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Quiz Prize Rules Current Rankings DIAGNOSIS:
Carcinoid with Liver Metastases
Fig. 2: Coronal CT scan of the abdomen shows a mesenteric mass (red arrow) with multiple liver lesions (small red arrows)
The coronal CT shows a lobulated mass in the mesentery with some amount of cicatrization with multiple liver lesions. The commonest lesion that produces this appearance is a carcinoid.
Carcinoid tumors develop from enterochromaffin cells, which are normally present in the small intestine, appendix, colon, rectum, bronchi, pancreas, bile ducts and liver. These cells produce histamine, serotonin, dopamine and tachykinins, which have profound effects on the circulatory system, gastrointestinal tract and lungs.
The usual symptomatology includes abdominal pain, intestinal bleeding and intestinal obstruction. Carcinoid syndrome is a combination of symptoms due to the release of hormones from these tumors into the blood stream, and include flushing, diarrhea, abdominal pain, fluctuating blood pressure, and wheezing due to bronchospasm.
Carcinoid tumors are usually slow growing, but can be benign or malignant. Benign tumors are usually less than 1 cm, and can be removed completely. They usually do not produce symptoms. Malignant tumors are typically more than 2 cm in diameter and can metastasize to liver, lung, nodes, bone and skin.
Carcinoids most commonly occur in the gastrointestinal tract, the distal ileum being the most affected site.
The plain radiograph is not a very helpful imaging modality for the diagnosis of carcinoids, but may show areas of curvilinear or speckled calcification. If the tumor is large and causes intestinal obstruction, air-fluid levels maybe seen. Barium studies may show an intraluminal filling defect if the mass is large or thickening of the valvulae conniventes and fixed angulation of the bowel secondary to the fibrosing mesenteritis.
CT scanning is probably the best modality for the diagnosis of carcinoids. The primary bowel tumor maybe small, and not visualized on a routine CT study, but maybe seen on CT enteroclysis. However the conglomerate enlarged mesenteric nodes appear as a soft tissue mass with spiculated margins and stellate or radiating surrounding fat stranding. Calcification may or may not be present. The linear strands within the mesenteric fat probably are thickened and retracted vascular bundles and represents peritumoral desmoplastic reaction. Bulky retoperitoneal adenopathy maybe seen, which may mimick lymphoma. Metastatic deposits to the liver are common and are almost always hypervascular.
RI is not used for the diagnosis of carcinoid. However, liver metastases maybe better seen on MRI, and appear hyperintense on T2 weighted images. On the dynamic contrast study, arterial phase enhancement of the lesions is seen, and which appear as filling defects in the portal venous phase of the study against the enhancing normal liver.
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PubMed References for Carcinoid with Liver Metastases
At any given time this link will provide references from Pubmed, including the most recent updates. Retrievals are designed to include articles available free and also Indian studies.
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A Gopinath
A L Kiranmayi
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ALAGAPPAN S
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Alli. A
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Amarnath C
Amit Kaur
Amit Suri
Amol Gautam
Anand S H
Antoine Marie annecy france
Ashish Gupta
Ashok Kumar R
Ashwin Kumar Patil
bhumika suthar
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C V Subbarao
Chary D
Chaudhari N
David Nucci
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Dharmashi Bhate
Divya Singh
Divyata Hingwala
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Franzil Miranda
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Genin Gilles
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kanchan gupta
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Lekshmi T P
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Swati dayanand chinchure
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