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Case Reports
. 2012 Jan;6(1):135-42.
doi: 10.1159/000337870. Epub 2012 May 23.

Endoscopic management of a primary duodenal carcinoid tumor

Albin Abraham  1 , Jaspreet Singh, Ghulam Siddiqui, Apsara Prasad, Sadat Rashid, Magdalene Vardaros, Vikas Garg, Kaleem Rizvon, Krishnaiyer Subramani, Paul Mustacchia
Affiliations
Case Reports

Endoscopic management of a primary duodenal carcinoid tumor

Albin Abraham et al. Case Rep Gastroenterol. 2012 Jan.

Abstract

Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS) revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer.

Keywords: Duodenal carcinoid tumors; Endoscopic mucosal resection; Endoscopic ultrasound; Neuroendocrine cell types.

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Figures

Fig. 1
Fig. 1
Upper endoscopy revealing the presence of a duodenal bulb mass with headed-up edges (arrow). Histopathological examination of the mass was suggestive of a carcinoid.
Fig. 2
Fig. 2
EUS view with a high-resolution 20 MHz probe showing the mass (arrow). The mass was confined to the mucosa and measured 10 mm in its largest diameter.
Fig. 3
Fig. 3
EMR of the mass was performed. Multiple surgical clips (shown in the figure) were used to close the mucosal defect.
See this image and copyright information in PMC

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