Case Report
American Journal of Gastroenterology (1998) 93, 1945–1948; doi:10.1111/j.1572-0241.1998.00551.x
Multimodality treatment for gastric carcinoid tumor with liver metastases
M E Caplin BSc Hons, MRCP1, H J Hodgson DM, FRCP2, A P Dhillon MD, FRCPath.3, R Begent MD, FRCP4, J Buscombe MD, FRCP5, R Dick FRCP, FRCR6, K Rolles FRCS7 and A K Burroughs FRCP1
- 1Department of Medicine, Royal Free Hospital School of Medicine, London, England, United Kingdom
- 3Department of Histopathology, Royal Free Hospital School of Medicine, London, England, United Kingdom
- 4Department of Oncology, Royal Free Hospital School of Medicine, London, England, United Kingdom
- 5Department of Nuclear Medicine, Royal Free Hospital School of Medicine, London, England, United Kingdom
- 6Department of Radiology Royal Free Hospital School of Medicine, London, England, United Kingdom
- 7Department of Surgery, Royal Free Hospital School of Medicine, London, England, United Kingdom
- 2Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, England, United Kingdom
Correspondence: Dr Martyn Caplin, Department of Medicine, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF, UK
Received 10 October 1997; Revised 0000; Accepted 29 May 1998.
Abstract
Carcinoid tumors are the most common neuroendocrine tumors in the gastrointestinal tract, and between 10% and 30% of these tumors are gastric in origin. Three types of gastric carcinoid tumors are recognized: type I, associated with chronic atrophic gastritis type A; type II, associated with multiple endocrine neoplasia; and type III, sporadic and the most malignant. We present a patient with an aggressive, sporadic-type gastric carcinoid that metastasized to the liver. Her symptomatic treatment included the somatostatin analog octreotide. Octreotide scintigraphy demonstrated that this tumor avidly bound the peptide. The patient's gastric carcinoid (assessed by endoscopy and endoscopic ultrasound) regressed and she underwent hepatic artery embolization for her liver metastases. After initial partial CT resolution the tumor grew, compressing the inferior vena cava. The patient underwent orthotopic liver transplant with excellent recovery, although she was subsequently found to have two small lung metastases. She has responded well to adjuvant Indium-111 octreotide receptor targeted therapy. This case highlights the therapeutic options for metastatic neuroendocrine tumors, including liver transplantation and adjuvant receptor targeted therapy.
