Elastic vascular sclerosis of mesenteric blood vessels in argentaffin carcinoma

Abstract

SYNOPSIS Argentaffin carcinoma (carcinoid tumour) of the ileum has been found to be associated with ischaemic ileal necrosis due to elastic sclerosis of the mesenteric blood vessels. This vascular change was present in 17 out of 25 ileal tumours, all of them invasive, but was absent in 75 appendicular, rectal, and other carcinoids. The pathology is described and essential points of difference are noted from the cardiovascular changes in the carcinoid syndrome. This elastic vascular sclerosis may be due to a product of the tumour and constitute an additional component of the complex range of changes that makes up 'the carcinoid spectrum'.Necropsy experience with 10 cases of ileal argentaffin carcinoma (carcinoid tumour) revealed four in which ischaemic necrosis of the tumour-bearing segment of intestine had resulted. The mesenteric blood vessels were found to be narrowed by massive proliferation of elastic tissue, mainly in the adventitia. In three cases death was directly attributable to peritonitis caused by this complication. Similar vascular changes were present in a further three cases, two of which showed evidence of impaired blood supply. This observation has prompted a retrospective study of the regional blood vessels in argentaffin carcinoma which confirmed the relatively frequent, though hitherto overlooked, occurrence of this vascular lesion. It was found to be present in ileal tumours only and the implications of this distribution on pathogenesis are discussed. MiterialHistological material from 100 cases of argentaffin carcinoma was reviewed. Ten of these were necropsy cases and 90 were surgical specimens. All occurred in the 12-year period from 1956 to 'Present address:

Highlights of the biology of endocrine tumours of the gut and pancreas.

“…A specific feature of ileal and jejunal well-differentiated endocrine tumours is the diffuse proliferation of both intimal and adventitial elastic tissue in large arterial and venous vessels of the mesenteric pedicle, often called vascular elastosis (Anthony & Drury 1970, Qizilbash 1977) and sometimes associated with proliferation of extravascular elastic fibres within the bowel wall (Qizilbash 1977). Not infrequently, vascular elastosis may cause ischaemic changes or even intestinal infarction.…”

Abdominal Surgery in Patients with Midgut Carcinoid Tumors

“…In others the bowel was entrapped by tumor and fibrosis and appeared partly occluded, without proximal dilatation, but frequently with a localized intestinal edema. consisting of elastic tissue proliferation within the adventitia of mesenteric arteries and veins (17)(18)(19)(20). A compromised circulation was evident in the present series only in intestinal segments neighboring large mesenteric lymph node metastases, but has been described also in their absence and in intestinal segments remote from the tumors (17-20).…”

Jejunoileal Neuroendocrine Tumors Complicated by Intestinal Ischemic Necrosis Are Associated With Worse Overall Survival

“…Mesenteric vascular elastosis is characterized by thick deposition of elastic tissue in the adventitia of mesenteric arteries and veins. 28 Some authors have suggested that mesenteric vascular elastosis associated with JINETs can cause IIN. 12,13,17,28 Finally, it is conceivable that decreased blood flow from preexisting cardiovascular disease, such as mesenteric arterial atherosclerosis, and decreased cardiac function could predispose to JINET-induced IIN.…”

“…28 Some authors have suggested that mesenteric vascular elastosis associated with JINETs can cause IIN. 12,13,17,28 Finally, it is conceivable that decreased blood flow from preexisting cardiovascular disease, such as mesenteric arterial atherosclerosis, and decreased cardiac function could predispose to JINET-induced IIN. Although no significant differences in hypertension, dyslipidemia, diabetes, and smoking status were found between patients with and without IIN, age itself is a risk factor for atherosclerosis.…”