small bowel carcinoid tumor

Neuroendokriner

Tumor des Ileums mit mesenterialer Lymphknotenmetastase in der Computertomographie: Oben Primarius der Ileumschlinge im wesentlichen nach intraluminal wachsend, jedoch auch mit organüberschreitender Infiltration. Unten Lymphknotenmetastase des Mesenteriums mit typischer desmoplastischer, sternförmige Reaktion. Verkalkungen in der Metastase. Die beiden linken Bilder jeweils in arterieller Phase, die anderen portalvenös. Der Patient war durch Subileusbeschwerden auffällig geworden.

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Kleiner

intraluminaler Tumor des Dünndarms (gelber Pfeil). Assoziierter Tumor im Mesenterium mit spikulierter Kontur und desmoplastischer Reaktion bei Karzinoid des Dünndarms.

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Carcinoid

tumor • Small bowel carcinoid tumor - Ganzer Fall bei Radiopaedia

Scola F, Small bowel carcinoid tumor. Case study, Radiopaedia.org (Accessed on 04 Jan 2023) https://doi.org/10.53347/rID-49964 • CC by-nc-sa 3.0 (modified)

Carcinoid

tumor • Small bowel neuroendocrine tumor with liver metastases - Ganzer Fall bei Radiopaedia

Shah V, Small bowel neuroendocrine tumor with liver metastases. Case study, Radiopaedia.org (Accessed on 04 Jan 2023) https://doi.org/10.53347/rID-46857 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Mesenteric carcinoid tumor - Ganzer Fall bei Radiopaedia

Abdelmonem H, Mesenteric carcinoid tumor. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-55449 • CC by-nc-sa 3.0 (modified)

Carcinoid

tumor • Carcinoid tumor - Ganzer Fall bei Radiopaedia

Ho F, Carcinoid tumor. Case study, Radiopaedia.org (Accessed on 04 Jan 2023) https://doi.org/10.53347/rID-62609 • CC by-nc-sa 3.0 (modified)

Carcinoid

tumor • Mesenteric neuroendocrine tumor deposit with small bowel ischemia - Ganzer Fall bei Radiopaedia

Shah V, Mesenteric neuroendocrine tumor deposit with small bowel ischemia. Case study, Radiopaedia.org (Accessed on 04 Jan 2023) https://doi.org/10.53347/rID-55394 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Mesenteric carcinoid causing acute cecal ischemia - Ganzer Fall bei Radiopaedia

Walker N, Mesenteric carcinoid causing acute cecal ischemia. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-74881 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Small bowel carcinoid - Ganzer Fall bei Radiopaedia

Bickle I, Small bowel carcinoid. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-78287 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Metastatic small bowel carcinoid - Ganzer Fall bei Radiopaedia

Bickle I, Metastatic small bowel carcinoid. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-80402 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Small bowel carcinoid tumor - Ganzer Fall bei Radiopaedia

Niknejad M, Small bowel carcinoid tumor. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-100203 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Small bowel carcinoid tumor - Ganzer Fall bei Radiopaedia

Knipe H, Small bowel carcinoid tumor. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-42873 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Metastatic small bowel carcinoid tumor - Ganzer Fall bei Radiopaedia

Hartung M, Metastatic small bowel carcinoid tumor. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-68993 • CC by-nc-sa 3.0 (modified)

Small bowel

neuroendocrine tumor • Small bowel carcinoid tumor - Ganzer Fall bei Radiopaedia

Haouimi A, Small bowel carcinoid tumor. Case study, Radiopaedia.org (Accessed on 20 Jan 2023) https://doi.org/10.53347/rID-77606 • CC by-nc-sa 3.0 (modified)

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Small bowel carcinoid tumors are the most common gastrointestinal carcinoid tumors and most frequently involves the terminal ileum.

Epidemiology

Small bowel carcinoid tumors account for ~40% of gastrointestinal carcinoid tumors .

Clinical presentation

Small bowel carcinoids are slow growing and may present with vague symptoms :

weight loss
fatigue
diarrhea
abdominal pain

More specific symptoms include:

carcinoid syndrome
small bowel obstruction
hematochezia
obstructive jaundice: in duodenal carcinoid

Pathology

Carcinoid tumors are neuroendocrine tumors arising from APUD cells. They can cause a desmoplastic reaction in nearby tissue, leading to fibrosis and tethering of the adjacent bowel (for further discussion, see the main article).

The primary tumor in small bowel carcinoid is typically only up to 3.5 cm in size. Metastases, commonly to the mesentery, liver, and lymph nodes, often exceed the size of the primary neoplasm. Multiple primaries and metachronous tumors in other organs can often occur.

About 45% (range 30-60%) of patients with small bowel carcinoid have metastatic disease at presentation . The larger the primary, the greater the likelihood of metastases .

Radiographic features

CT

On CT, the primary lesion is often polypoid or plaque-like, and hyperenhancing . However, due to their small size, the primary is not always seen on imaging . They can cause distortion of the small bowel and fixed, “hairpin” kinks in the course of the small bowel . The primary contains calcification in up to 70% of cases .

Mesenteric metastases can appear well-defined or spiculated on CT, with stranding due to fibrosis and desmoplastic reaction (leading to a characteristic “spoke-like” appearance of mesenteric vessels) .

In the liver, metastases strongly enhance in the arterial phase due to their vascularity , then become isodense to liver parenchyma in the delayed phase.