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Tumor carcinóide jejunoileal com síndrome carcinóide : um caso clínico
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Os tumores carcinóides são raros e uma pequena percentagem apresenta-se com síndrome carcinóide (diarreia e flushing cutâneo). Cerca de metade dos doentes com estes tumores apresenta metástases hepáticas, sendo a metastização óssea menos frequente. No presente trabalho, descreve-se o caso clínico de um homem de 65 anos com quadro de dor abdominal, diarreia e flushing facial. Ao exame objectivo, salientou-se a presença de hepatomegália nodular indolor, de consistência pétrea. A avaliação analítica revelou anemia, elevação de transaminases, GGT, FA, NSE e Cromogranina A, bem como de 5--HIAA (em urina de 24h) acima do limite superior de referência. A TAC revelou múltiplas lesões hepáticas. A colonoscopia demonstrou uma lesão polipóide infiltrativa no íleon distal, cuja biópsia diagnosticou o tumor carcinóide. O OctreoScan detetou metastização óssea em D10-D12, tendo sido realizada radioterapia. O seguimento indiciou progressão tumoral. Descreve-se, portanto, um caso de um tumor carcinóide com síndrome carcinóide à apresentação e com metastização hepática e óssea.
Carcinoid tumours are rare and a small percentage present with carcinoid syndrome (diarrhea and cutaneous flushing). About half of the patients with these tumours present hepatic metastasis, whereas bone metastasis are rarer. In this present article, it is reported a clinical case of a 65 year old man with abdominal pain, diarrhea and facial flushing. The clinical examination demonstrated hard painless nodular hepatomegaly. Laboratory evaluation revealed anemia, elevated transaminases, GGT, AP, NSE and Chromogranin A, as well as elevated 5-HIAA (in 24h urine), above the superior reference level. CT scan revealed multiple hepatic lesions. Colonoscopy demonstrated an infiltrative polypoid lesion in the distal ileon, which its biopsy diagnosed as a carcinoid tumour. OctreoScan detected bone metastasis in D10-D12, having then received radiotherapy. Follow-up indicated tumoral progression. This is a report of a case of a carcinoid tumour with carcinoid syndrome at presentation, with hepatic and bone metastasis.
Carcinoid tumours are rare and a small percentage present with carcinoid syndrome (diarrhea and cutaneous flushing). About half of the patients with these tumours present hepatic metastasis, whereas bone metastasis are rarer. In this present article, it is reported a clinical case of a 65 year old man with abdominal pain, diarrhea and facial flushing. The clinical examination demonstrated hard painless nodular hepatomegaly. Laboratory evaluation revealed anemia, elevated transaminases, GGT, AP, NSE and Chromogranin A, as well as elevated 5-HIAA (in 24h urine), above the superior reference level. CT scan revealed multiple hepatic lesions. Colonoscopy demonstrated an infiltrative polypoid lesion in the distal ileon, which its biopsy diagnosed as a carcinoid tumour. OctreoScan detected bone metastasis in D10-D12, having then received radiotherapy. Follow-up indicated tumoral progression. This is a report of a case of a carcinoid tumour with carcinoid syndrome at presentation, with hepatic and bone metastasis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Tumor carcinoide Síndrome do carcinoide maligno Metástase neoplásica Gastroenterologia