This is the most common primary tumour of the small bowel ; it is a low-grade malignancy. It mostly originates in the distal small bowel, ou...
This is the most common primary tumour of the small bowel; it is a low-grade malignancy. It mostly originates in the distal small bowel, outside the gut lumen, and rarely causes symptoms in itself. It may present with pain, obstruction or carcinoid syndrome (7%). Urine analysis shows 5-hydroxyindole-acetic acid (5-HIAA). Carcinoid syndrome is a clinical entity comprising flushing, wheezing and diarrhoea in the presence of lung and liver metastases.
1/3 Small bowel, 1/3 metastasis to liver ,1/3 malignant ,1/3 multiple ,1/3 associted with other malignancy,1/3 symtomatic
CT
• Mesenteric mass is the most typical feature, 70% contain calcification.
• Surrounding desmoplastic reaction—multiple linear strands that radiate out towards the adjacent bowel loops, giving a ‘spoke-wheel’ appearance.
• Appendix and distal small bowel most commonly.
• Thickening of surrounding small bowel loops.
• Liver metastases enhance avidly—more common with ileal carcinoid.
NUCLEAR MEDICINE
• Indium-111-labelled octreotide study is specific for carcinoid and its liver metastases.
Recommend In-111 octreotide scan / I-123 labelled MIBG scan, and image guided biopsy of one of the liver lesions.Correlate with chromogranin A and 5HIAA levels.
Carcinoid. Axial CT image of the abdomen with intravenous contrast demonstrating a calcified soft tissue mesenteric mass (red arrow) with a surrounding desmoplastic reaction (spoke-wheel appearance [white arrow]).
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