Magnetic resonance imaging of an ileal carcinoid tumor: Correlation with CT and US

doi:10.1016/S0899-7071(03)00004-4

Clinical Imaging

Volume 27, Issue 6, November–December 2003, Pages 403-407

https://doi.org/10.1016/S0899-7071(03)00004-4 Get rights and content

Abstract

The authors report the case of an advanced carcinoid tumor located in the distal ileum studied with CT, US and MRI. The lesion was deeply invasive and associated with liver metastases and peritoneal spreading. Imaging findings obtained with the different modalities have been reported, compared and discussed. MRI may play a role in the diagnosis and staging of carcinoid tumors, although CT still remains the investigation of choice.

Introduction

Carcinoid tumors represent approximately 25–41% of all small bowel malignancies and are also classified as neuroendocrine tumors, since they derive from Kulchitsky cells and are capable of synthesizing bioactive peptides, with the potential for malignant degeneration [1], [2], [3], [4], [5], [6], [7], [8].

The early diagnosis of carcinoid tumor is usually difficult and needs cooperation from the clinicians and radiologists.

The presentation is typically nonspecific, since the clinical features of these tumors are caused by the local effects of their mass and by the systemic effects of hormone secretion [6]. The most common clinical presentation is intestinal obstruction (45%) followed by abdominal pain (41%). The carcinoid syndrome with flushing diarrhea is more frequently observed in the presence of extensive hepatic metastases, where it is rarely the first evidence of the tumor (4%) [3], [4], [5]. This is due to the hepatic deactivation of the serotonin produced by the primary tumor; the serotonin contained in the portal blood is, in fact, metabolized in the liver and then excreted in the urine as 5-hydroxyindolacetic acid (5-HIAA), which represents an important tumor marker.

CT examination is actually considered the method of choice for the radiological diagnosis, characterization and staging of the carcinoid tumor [9], [10], [11], [12], [17], [19]. Important information on the local extension and liver diffusion can also be obtained with the ultrasound examination. So far, the role or MRI has not been extensively investigated [23], [24].

The authors report a case of an advanced metastatic carcinoid tumor located in the distal ileum studied with CT, US and MRI.

Section snippets

Case report

A 64-year-old woman presented for several months with mild persistent irradiating posterior abdominal pain and occasional episodes of nausea, vomiting and diarrhea, without hemorrhage. The patient was treated medically with antiperistaltic drugs, but the symptoms persisted despite of the treatment.

One year later, an US examination of the liver showed multiple diffuse hyperechoic nodules, ranging in size 10–45 mm, likely to be multiple hepatic metastasis. Following this US examination, the

Discussion and conclusion

Carcinoid tumors are uncommon, well-differentiated neoplasms with the potential for hormone secretion and malignant degeneration. The organ distribution varies widely; about 85% of carcinoids are located in the intestines and about 10% occur in the lungs [20].

Intestinal carcinoid tumors are classified as foregut, midgut and hindgut tumors, defined by their blood supply (stomach–duodenum supplied by the celiac artery as foregut; small intestine, ascending and proximal transverse colon supplied

Acknowledgements

We thank the M.R.S.T. Luciano Di Gregorio for the photographic support.

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Magnetic resonance imaging of an ileal carcinoid tumor: Correlation with CT and US

Abstract

Introduction

Section snippets

Case report

Discussion and conclusion

Acknowledgements

Small bowel cancer: epidemiological and clinical characteristics from a populations-based registry

Am J Gastroenterol

Carcinoid tumors: an analysis of 2837 cases

Cancer

Carcinoid tumours and syndrome

Semin Oncol

Carcinoid tumours

The carcinoid syndrome

Carcinoids of the jejunum and ileum: an immunohistochemical and clinicopathologic study of 167 cases

Cancer

Carcinoid tumors

J Surg Oncol

Neural crest origin of the endocrine polypeptide 4APUD7 cells of the gastrointestinal tract and pancreas

Gut

Carcinoid tumours: CT and I-131 meta-iodo-benzylguanidine scintigraphy

Radiology

J Comput Assist Tomogr

Primary tumors of small intestine: CT evaluation

Am J Roentgenol

Midgut carcinoid tumors: CT findings and biochemical profiles

J Comput Assist Tomogr

Diagnosis with computerized tomography and magnetic resonance of a case with double abdominal carcinoid tumor location and hepatic metastasis

Radiol Med