Gastrointestinal Pathology I Case Studies


CASE 6: Carcinoid tumor of small intestine


Clinical History:

A 43-year-old man came in to the emergency room because of intense abdominal pain associated with abdominal swelling which had developed over the past two days. A plain film radiograph of the abdomen showed numerous dilated loops of small intestine. A laparotomy was performed. The lower ileum was found to have a palpable mass lesion involving the muscular wall that obstructed the lumen (image 6.1). A segmental resection of ileum was performed. The opened bowel specimen from surgery shows a segment of buckled small bowel. At the apex of the buckle, the mucosa is ulcerated. Beneath this can be seen the lesion (images 6.2 to 6.3).
  1. What is the diagnosis?

    2. This is a carcinoid tumor. All of these are potentially malignant, but most are not and are incidental findings at autopsy. Those in the small intestine, particularly when they are larger than 2 cm or when they invade, are more likley to metastasize.

  2. What are common sites for this lesion?

    3. Common locations are the small intestine and appendix, but they can occur from stomach to rectum.

  3. What are more typical etiologies for intestinal obstruction in adults?

    4. Hernias, adhesions, and malignancies are more common causes for obstruction.

  4. What syndrome may be associated with this neoplasm?

    5. The "carcinoid syndrome" may accompany carcinoids that are metastatic to liver and elaborate a large quantity of serotonin to produce flushing, diarrhea, right heart endocardial fibrosis, and symptoms of bronchoconstriction (cough, dyspnea, and wheezing). This syndrome is quite rare.