title: A stepwise approach to the management of metastatic midgut carcinoid tumor.
abstract: 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.
authors: Department of Cardiology, Royal Free Hospital, London, UK.
authors: Sanjeev
authors: S
authors: Bhattacharyya
authors: Dorothy M
authors: DM
authors: Gujral
authors: Christos
authors: C
authors: Toumpanakis
authors: Gilles
authors: G
authors: Dreyfus
authors: Brian R
authors: BR
authors: Davidson
authors: Joseph
authors: J
authors: Davar
authors: Martyn E
authors: ME
authors: Caplin
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D003692:Delayed-Action Preparations; D013004:Somatostatin