Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this study, we present a rare case of gastrointestinal carcinoid tumor that metastasized to a transplanted liver graft. A 14-year-old female patient suffering from cryptogenic cirrhosis had undergone liver transplantation. The liver was received from a deceased donor. She presented to our clinic with complaints of abdominal pain, diarrhea, flushing, fatigue, and syncope four years after transplantation. On multislice computed tomography, multiple masses ranging from 1 cm to 4 cm in size were detected in both lobes of the transplanted liver. Biopsy from both lobes revealed carcinoid tumor. The primary tumor could not be localized, and a colonoscopy was scheduled. As the patient refused an invasive investigation, octreotide therapy was begun. Her symptoms related to the carcinoid tumor diminished following initiation of the octreotide therapy. During the fifth year of octreotide therapy, a whole-body positron emission tomography (PET CT) with 10 mCi F-18 fludeoxyglucose (FDG) showed an increase in the metabolic activity with a SUVmax value of 8 at the localization site, consistent with the ileocecal region. The findings were considered secondary, as the carcinoid tumor originated from the appendix or distal ileum. Again, the patient again refused endoscopic investigations and continued the follow-up visits. To our knowledge, this is the only reported case in the scientific literature of a carcinoid tumor that metastasized to a transplanted liver.
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PMID:Metastasis of carcinoid tumor to the transplanted liver graft: a rare case report. 2491 43

Neuroendocrine tumors (NETs) (previously termed carcinoids) are slow-growing tumors of the neuroendocrine system. They can occur anywhere within the body but are most commonly found in the midgut. This review is therefore confined to a discussion of gastroenteropancreatic NETS (GEP-NETS). GEP-NETS may be asymptomatic and are found incidentally (eg, during appendicectomy) or can present with symptoms attributable to either the site of the primary tumor or the secretion of serotonin and other substances from metastatic carcinoid disease (carcinoid syndrome). Symptoms of carcinoid syndrome include facial flushing, diarrhea, wheezing, colicky abdominal pain, and edema. Surgical resection offers the only curative treatment for neuroendocrine tumors, although peptide hormone analogues can be used to control carcinoid symptoms. Guidelines exist to determine when further surgical resection is required when NETs (carcinoids) are found incidentally during appendicectomy. A multi-disciplinary approach is essential for the management of all children with these rare and challenging tumors.
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PMID:Gastroenteropancreatic neuroendocrine (carcinoid) tumors in children. 2493 54

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare, generally indolent neoplasms that can arise throughout the gastrointestinal system. Some GEP-NETs, known as functional, secrete hormones that can lead to a complex of symptoms. Classical carcinoid syndrome is associated with flushing, diarrhea, bronchospasm, and symptoms of valvular heart disease. GEP-NETs are classified according to the primary tumor site, functionality of the disease, and histology. Treatment is guided by the resectability of the tumor, the location and extent of metastases, and the presence of clinical symptoms. Typically, first-line treatment of patients with unresectable disease includes the use of somatostatin analogs, such as octreotide LAR depot or lanreotide depot/autogel, which was recently approved by the US Food and Drug Administration for treatment of GEP-NETs. Somatostatin analogs can improve the severe diarrhea/flushing episodes that may be associated with metastatic carcinoid tumors. For patients with pancreatic NETs, additional approved treatment options include the targeted agents everolimus and sunitinib, which have demonstrated antitumor activity. Chemotherapy may also have a selective role, particularly in pancreatic NETs. Localized approaches, including cytoreductive surgery, hepatic arterial embolization, and ablative therapies, may be used for palliative treatment in patients with liver metastases.
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PMID:New and Emerging Treatment Options for Gastroenteropancreatic Neuroendocrine Tumors. 2643 Sep 56

A 55-year-old female patient was admitted for flushing and abdominal pain in the right upper quadrant. Her past medical history revealed high blood pressure and a recent echocardiography showed thickened appearance of tricuspid valve with coaptation defect and grade II tricuspid regurgitation. Contrast enhanced abdominal CT scan and MRI were subsequently performed and revealed a large macronodular liver mass, as well as other micronodular lesions disseminated in the liver parenchyma. CT guided biopsy from the main liver mass revealed neuroendocrine tumor of unknown origin (probably GI) with Ki-67 of 8%. Surgical exploration was decided. During laparotomy, the primary tumor was found in the proximal ileum and the patient underwent segmental enterectomy. Non-anatomical hepatectomy was also performed to remove the bulk of the tumor burden (more than 90%). Postoperative course was uneventful and the carcinoid syndrome relieved. At present, 15 months postoperatively, the patient is under treatment with somatostatin analogue for its antiproliferative effect, with good clinical, biochemical and tumoral control and stable heart disease. In patients with neuroendocrine liver metastases from unknown primary, surgical exploration could allow detection (and resection) of the primary tumor and surgical debulking of liver metastases to control carcinoid syndrome and carcinoid heart disease.
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PMID:THE ROLE OF SURGERY IN A PATIENT WITH CARCINOID SYNDROME, COMPLICATED BY CARCINOID HEART DISEASE. 3114 45


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