A stepwise approach to the management of metastatic midgut carcinoid tumor.
BACKGROUND
A 48-year-old man presented with diarrhea, flushing, abdominal pain and weight loss of 10 kg over a 6-month period. He subsequently developed dyspnea on exertion.


METHODS
Physical examination, laboratory tests, CT of the abdomen, liver biopsy, echocardiography, immunohistochemistry staining of the biopsy specimen for neuroendocrine markers including chromogranin A, synaptophysin and protein gene product 9.5, and (111)In-pentetreotide scintigraphy (Octreoscan).


METHODS
Carcinoid tumor of midgut origin with large segment 3 liver metastasis. Carcinoid syndrome and carcinoid heart disease.


RESULTS
Symptomatic relief with somatostatin analog therapy and subsequent resection of the segment 3 liver metastasis. Tricuspid and pulmonary valve replacement.
Bhattacharyya
Sanjeev
S
Department of Cardiology, Royal Free Hospital, London, UK.
Gujral
Dorothy M
DM
Toumpanakis
Christos
C
Dreyfus
Gilles
G
Davidson
Brian R
BR
Davar
Joseph
J
Caplin
Martyn E
ME
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002275:Carcinoid Heart Disease / Q000628:therapy; D002276:Carcinoid Tumor / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D006801:Humans; D007414:Intestinal Neoplasms / Q000556:secondary* / Q000628:therapy*; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D003692:Delayed-Action Preparations; D013004:Somatostatin