence.     

Iliopsoas abscess accompanied by epidural abscess--a case report

A 55-year-old man was admitted to a hospital with pain of the low back as well as the left leg, and fever. He was suspected of suffering from the lumbar disc herniation because of the presence of Lasegue's sign on the first physical examination. Abdominal computed tomography, however, revealed the swelling of the left iliopsoas muscle. Iliopsoas abscess accompanied epidural abscess was confirmed by subsequent magnetic resonance imaging (MRI). Antibiotic therapy was started for the successive 8 days. The fever resolved, but the pain persisted. The abscess extending from the iliopsoas muscle to the epidural space was still seen on the MRI 20 days after the completion of the antibiotic therapy, and he still complained of the pain of his low back and left leg. Therefore, we conducted epidural puncture under fluoroscopic guidance. Approximately 3 ml of pus was aspirated from the epidural space. Then, his complains decreased remarkably. Iliopsoas abscess should be taken into account in case of a patient with pain on the low back and leg and also inflammatory signs such as fever and leucocytosis.     

Transverse sinus thrombosis accompanied by intracerebellar hemorrhage: a case report

This case report deals with transverse sinus thrombosis accompanied by intracerebellar hemorrhage. A 33-year-old woman had sudden onset of headache, vomiting, and disturbance of consciousness. Computed Tomography (CT) scan showed left intracerebellar hematoma, while vertebral angiography revealed no visualization of the transverse sinus and cerebellar cortical veins on the left side. Evacuation of the intracerebellar hematoma along with decompression of the posterior fossa was carried out. Findings of the histopathological examination of the operation specimen showed the cortical veins to be filled with fresh thrombus and softened cerebellar parenchyma mixed with many small clots. Until now, cases such as hemorrhagic infarction in the cerebellum, due to transverse sinus thrombosis have not yet been reported. It is considered that there is much more collateral circulation in the infratentorial region rather than in the supratentorial region. This indicates that cerebellum hemorrhagic infarction rarely occurs due to transverse sinus thrombosis. In our case, the inflammation of the cortical veins (thrombophlebitis) was thought to have disturbed the collateral circulation in the cerebellum.     

Primary carcinoid of the testis: a case report

A 66-year-old male was hospitalized with right femur fracture and injury of the popliteal artery sustained in a traffic accident. The patient underwent external fixation and repair of popliteal artery. At operation, the orthopedists noticed a mass in the scrotum and requested our consultation. A right orchiectomy was done under the diagnosis of a testicular tumor. The tumor measured 9 x 6 x 5 cm in size. Histological diagnosis was pure carcinoid of the testis. Computerized tomography and other studies showed no tumorous lesions elsewhere. Symptoms of a carcinoid syndrome were not noted. No evidence of metastasis has been seen for 12 months after surgery.