Adenocarcinoma of the gastro-oesophageal junction with a synchronous carcinoid of the duodenum

Duodenal carcinoids are rare tumours. There is an increased incidence of primary carcinomas, especially in the gastrointestinal tract, which occur synchronously with gastrointestinal tract carcinoids. However, the synchronous occurrence of adenocarcinoma of the gastro-oesophageal junction with a duodenal carcinoid has not been previously described. A case report is presented, with discussion of carcinoid tumours and management when occurring synchronously with non-carcinoid tumours.     

Carcinoid tumour arising in a Meckel's diverticulum

A patient with a carcinoid tumour arising in a Meckel's diverticulum and presenting with acute small intestinal obstruction is described. Review of previously reported cases indicates that the initial clinical presentation of carcinoid tumours occurring in a Meckel's diverticulum is usually similar to that of appendiceal carcinoids. While most carcinoids in Meckel's diverticula present as incidental findings at post-mortem examination or laparotomy, their metastatic potential and subsequent behaviour resembles that of other small intestinal carcinoid tumours.     

Carcinoid Klatskin tumour: A rare cause of obstructive jaundice

Carcinoid tumours of the extrahepatic biliary ducts represent an extremely rare cause of bile duct obstruction. We report a case of obstructive jaundice secondary to carcinoid tumour arising at the hilar confluence. Resection of the primary tumour was done and the patient is doing well on follow-up. This case demonstrated that surgery offers the only potential cure for biliary carcinoid and aggressive surgical therapy should be the preferred treatment in cases of potentially resectable biliary tumours.     

前白蛋白诊断支气管肺类癌的研究

本研究检测了前白蛋白作为诊断支气管肺类癌的可靠性以及前白蛋白在其它类型肺癌的分布。结果表明：类癌前白蛋白阳性率为５０％，其中典型类癌１００％，不典型类癌２５％。小细胞癌尚有１１．８％的阳性率。１４例鳞癌，６例腺癌均为阴性。因而前白蛋白是诊断肺支气管类癌有用的标记，其价格便宜，稳定可靠，适合常规开展。     

Carcinoid tumour of gall bladder--a case report

Gall bladder carcinoid tumours are rare, constituting less than 1% of all carcinoid tumours arising from different parts of the body. They usually lack specific symptoms as they typically are unassociated with the carcinoid syndrome, despite frequent hepatic spread and mostly detected after cholecystectomy. A case of gall bladder carcinoid is reported in a 35-year-old woman who underwent laparoscopic cholecystectomy for clinical features of cholelithiasis. Several comparative evaluation was attempted mainly between the carcinoid and variant groups (endocrinomas) and occasionally between the typical and atypical carcinoid series to solve the existing serious problem in categorisation of this group of tumours. While the usual criteria for judging malignancy, such as anaplasia and mitotic figures, are unreliable in these sites of carcinoid tumour, malignancy is well determined from evidence of tumour invasion into adjacent structures. This rarity and the ambiguity around it stresses for its documentation and warrants for international agreements and standards on basic criteria for such classification of these endocrine carcinomas.     

Multiple endocrine neoplasia associated with von Recklinghausen's disease

Details were studied of three patients with duodenal carcinoid tumour in association with neurofibromatosis and phaeochromocytoma, and of four patients with duodenal carcinoid and either von Recklinghausen's disease or phaeochromocytoma. The rarity of these endocrine tumours, together with the unusual morphological features and somatostatin content of the two duodenal carcinoids examined, suggest that this combination of tumours is not a chance association. It is suggested that this linkage of neurofibromatosis, phaeochromocytoma, and duodenal carcinoid is a specific multiple endocrine neoplasia syndrome.     

Carcinoid tumour of the kidney in a Chinese woman presenting with loin pain.

Renal carcinoid tumours are uncommon. The aetiology is not yet fully understood and there is still no useful diagnostic tool for detecting them. We report our experience managing a Chinese woman with a primary renal carcinoid tumour.     

Co-secretion of calcitonin gene-related peptide, gastrin-releasing peptide and ACTH by a carcinoid tumour metastasizing to the cerebellum

A carcinoid tumour presenting as Cushing's syndrome is reported. Although no tumour mass could be initially identified the patient returned with first a liver and subsequently a cerebellar mass both of which were resected. Only at post-mortem was the lung primary discovered. ACTH, gastrin-releasing peptide (GRP) and calcitonin gene-related peptide were elevated in plasma before resection of the hepatic tumour. These peptides were demonstrated in both the hepatic and cerebellar tumours by immunocytochemistry and radioimmunoassay. This case illustrates the occasional tendency of primary lung carcinoids to remain small and clinically undetectable while generating secondary tumours which are symptomatic. It is suggested that immunological demonstration of GRP may be diagnostically helpful in directing attention to the lung as a primary site in neuroendocrine tumours which present in this fashion.     

A patient with co-existing bronchial carcinoid tumour and bilateral phaeochromocytoma.

We report a 31-year-old Chinese man with bronchial carcinoid tumour and bilateral phaeochromocytoma. His sister also gave a history of bilateral carotid body paraganglioma. This case demonstrates the importance of screening for other endocrine disorders in patients with foregut carcinoid tumours.     

Lung carcinoid related Cushing's syndrome: report of three cases and review of the literature

Three patients with lung carcinoid related Cushing''s syndrome (LCRCS) treated at Frenchay Hospital, Bristol between 1984 and 1994 are described. The first patient presented with hyperpigmentation 13 years after bilateral adrenalectomy. The second patient had no recurrence or metastases 14 years after removal of a typical carcinoid tumour. The last patient survived nine years after diagnosis of liver metastasis. The possibility of LCRCS should be considered in every patient proved to have Cushing''s disease and bilateral adrenal enlargement on abdominal computed tomography. Biochemical sets of investigation (for example, adrenocorticotrophic hormone (ACTH) stimulation, dexamethasone suppression, and metyrapone response) could be misleading and should not be relied upon solely. Search for an ectopic ACTH source should be called off only when ACTH has been demonstrated in the surgically removed specimen, and most importantly, when the serum ACTH concentration returns to normal after surgery. Lung carcinoid tumours are compatible with long survival, and liver metastasis could prove indolent and slowly growing.


     

Cutaneous scleroderma in association with carcinoid syndrome.

A case of scleroderma in a woman with carcinoid syndrome is described and the similarities between our case and those in the literature are reviewed. The carcinoid tumours were all of midgut origin and liver metastases were present. All subsequently developed fibrotic heart disease and none had clinical features or autoantibodies suggestive of systemic sclerosis. The association between carcinoid syndrome and particular features of scleroderma is likely to be more than fortuitous.     

Primary tumours of the duodenum.

Six primary duodenal tumours were diagnosed in our 300 bed institute during a period of 10 years. Two patients had benign tumours (leiomyoma and carcinoid) and four had malignant tumours (adenocarcinoma). The most common manifestation was severe iron deficiency anemia. Diagnosis was usually delayed (with a mean time of 7.7 months from initial complaints), endoscopy being the most common and useful diagnostic tool. A curative procedure was performed in two patients. Patients with unexplained chronic iron deficiency anaemia should undergo thorough gastrointestinal evaluation, including the small intestine, as a curable disease may be found to be the source of the complaint.     

Granulosa cell tumour of the ovary with bilateral mature cystic teratomas. A case report

Granulosa cell tumour with synchronous mature cystic teratoma is extremely rare and only eight cases are documented in the literature. Granulosa cell tumours are low-grade malignancies and need a close follow-up for recurrences which may be late. We report a case of granulosa cell tumour and mature cystic teratoma occurring synchronously in the same ovary in a post-menopausal woman.     

Carcinoid tumour of the cervix.

A case of non-metastatic carcinoid tumour of the cervix is described from a patient without the carcinoid syndrome. The rarity of carcinoid tumour involving gynaecological structures other than the ovaries is discussed and a bried review of carcinoid disease presented.     

Carcinoid syndrome due to a malignant somatostatinoma.

Somatostatinoma is one of the rarest tumours of the endocrine pancreas. Cardinal manifestations of a somatostatinoma include gallstones, mild diabetes mellitus, steatorrhoea, diarrhoea and dyspepsia. Like any other pancreatic islet cell carcinoma, a somatostatinoma may also produce several different hormones such as adrenocorticotropic hormone, calcitonin, vasoactive intestinal polypeptide, pancreatic polypeptide, gastrin, insulin, and glucagon. In many cases, the clinical picture is dominated by the effect of these other hormones. We present a patient with somatostatinoma in which an immunocytochemical study of the specimens from pancreas and liver showed a weak positive reaction for gastrin besides a strong positive reaction for somatostatin. Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide.     

Three synchronous gastrointestinal tumours

Mucinous cystadenomas of the appendix are rare, with significant malignant potential [Lo and Sarr in Hepatogastroenterology 50(50):432–437, 2003]. Carcinoid tumours are similarly uncommon, rarely occurring in Meckel’s diverticula but are still the commonest tumour of Meckel’s diverticulae [Nies et al. in Dis Colon Rectum 35(6):589–596, 1992; Modlin and Lye in Cancer 97(4):934–959, 2003; Sutter et al. in Schweiz Med Wochenschr Suppl 89:20S–24S, 1997; Weber and McFadden DW in J Clin Gastroenterol 11(6):682–686, 1989]. A 77-year-old woman presented to our clinic with a 6-week history of non-specific lower abdominal pain. A pelvic ultrasound showed an 8 × 3 × 2.5 cm mass in the right iliac fossa. Colonoscopy and CT confirmed this mass and also revealed a left colonic tumor. At laparotomy, three tumours were identified; in the appendix, a Meckel’s diverticulum, and the descending colon. A subtotal colectomy and diverticulectomy were performed. Histology confirmed a T3N0 Dukes B colonic adenocarcinoma, a carcinoid of Meckel’s diverticulum and a mucinous adenoma of the appendix. The patient is tumor free to date, 5 years after presentation. The presence of three synchronous tumours of different histological origin in the gastrointestinal tract has not previously been described in the literature.     

Gastro-intestinal haemorrhage��an unusual presentation of carcinoid tumours

A case of small bowel carcinoid tumours causing gastro-intestinal haemorrhage is presented. The difficulties associated with pre-operative diagnosis and operative localization are discussed.     

Synchronous adenocarcinoma and primary malignant lymphoma of the stomach

A synchronous presentation of an adenocarcinoma and a primary low grade B cell lymphoma of the stomach is reported in a 79 year old man. Both diagnoses were made on endoscopic biopsies and immunocytochemistry was essential in confirming the lymphoma. The true incidence, aetiology and spatial relations of these tumours are unknown since only few cases of such synchronous gastric tumours have been reported in the literature.     

Imaging spectrum of bronchial carcinoid--a case of central bronchial obstructing lesion

Here one case of bronchial carcinoid is reported, which presented as intrabronchial obstructing lesion with sequelae. Carcinoid syndrome is quite uncommon with bronchial carcinoids and x-ray or CT usually gives non-specific appearances. Still, the relatively younger age group of patients and presence of obstructing lesions in major bronchi with features like extraluminal extension and mucoid impactions are helpful signs. However, a few instances of carcinoid mimics do occur during imaging studies, like other types of intrabronchial tumours and long standing foreign bodies.     

卵巢原发性胰腺类癌

背景：卵巢原发性胰腺类癌是一种罕见的肿瘤，在全身类癌发病总数中的比例〈1％。除1例病例报道外，先前所有报道的功能性卵巢类癌直径均〉10cm。因此，肿瘤的直径与类癌综合征具强相关性。病例报道：本文描述1例卵巢原发性功能性胰岛类癌，其最大直径仅为6cm。结论：虽然卵巢原发性类癌很罕见，但在临床推断中还是应当给予足够重视，尤其是患者表现出类癌综合征而附件肿物很小时。