A case of atypical pulmonary carcinoid accompanying skin metastasis]

A 73-year-old woman underwent cranial surgery in 1999 after receiving a diagnosis of suspected malignant meningioma. She began complaining of headache 2 years postoperatively, and around the same time, she noticed a painful skin tumor. She was then transferred to our hospital for further evaluation. The skin tumor was diagnosed by skin biopsy as an atypical metastatic carcinoid tumor. Systemic examination demonstrated a primary lesion in the left lung. Pulmonary, skin and bone biopsy samples exhibited the same pathological findings as those of the atypical pulmonary carcinoid tumor. She did not show any carcinoid symptoms. EP therapy (etoposide + carboplatin) and CAV therapy (cyclophosphamide + doxorubicin + vincristin) were administered, but there was no clinical response. The patient is currently doing well without chemotherapy and is being followed by the Outpatient Department.     

A case of gastric carcinoid with type A gastritis]

A 40-year-old man was admitted to our hospital for treatment of gastric carcinoid of 7-mm in diameter associated with type A gastritis. Endoscopic mucosal resection was performed and histological examination revealed a gastric carcinoid with submucosal invasion (2500microm). Three months after the resection, the other carcinoid of 3-mm lesion was found, but no recurrence of resected portion. Neither local recurrence nor distant metastasis has been observed during 1-year follow-up period. These findings revealed that gastric carcinoid with type A gastritis, when smaller than 1-cm in diameter, could be cured with endoscopic procedure.     

Small rectal carcinoid with lymph node metastasis diagnosed prior to treatment

We treated a 59-year-old man with a small, yellowish, submucosal rectal tumour that was detected incidentally during a colonoscopic examination. Endoscopic ultrasonography revealed a hypoechoic submucosal tumour 13 mm in diameter. Computed tomography and magnetic resonance imaging studies were performed, and pararectal and para-obturator lymph node involvement was confirmed. The patient underwent Miles' operation with lymph node dissection; 24 months later, he is disease free. We were able to diagnose rectal carcinoid tumour and evaluate the lymph node metastasis prior to surgery. Even with a small carcinoid, it is important to determine the depth of invasion and the presence of lymph node metastasis prior to treatment.     

Living-related liver transplantation for multiple liver metastases from rectal carcinoid tumor： A case report

A 42-year-old woman was admitted to our hospital because of multiple liver tumors detected by ultrasono-graphy. Colonoscopy revealed submucosal tumor in the rectum, which was considered the primary lesion. Endo-scopic mucosal resection followed by histopathological examination revealed that the tumor was carcinoid. The resected margin of the tumor was positive for malignant cells. Two courses to transcatheter arterial chemotherapy for liver metastasis were ineffective. Accordingly, the rectal tumor and metastatic lymph nodes were surgically resected. One month after the operation, she received liver transplantation (left lateral segment and caudate lobe) from her son. No recurrent lesion has been observed at two years after the liver transplantation. Liver transplantation should be considered as a treatment option even in advanced case of carcinoid metastasis to the liver. We also discuss the literature on liver transplantation for metastatic carcinoid tumor.     

A case of cystic bronchial typical carcinoid]

A 53-year-old man was admitted with a nodular lesion on chest radiograph. Chest CT scan showed a cystic nodule in right S4 which gradually enlarged during follow-up without therapy. Two years after the first examination, we performed middle lobectomy using video assisted thoracoscopy. Histologically, the tumor was found to be typical carcinoid by immunostaining.     

A case of rectal schwannoma presenting with hematochezia]

Rectal schwannoma is a rare mesenchymal tumor originating from Schwann's cell. We experienced a 61- year-old female patient who complained of blood tinged and narrow calibered stool for several years, and found a 4 cm sized submucosal tumor with a central ulcer on the rectal wall during colonoscopy. She underwent transanal excision. Microscopically, the tumor was composed of fasciculating bundles of spindle cells with benign nuclear atypia and peripheral lymphoid cell cuffing. Tumor cells showed a diffuse strong immunoreactivity to S-100 protein, but not stain for CD 34, desmin and smooth muscle actin. This is the first case report of rectal schwannoma in Korea.     

Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer

Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma. We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases. He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil, leucovorin and oxaliplatin plus bevacizumab, FOLFIRI consisting of 5-fluorouracil, leucovorin and irinotecan plus bevacizumab, and irinotecan plus cetuximab. One of the liver tumors showed a different response to chemotherapy and was diagnosed as a leiomyosarcoma following histopathological examination. This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas. The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.