Endoscopic Management of a Primary Duodenal Carcinoid Tumor

Abstract

Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS) revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer.

Duodenal neuroendocrine tumors: retrospective evaluation of CT imaging features and pattern of metastatic disease on dual-phase MDCT with pathologic correlation

“…Most duodenal carcinoid tumors are nonfunctioning and therefore present as bowel obstruction, jaundice if peri-ampullary, mass effect or with metastatic disease [4, 5, 11, 12]. The results of our study also demonstrated similar to published reports that duodenal carcinoid tumors were more common in the proximal duodenum seen on CT in the first and second portions in 78.3% in our study [4].…”

“…Ampullary masses frequently cause biliary obstruction, jaundice, and biliary dilation [8, 11]. This was also seen in our study as of the ten patients with ampullary carcinoid tumors in our study, six resulting in biliary obstruction and three also with mild pancreatic duct obstruction.…”

“…However, similar to published reports, these three patients were all female and had tumors located in the peri-ampullary region often presenting with signs of biliary obstruction [4, 5]. Approximately, 30% of patients with peri-ampullary carcinoid tumors also have NF-1 [4] which is often somatostatinomas [11]. …”

Duodenal carcinoid with carcinoid syndrome

“…Once the tumour invades the serosa and involves the retroperitoneum it causes severe desmoplastic reaction leading to retroperitoneal fibrosis and subsequent urethral obstruction, peyronie’s disease of the penis, intra-abdominal fibrosis and occlusion of the mesenteric arteries or veins. In patients with duodenal carcinoid, carcinoid syndrome may occur in 4% 4. Our patient had typical features of carcinoid syndrome which is rare.…”

Endoscopic mucosal resection of duodenal carcinoid

“…The majority of patients with small-bowel carcinoid tumors present with metastases to lymph nodes or the liver, and 5 % -7 % present with carcinoid syndrome [3]. As a result, the most important consideration in determining whether patients are candidates for endoscopic treatment is evaluation for metastatic disease [4]. Carcinoid tumors with evidence of lymphatic or distant metastases should not be treated by endoscopic resection [5].…”