Please provide any information on how carcinoids in the liver can affect heart valves and current treatments of the heart valves.
Serotonin and other tumor products in the blood cause overgrowth of fibrous tissue on the heart valve in an unknown way. Treatment consists of neutralizing vasoactive tumor products by injection of octreotide (Sandostatin) and, when very advanced and severe, replacing the valves via heart surgery.
My little sister had her appendix out recently and the doctor discovered a carcinoid in it. Is there information I could get relating to Carcinoid of the appendix?
Carcinoid is found coincidentally in approximately 1 of every 200 appendixes removed. Its importance depends on its size and also whether its growth is limited to just the lining of the appendix. Most of them are tiny and just a harmless curiosity. Those few which are larger or have invaded into or through the wall of the appendix require a second, more extensive, operation to thoroughly clean out the area to which the appendix was attached. These few patients will require periodic x-ray and blood tests in the future years to watch for recurrence or spread.
I have been diagnosed with a carcinoid tumor of my appendix after an appendectomy found it incidentally. The tumor measured 1.1 x 0.3 x 0.5. I am concerned I may have other tumors. I am wondering if I should be worked up for this. I had an anaphylactic reaction a few years ago thought to be from pesticides and was worked up for Carcinoid at the time, including a 24 urine for 5HIAA. This coincidence frightens me. Most of what I have read suggests that a carcinoid of this size is curable. Please advise.
Carcinoid syndrome almost never comes from appendiceal carcinoids and the 1 or 2 cases reported required extensive and obvious metastases to cause the syndrome. Usually carcinoids of the appendix are coincidental findings and have not spread until greater than 2 cm in diameter. However, even with a small one like yours it is important to know that the tumor has not gone through the full thickness of the appendix wall and does not show any microscopic invasion of lymph nodes and blood vessels. If all these criteria are okay, then you are cured and no further testing is required.
With benign bronchial carcinoid tumors, what is the percentage of people who usually undergo lobectomy surgery? Is it recommended to get a second opinion on this diagnosis for other options? I have been diagnosed with a carcinoid tumor in my lower right lobe and have been recommended for trochometry surgery. Im' getting second opinions to confirm, but it seeks like everything Ive read points to surgery. Is there no other option? I have had recurring pneumonia over the last 3 years and this is why they finally discovered it. What are the real risks and what percentages of people live just perfectly normal lives after the operation and have no further complications?
The term benign bronchial carcinoid is a misnomer. These tumors all have malignant potential but are usually very slow growing, hence the misuse of the adjective benign. Whether a lobectomy is required or bronchoscopic destruction of the tumor or some lesser type of surgery depends on the size, precise location and other features of any given tumor. These are rare tumors and unless you are at a large major medical center, your doctor probably has limited experience with this condition. A second opinion is advised but will only be as good as the experience of your consultant. Be CERTAIN to see one who is a known expert in this condition. No one can give you a recommendation on your particular case without reviewing the specific details in your records, but in general most people who have lung surgery for this condition do well thereafter.
My 58-year-old father was diagnosed with carcinoid about 1.5 years ago--he presented with a small bowel obstruction, which was treated surgically. He was found to have a Meckels diverticulum with carcinoid cells within the diverticulum. The work-up was negative for a primary site or any other metastases. Follow-up testing a year later have been negative (i.e., CT scans, urine tests, etc.). My father began experiencing episodes of angioedema of the lip, tongue, and posterior oropharynx at about the time of the carcinoid diagnosis. He has seen an allergist - all skin testing for allergies was negative. The episodes have recently increased to every few weeks. Any thoughts about the possible relationship of angioedema to carcinoid?
Angioedema is extremely rare in carcinoid disease but can occur with some foregut carcinoids.
Carcinoid originating in Meckels Diverticulum are usually midgut type. Furthermore, for the attacks to occur when only a small tumor is present without metastases and then to continue after removal of the tumor is not logical, since these episodes are due to humeral products of the tumor. It is thought that these tumors produce histamine and are deficient in 5HT decarboxylase and hence are associated with increased blood and urine levels of 5HTP. These substances can be measured. It is more likely that the angioedema is of some other cause. Was an Octreoscan done in search of metastases?
Could you please explain what adrenal neoplasms are and also the recommended treatment and prognosis.
The word adrenal refers to the adrenal glands. There are two, one on top of each kidney. Neoplasm means new growth. This means a new tumor. There are two categories of neoplasms, benign and malignant, the latter means cancer. Therefore, adrenal neoplasms are tumorous growths arising from the adrenal glands and can be either benign or malignant (cancerous). Furthermore, the adrenal glands are endocrine glands and make various types of hormones essential for the body, such as cortisone, adrenaline, and others. Each of these comes from separate and different types of cells in the adrenal gland and each type of cell can give rise to a separate and distinct type of neoplasm. There is no one treatment for all of these except for their surgical removal, but they often also require additional treatment with either/or radiation, chemotherapy, hormones and other medicationsparticularly if they are of the malignant variety and have spread.
I recently had an octreoscan that showed a hot spot in my right lower quadrant. Now my doctor want to do a needle biopsy of my liver. He mentioned my appendix, but said he wants to look at the liver. Why?
Why should they biopsy your appendix ? Are you assuming that the hot spot in your RLQ on the octreoscan is a primary carcinoid in the appendix, which is the origin of the small, presumably metastatic lesion, in the liver ? Very unlikely. More likely a carcinoid originates in the terminal ileum (which is so close to the appendix that the scan cannot differentiate between the two). Furthermore, appendiceal carcinoid only rarely spread so far as the liver while carcinoids of the terminal ileum much more frequently do so. But if neither was seen as a mass on the CT-scan or on colonoscopy or small intestine barium X-ray series (was this done?), they would be too small for, and it would be too dangerous, to do a needle biopsy. In short, needle biopsy of the liver is easier and safer.
I am a doctor and recently removed an adhesed appendix from a woman with pelvic pain and abscess (right ovary) pathology revealed a small carcinoid. She did not appear to have pre-operative carcinoid syndrome. Does she require colonoscopy to rule out additional GI lesions or an octreoscan?
If the carcinoid was greater than 1.5 cm diameter, or if it extended through the appendiceal wall to the serosa or the fat regardless of size, or if mesoappendix or nodes involvement were present - a right hemicolectomy should be done preceded by an Octreoscan. If it was small and did not meet the above criteria, no colonoscopy or further workup is needed. Carcinoid syndrome almost always requires a fairly large bulk of metastatic carcinoid and even then almost never results from appendiceal carcinoid. There are only 2 such cases in the world literature.
Upon reading the editorial section on when to start treatment, one outlined point read:Liver transplant ( only in very special selected cases) Is there further information as to what those "very special selected cases" would involve?
The reported World Experience with liver transplant for carcinoid indicates that the outcome in general is as good but no better than that resulting from the best combination of multimodality treatment ( i.e. Octreotide/Sandostatin, Hepatic Artery Chemo Embolization, Alpha Interferon, tumor debulking by surgical excision, RFA, cryoablation, systemic chemotherapy and supportive measures) The rare exception when Liver Transplant is better are in those few cases with severe Carcinoid Syndrome unresponsive to Sandostatin with tumors restricted to the liver or in young patients with extensive tumors in liver only and no tumors elsewhere.
