Metastatic Carcinoid Tumour in Association with Small Bowel Ischaemia and Infarction

Payne-James, Jason; Cj, de Gara; Lovell, David; Jj, Misiewicz; Nm, Gow

doi:10.1177/014107689008300124

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…This is supported by the lower colonic NET prevalence in multivariate analysis for IBD patients with a resection compared to diverticulitis and ischemia patients with a resection. Similar comparisons have not been made in literature before and only case reports regarding NET in diverticulitis or ischemia patients are available . Prevalence rates of carcinoid tumors in appendectomy specimens were similar in IBD patients compared with non‐IBD controls, supporting our findings .…”

Section: Discussionsupporting

confidence: 90%

“…Similar comparisons have not been made in literature before and only case reports regarding NET in diverticulitis or ischemia patients are available. [23][24][25][26][27][28][29][30][31][32][33] Prevalence rates of carcinoid tumors in appendectomy specimens were similar in IBD patients compared with non-IBD controls, supporting our findings. 6 Another study reported 9 cases (5 CD and 4 UC), all discovered incidentally, in 2,284 patients undergoing intestinal surgery for IBD resulting in a prevalence of 0.26% which was nearly identical to a rate of 0.27% in non-IBD patients undergoing intestinal surgery.…”

Section: Discussionsupporting

confidence: 75%

See 1 more Smart Citation

Is the prevalence of colonic neuroendocrine tumors increased in patients with inflammatory bowel disease?

Derikx

Vierdag

Kievit³

et al. 2016

Int. J. Cancer

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Inflammatory bowel disease (IBD) patients may bear an increased neuroendocrine tumor (NET) risk. These tumors are mostly reported as coincidental findings during surgery. We aimed to determine the prevalence of colonic NET in a Dutch nationwide IBD cohort and calculate the prevalence rate ratios (PRR) compared with the general Dutch population. Our second aim was to investigate whether a high bowel surgery rate in IBD could result in a high PRR for NET. The Dutch Pathology Registry (PALGA) was searched to identify all IBD patients with colonic NET in The Netherlands between 1991 and 2011. We determined the prevalence and PRR of colonic NET in a 20-year period. For our second aim, we compared NET prevalence in colonic resection specimens between IBD cases and non-IBD controls (diverticulitis and ischemia). We identified 51 IBD patients who developed colonic NET resulting in a prevalence of 60.4-89.3 per 100,000 patients in a 20-year period with a PRR of 2.8-4.1. However, adjusted for resection type, sex and age, a higher NET prevalence was shown in diverticulitis (OR 5.52,) and ischemia (OR 1.97, 95% CI 1.09-3.58) compared with IBD. Our key finding is that NET are more prevalent in IBD patients compared with the general population (PRR 2.8-4.1). This might be attributed to a high rate of incidental NET as IBD patients frequently undergo intestinal surgery. A lower adjusted NET prevalence in colonic resection specimens for IBD compared to ischemia and diverticulitis supports this hypothesis.Colorectal cancer (CRC) risk is increased in patients with inflammatory bowel disease (IBD). 1,2 As IBD duration, extent and severity of disease drive CRC risk, it is assumed that chronic intestinal inflammation is an important contributing factor. 3 In addition to an increased CRC risk, IBD patients also carry a risk to develop other types of neoplasia such as neuroendocrine tumors (NET). Several authors have reported cases of both IBD and NET resulting in the hypothesis that inflammation may cause hyperstimulation of enteroendocrine cells leading to hyperplasia and neoplasia. [4][5][6] However, convincing epidemiological evidence of an association between IBD and NET is lacking so far.NET risk in IBD patients has been poorly investigated and reported results are variable. Two studies including, respectively, 590 and 111 IBD patients, found an increased risk of NET development compared to the background population. 5,7 By contrast another study among 705 IBD cases did not detect an increased prevalence. 6 However, all these data were collected from single tertiary referral centers introducing referral and selection bias and as such may not be representative for the IBD population at large. Furthermore, high surgery rates in IBD [25-30% in ulcerative colitis (UC) and 70-80% in Crohn's disease (CD)] may lead to high NET risks, as these tumors are mostly detected by coincidence during surgery. 8,9 Therefore, the comparison of NET risks across studies is difficult given the variable rates of bowel surgery in control groups in the ...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 75%

Is the prevalence of colonic neuroendocrine tumors increased in patients with inflammatory bowel disease?

Derikx

Vierdag

Kievit³

et al. 2016

Int. J. Cancer

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“…There is still much to be elucidated about the pathophysiology of intestinal ischemia in carcinoid disease. After the description of Anthony and Drury, several authors have confirmed their observations [4,[9][10][11][12][13][14][15][16]. Intestinal ischemia in carcinoid disease is only seen when the primary tumor is located in the midgut.…”

Section: Discussionmentioning

confidence: 91%

“…The effect of nitroglycerin on abdominal angina is suggestive for reversible vasoconstriction. Most authors agree that ischemia is seen only in patients with residual metastatic disease in the mesentery, consistent with a loco-regional biochemical effect [9][10][11][12][13][14][15][16]. Overexpression of acidic fibroblast growth factor (aFGF) in stroma of a carcinoid tumor might represent an additional local factor [17] the cornerstone of therapy.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Angina in Patients with a Midgut Carcinoid, a Sign of Severe Pathology

et al. 2005

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In 36 consecutive patients with a foregut carcinoid with extensive local tumor growth and liver metastases with a carcinoid syndrome, six patients had complaints of postprandial abdominal pain and attacks of subileus based on segmental intestinal ischemia. A diagnosis of abdominal angina was supported by a positive response to nitroglycerin in two and ischemia of the ileum demonstrated by angiography in two other patients. Complaints were reduced in all patients after surgery. Histopathology of the resected small bowel specimens showed elastic vascular sclerosis in three patients and ischemic changes in three other patients, confirming the clinical diagnosis. Resection of ischemic bowel can provide relief in patients with segmental intestinal ischemia caused by carcinoid-induced vascular sclerosis.

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“…However, some patients present acutely and this will most commonly be due to small bowel obstruction. Bowel ischaemia, or even intestinal infarction, is an extremely rare presentation, with very few previously reported cases 5‐8 …”

Section: Discussionmentioning

confidence: 99%

Small Bowel Carcinoid Tumour Presenting With Intestinal Ischaemia

Ormandy

Parks

Madhavan

2000

Int J Clinical Practice

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Metastatic Carcinoid Tumour in Association with Small Bowel Ischaemia and Infarction

Cited by 5 publications

References 4 publications

Is the prevalence of colonic neuroendocrine tumors increased in patients with inflammatory bowel disease?

Is the prevalence of colonic neuroendocrine tumors increased in patients with inflammatory bowel disease?

Abdominal Angina in Patients with a Midgut Carcinoid, a Sign of Severe Pathology

Small Bowel Carcinoid Tumour Presenting With Intestinal Ischaemia

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