title: Management of sub-5 mm rectal carcinoids with lymph node metastases.
abstract: Minute (<5 mm) and small (5-10 mm) rectal carcinoids discovered during colonoscopy are generally considered to be non-aggressive, and the management and surveillance of patients with this entity are usually limited. We present the case of a 61-year-old Chinese female with multiple sub-5 mm carcinoid tumours in the rectum without any computed tomography (CT) evidence of lymph node or distant metastases. She underwent an ultra-low anterior resection for a sessile rectal polyp with the histological appearance of a moderately differentiated adenocarcinoma. Seven foci of minute carcinoids in the rectum and perirectal lymph node metastastic spread from the carcinoid tumours were also discovered on histopathology. There were no lymph node metastases originating from adenocarcinoma. This case report and review of the literature suggests that minute rectal carcinoids are at risk of metastasizing and that these patients should be investigated for lymph node and distant metastatic spread with CT and somatostatin receptor scintigraphy or its equivalent, as this would influence prognosis and surgical management of these patients. Findings relating to lymphovascular invasion, perineural invasion, high Ki-67, mitotic rate, depth of tumour invasion, central ulceration, multifocal tumours and size are useful in predicting metastases and may be used in scoring tools. Size alone is not a good predictor of metastastic spread.
authors.affiliation: Department of General Surgery, Liverpool Hospital, Liverpool, New South Wales (NSW), Australia, james.toh@unsw.edu.au.
authors.forename: James Wei Tatt
authors.initials: JW
authors.lastname: Toh
authors.affiliation: Department of Pathology, Liverpool Hospital, Liverpool, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Department of General Surgery, Liverpool Hospital, Liverpool, New South Wales (NSW), Australia.
authors.forename: Takako Eva
authors.initials: TE
authors.lastname: Yabe
authors.affiliation: South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Evonne
authors.initials: E
authors.lastname: Ong
authors.affiliation: Department of Colorectal Surgery, Concord Hospital, Sydney, NSW, Australia and.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chapuis
authors.affiliation: Department of Colorectal Surgery, Liverpool Hospital, Liverpool, NSW, Australia.
authors.forename: Les
authors.initials: L
authors.lastname: Bokey
keywords: lymph node metastases; rectal carcinoid; tumour size