124H Carcinoid Syndrome and Tricuspid Stenosis

  • 55 y.o. male with dx of metastatic WD G2 NET (liver biopsy, Ki 67=8.2%, unknown primary) with carcinoid syndrome, currently on SSA injection.
  • Oncologic hx:
    Weight loss and ongoing diarrhea prompted CT A/P 18 months prior which showed innumerable hepatic lesions including a dominant lesion occupying majority of the right hepatic lobe measuring up to 14.6 cm. Also a mildly hyperdense U-shaped mass in the root of the mesentery, which was thought to represent an enlarged lymph node. Biopsy of a liver lesion  showed metastatic well differentiated neuroendocrine tumor, grade 2 Ki 67=8.2%. DOTATATE PET  showed DOTA-avid disease in the liver, mediastinal and mesenteric LN, could not identify primary site. Patient started monthly octreotide injections on
  • CT CAP
  • showed overall stable disease.
  • Interim History:
    Pt has no acute complaints. other than  diarrhea. Taking imodium daily for control of stools.  Denies abdominal pain.

 

18 Months prior
Liver Metastases – Some Necrotic 

Carcinoid Syndrome Metastatic to Liver
18 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows a necrotic mass in the right lobe with multiple other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 135894
Carcinoid Syndrome Metastatic to Liver
18 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows a necrotic mass in the right lobe with multiple other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 135895

Tricuspid Stenosis

Carcinoid Syndrome with Tricuspid Valve Involvement
12 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
Ashley Davidoff TheCommonVein.net 124H 135896

Liver Metastases Some Necrotic – 1 Year Prior

Carcinoid Syndrome Metastatic to Liver
12 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows a necrotic mass in the right lobe with multiple other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 135897
Carcinoid Syndrome Metastatic to Liver
12 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows central necrosis of some of the lesions in the right lobe of the liver with other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 135898

Diarrhea – Liver Metastases Enlarged IVC Empty Colon

Carcinoid Syndrome Metastatic to Liver
12 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows central necrosis in some of the lesions in the right lobe of the liver with other foci of metastasis throughout the liver No formed stool is seen in the visualised parts of the colon The patient is known to have chronic diarrhea caused by excessive serotonin
Ashley Davidoff TheCommonVein.net 124H 135901
Carcinoid Syndrome Diarrhea
12 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the transverse colon shows no formed stool. The patient is known to have chronic diarrhea caused by excessive serotonin
Ashley Davidoff TheCommonVein.net 124H 135899

Diarrhea – Empty Sigmoid Colon

Carcinoid Syndrome Diarrhea
12 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the sigmoid colon shows no formed stool. The patient is known to have chronic diarrhea caused by excessive serotonin
Ashley Davidoff TheCommonVein.net 124H 135900

Tricuspid Stenosis

Carcinoid Syndrome with Tricuspid Valve Involvement
4 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
Ashley Davidoff TheCommonVein.net 124H 135902

Liver Metastases 4 Months Prior

Carcinoid Syndrome Metastatic to Liver
4 Months Prior
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows central necrosis of some of the lesions in the right lobe of the liver with other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 135903

Tricuspid Stenosis – Current

Carcinoid Syndrome with Tricuspid Valve Involvement
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
Ashley Davidoff TheCommonVein.net 124H 135904
Carcinoid Syndrome with Tricuspid Valve Involvement
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
Ashley Davidoff TheCommonVein.net 124H 135905
Carcinoid Syndrome with Tricuspid Valve Involvement
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
Ashley Davidoff TheCommonVein.net 124H 135906
Carcinoid Syndrome with Tricuspid Valve Involvement
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
The dome of the liver with metastases is seen at the right base
Ashley Davidoff TheCommonVein.net 124H 135907
Carcinoid Syndrome with Tricuspid Valve Involvement
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart in the coronal plane shows thickened tricuspid valve and enlarged right atrium indicating tricuspid stenosis
The dome of the liver with metastases is noted
Ashley Davidoff TheCommonVein.net 124H 135908
Carcinoid Syndrome with Tricuspid Valve Involvement
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the heart in the sagittal plane shows a thickened tricuspid valve and enlarged right atrium indicating tricuspicd stenosis
The dome of the liver with metastases is noted
Ashley Davidoff TheCommonVein.net 124H 135909
Carcinoid Syndrome Metastatic to Liver
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows central necrosis of some of the lesions in the right lobe of the liver with other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 135910b
Carcinoid Syndrome Metastatic to Liver
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the liver shows a necrotic mass in the right lobe with multiple other foci of metastasis throughout the liver
Ashley Davidoff TheCommonVein.net 124H 13910a

Diarrhea

Carcinoid Syndrome Diarrhea
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the pelvis shows a fluid filled small bowel and no formed stool in the visualised bowel. he patient is known to have chronic diarrhea caused by excessive serotonin
Ashley Davidoff TheCommonVein.net 124H 135911
Carcinoid Syndrome Diarrhea
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the pelvis shows a fluid filled sigmoid colon and rectum and no formed stool in the visualised. he patient is known to have chronic diarrhea caused by excessive serotonin
Ashley Davidoff TheCommonVein.net 124H 135911

Blastic Bone Metastases

Carcinoid Syndrome Blastic Metastasis
Current
55-year-old male with carcinoid of unknown primary with extensive metastatic disease to liver. CT scan through the lower liver shows a blastic metastasis in L2
Ashley Davidoff TheCommonVein.net 124H 135913