Carcinoid heart disease secondary to ovarian tumour: a logical sequence of management? (original) (raw)
Related papers
2020
Cite as: Albareda J, de Meo S, Merinero MD, Alemany I, Robles P. Primary carcinoid tumour of the ovary presenting with carcinoid heart disease. Rev Peru Ginecol Obstet. 2020;66(4). DOI: https://doi.org/10.31403/ rpgo.v66i2295 ABSTRACT Primary ovarian carcinoid tumor is a rare neoplasm characterized by the production of vasoactive substances that enter the bloodstream and give rise to the so-called carcinoid syndrome. These substances may also cause fibrotic plaques in the heart valves, mainly those in the right cardiac chambers. We describe the case of a primary ovarian carcinoid tumor with tricuspid valve involvement in which the diagnosis was prompted by identification of cardiac involvement. Knowledge of the clinical manifestations of neuroendocrine tumors is important in diagnosis and patient management. Recognition of typical clinical features may help suggest the correct diagnosis. Multidisciplinary discussion allows the formulation of a comprehensive management strategy invol...
Journal of perioperative echocardiography, 2023
The breathlessness progressed from New York Heart Association I to IV in addition to swelling of the feet and platypnea. She had no history of joint pain, oral ulceration, skin rash, photosensitivity, or flushing. After admission, the patient was medically managed with antibiotics, diuretics, antihypertensive, and anticoagulants. Upon detailed investigations, DOTANOC showed increased somatostatin receptor uptake in the uterine neuroendocrine cell, 24 hours urinary 5-hydroxyindoleacetic acid and serum chromogranin A were positive. The hemogram, electrolytes, and renal and liver functions were within normal limits. The room air saturation in the supine position was 88%, while saturation was reduced to 80% on assuming the sitting position. Magnetic resonance imaging (MRI) revealed a large heterogeneous pelvic mass with necrosis (10 × 14 × 9) IntroductIon Carcinoid tumors are neuroendocrine tumors arising primarily from the small bowel. The incidence is 1-2 per lakh people. 1 Around 20-30% of individuals develop carcinoid syndrome due to the release of vasoactive substances like histamine, serotonin, bradykinin, and prostaglandin. It is manifested in the form of episodic vasomotor symptom, hypotension, diarrhea, bronchospasm, and right heart failure due to CHD. Carcinoid heart disease (CHD) develops in 20-30% of patients with a carcinoid tumor, which has a very poor outcome. 2 The median life expectancy is approximately 5.9 years without CHD, whereas reduced to 2.6 years with CHD. 3 Therefore, screening for cardiac involvement is vital in patients with novel carcinoid syndrome. Carcinoid tumors of the small bowel, followed by the lung, large bowel, pancreas, appendix, and ovaries, have the highest incidence of HD. It is characterized by the deposition of carcinoid plaque (myofibroblast and collagen in the myxoid matrix), mainly around the right heart structure. Tricuspid regurgitation and mixed pulmonary stenosis and regurgitation are the major manifestations that may result in right heart failure. Here, we are reporting a case of CHD with a primary tumor located at the ovary that had undergone salpingo-oophorectomy and TV replacement and both aortic and mitral valve repair in the same setting. case descrIptIon A 69-year-old female patient was admitted with symptoms of congestive heart failure. Initially, the patient complained of recurrent diarrhea on and off refractory to treatment, pain in the abdomen, and a mass in the lower abdomen for which she had undergone routine investigations and ultrasound. Ultrasound revealed a mass (11 × 8.8 × 11.3 cm) attached to the uterus. She also reported progressive dyspnea, swelling of the legs, chronic fatigue, and about 20 kg weight loss over a period of 6 months.
A 15-year comprehensive literature review of 99 primary ovarian carcinoid tumors
Clinical and Experimental Obstetrics & Gynecology
Objective: Primary ovarian carcinoids are neuroendocrine tumors, representing up to 1% of all ovarian tumors. In this paper, the authors aimed at analyzing the clinical and pathological aspects of all recently published ovarian carcinoid, providing new correlations regarding them. Mechanism: The authors have reviewed all cases of primary ovarian carcinoid reported in international journals since 2005 to date. A total of 99 cases published in 68 articles have been found and analyzed. Findings in brief: Our results up to 29.31% of patients presented with carcinoid heart disease, and 17.24% had an abdominal mass, which caused them to present to the physician. Patients presenting with metastases had more frequently the insular subtype (33.33%) and had similar median age as those without metastases. A teratoma component was noticed in 58.9% of cases and was also associated with the insular pattern of carcinoid. To our best knowledge, this paper includes the largest review of primary ovarian carcinoid to date. Conclusions: The incidence of carcinoid heart disease might have been underestimated up to this moment, thus, requiring further imagistic investigations of patients presenting with these symptoms. Additionally, the insular variant was most frequently associated with the presence of both teratoma (52.94%) and metastases (33.33%), although previous reports have noticed a higher incidence of teratoma in the mucinous variant. In our opinion, these apparently divergent results warrant further studies of this rare subtype of ovarian tumor.
Carcinoid heart disease: a case report and literature review
Journal of Clinical Anesthesia, 2002
We report a patient who presented for elective exploratory laparotomy, and resection of a pelvic mass, which was thought to be ovarian carcinoma. Intraoperative transesophageal echocardiography demonstrated right-sided valvular heart lesions, which suggested the diagnosis of carcinoid syndrome before a pathologic confirmation was obtained. This article discusses the classical presentation and anesthetic management of patients with carcinoid syndrome and emphasizes the importance of proper preoperative diagnosis and careful planning if the incidence and severity of the symptoms that this condition can provoke are to be reduced.
Carcinoid heart disease: presentation, diagnosis, and management
Heart, 2004
T ricuspid and pulmonary valve regurgitation usually occurs as a secondary phenomenon caused by dilatation of the valve ring secondary to right ventricular failure or pulmonary hypertension, respectively. Primary diseases of the tricuspid or pulmonary valves are uncommon, but the more likely causes might include congenital abnormalities, rheumatic heart disease, or infective endocarditis. Carcinoid heart disease is a rare, but interesting and important cause of intrinsic tricuspid and pulmonary valve disease leading to significant morbidity and mortality caused by right heart failure. When treated medically, and in appropriate cases surgically, significant benefits in overall quality of life and long term survival can be achieved. We review the current literature regarding the pathophysiological basis of the disease, the cardiovascular complications, and the currently available treatment strategies.
Carcinoid Heart Disease and Review of Literature
Heart Research - Open Journal, 2017
Carcinoid Heart Disease (CHD) is one of the rare causes of acquired valvular heart disease. CHD develops as a systemic manifestation of metastatic neuroendocrine tumors (NETs). When these tumors metastasize to the liver, they can release vasoactive amines into the systemic circulation, which can result in carcinoid syndrome and CHD. The key for diagnosing CHD is a thorough history and physical examination supplemented with characteristic echocardiographic findings. We report a case with classic echocardiographic features of CHD, which unfolded the diagnosis of metastatic carcinoid tumor.