Clin Transl Oncol (2007) 9:804-805 DOI 10.1007/s12094-007-0143-z
C A S E R E P O RT S
Peritoneal carcinomatosis secondary to carcinoid tumour J. Ruiz-Tovar, N. Alonso Hernández, V. Morales Castiñeiras, E. Lobo Martínez, A. Sanjuanbenito Dehesa and E. Martínez Molina Department of General and Digestive Surgery. University Hospital Ramón y Cajal. Madrid, Spain
Abstract Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals.
Case report
Ruiz-Tovar J, Alonso Hernández N, Morales Castiñeiras V et al (2007) Peritoneal carcinomatosis secondary to carcinoid tumour. Clin Transl Oncol 9:804-805
A 64-year-old male had been diagnosed 7 years before with ileal carcinoid tumour, causing intermittent abdominal pain and weight loss of 12 kg in one year from evolution of the disease. The patient underwent ileal resection and resection of a liver metastases in segment II, discovered during surgery. Adjuvant chemotherapy (5-FU, 6 cycles) was given to the patient. Follow-up of the patient was yearly, with physical examination, analytics with serum tumoral markers and CT scan. In the last control CT scan, 2 solid subcentimetric hepatic lesions were discovered in segments III and VI, peripherally located, and a third lesion of 2 cm diameter close to the right suprahepatic vein. A gammagraphy enhanced with octreotide showed capitation of these lesions. Surgical resection of the hepatic lesions was proposed. At surgery disseminated massive peritoneal carcinomatosis was discovered; intraoperative biopsy of a peritoneal node revealed metastases of carcinoid tumour. Surgical resection was dismissed. Due to the slow progression of the disease, new chemotherapic treatment was discarded.
Introduction
Discussion
Carcinoid tumours are neuroendocrine neoplasms, which can appear in every location of the gastrointestinal tract, most frequently in terminal ileum, rectum and appendix. They are low aggressive tumours, although they often produce local invasion and liver metastases, whose resection allows long-term survivals [1].
Liver metastases of carcinoid tumours are well documented in the literature and their resection has been associated with an increase in survival [2]. Notwithstanding, peritoneal carcinomatosis has been rarely described. Vasseur et al. [3] describe, in a series of 30 carcinoids, an incidence of peritoneal carcinomatosis of 27%, most of them associated to liver metastases and whose primary tumour was located in ileum. These authors determined that peritoneal carcinomatosis affects survival only when liver metastases are also present. Meanwhile, Elias et al. [4] conclude in their study that peritoneal carcinomatosis of carcinoid tumours is a direct cause of disease in 40% of the patients, when any specific treatment against it is used. These authors performed a cytoreductive surgery associated to intraperitoneal chemotherapy with palliative aims to diminish pain and bowel obstruction, obtaining a 5-year survival rate of 67% vs. 41% in those cases where surgery was not possible. In this situation, surgery appears to be the most accurate therapeutic option for these tumours. The slow progression of the disease, similar to other processes, such as pseudomyxoma peritonei, suggests that peritonec-
Key words Peritoneal carcinomatosis • Carcinoid tumour • Neuroendocrine tumour • Liver metastases
J. Ruiz-Tovar (쾷) Servicio de Cirugía General y del Aparato Digestivo Hospital Universitario Ramón y Cajal Crta. Colmenar, Km, 9,100 28034 Madrid, Spain E-mail:
[email protected] Received 28 June 2007 / Accepted 21 July 2007
J. Ruiz-Tovar et al.: Peritoneal carcinomatosis secondary to carcinoid tumour
tomy associated to intraperitoneal chemotherapy, in cases of peritoneal carcinomatosis of carcinoid tumours, may be an interesting alternative in selected patients. Cytoreductive surgery in carcinoid tumours is focused on palliating the symptoms of hormonal hypersegregation. In most cases, surgery is not curative, but due to the slow progression of these neoplasms, longterm survivals can be achieved. Up to now, surgery has been focused on those cases with a limited number of metastases with complete resection aims, thus incomplete surgeries are associated with a high rate of postop-
References 1. Stunner B, Kicker O, Zilches A, Rothmans M (1996) Surgical management for carcinoid tumours of small bowel, appendix, colon and rectum. World J Surg 20:183–188 2. Gutierrez G, Daniels IR, Garcia A, Ramia JM (2006) Peritoneal carcinomatosis from a small
805
erative complications due to the catabolic state of the patient [5, 6]. The impossibility of complete eradication of the disease was the determinant for therapeutic abstention in our patient. Diverse drugs have been studied as adjuvant treatment of carcinoid tumours (5-FU, streptozotocin, doxorubicin, leucovorin, cyclophosphamide, dacarbazine and interferon) as single treatments or in association, with poor responses in all cases. Somatostatin and its analogues appear to be useful in symptomatic control, but without oncological efficacy [2].
bowel carcinoid tumour. World J Surg Oncol 4: 75–79 3. Vasseur B, Cadiot G, Zins M et al (1996) Peritoneal carcinomatosis in patients with digestive endocrine tumours. Cancer 78:1686–1692 4. Elias D, Sideris L, Liberale G et al (2005) Surgical treatment of peritoneal carcinomatosis from well-differentiated digestive endocrine carcinomas. Surgery 137:411–416
5. McEntee GP, Nagorney DM, Kvols LK et al (1990) Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 108:1091–1096 6. Cherner JA, Sawyers JL (1992) Benefit of resection of metastatic gastrinoma in multiple endocrine neoplasia type I. Gastroenterology 102: 1049–1053