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Zhai LR, Zhang XW, Yu T, Jiang ZD, Huang DW, Jia Y, Cui MH. Primary ovarian carcinoid: Two cases report and review of literature. Medicine (Baltimore) 2020; 99:e21109. [PMID: 33019380 PMCID: PMC7535635 DOI: 10.1097/md.0000000000021109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Carcinoid tumor is one of the most frequent neuroendocrine tumors, and the majority of which are usually observed in the lungs and gastrointestinal tract. The prevalence of ovarian carcinoids is merely 0.1% in ovarian neoplasms and 1% in carcinoid tumors. We described 2 rare cases in our hospital of primary ovarian carcinoid (POC), causing carcinoid syndrome (CS) of the diarrhea, constipation, and carcinoid heart disease. Besides, we also reviewed related literatures about its origin, variant, clinical manifestation, diagnosis methods, pathological features, treatment strategies and prognosis from 2009 to 2019. PATIENT CONCERNS Case 1 was a 61-year-old postmenopausal woman and presented with diarrhea, abdominal pain, enlargement, bloating and dizziness. Case 2 was a 49-year-old patient who complained of constipation, abdominal pain, bloating, and headache. DIAGNOSIS Both patients were diagnosed as primary ovarian carcinoid, insular type. INTERVENTIONS Total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy, pelvic lymphadenectomy, and appendectomy without chemotherapy were performed in case 1. Cervix resection, right salpingo-oophorectomy, appendectomy, and pelvic lesion resection with chemotherapy was conducted in case 2. OUTCOMES Both patients achieved satisfactory treatment effects. The follow-up period was 18 and 17 months in case 1 and case 2, respectively. Case 1 encountered carcinoid heart disease and received percutaneous transluminal coronary angioplasty (PTCA) postoperatively. Case 2 suffered multiple metastases postoperatively. However, after effective treatment, both patients were in good condition during follow-up duration. CONCLUSION POC is an extraordinarily rare disease, and commonly with a satisfactory outcome. TAH+BSO with or without postoperative chemotherapy has been considered as an acceptable treatment strategy for POC patients.
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Affiliation(s)
| | | | | | | | - Dong-Wei Huang
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yan Jia
- Department of gynecology and Obstetrics
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Narula N, Narula N, Argulian E. The Thickened Valve. JACC Case Rep 2020; 2:1845-1848. [PMID: 34317064 PMCID: PMC8299234 DOI: 10.1016/j.jaccas.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Navneet Narula
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Nupoor Narula
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Edgar Argulian
- Department of Cardiology, Mount Sinai Hospital Morningside, New York, New York
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Sharma YP, Panda PK, Uppal L, Debi U. Case of calcific tricuspid and pulmonary valve stenosis. BMJ Case Rep 2020; 13:13/9/e235190. [PMID: 32900724 DOI: 10.1136/bcr-2020-235190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Isolated right-sided valvular disease is a much less recognised entity when compared with left-sided valvular heart disease. Almost all the cases of combined pulmonary valve with tricuspid valve involvement are a consequence of underlying carcinoid heart disease. Moreover, severe calcification of tricuspid valve is an extremely unusual finding. We report a case of a severe calcific tricuspid valve stenosis along with severe pulmonary valve stenosis where the exact aetiology could not be established. On reviewing the literature, we did not find any reports describing such a morphology.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Kumar Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Debi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Nath E, Sawyer MB, Choy J. First Case of Regression of Carcinoid Heart Disease on Serial Transthoracic Echocardiograms following Octreotide Monotherapy in a Patient with Metastatic Pancreatic Neuroendocrine Tumor. Case Rep Oncol 2020; 13:1454-1462. [PMID: 33442370 PMCID: PMC7772855 DOI: 10.1159/000511414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022] Open
Abstract
Well-differentiated neuroendocrine tumors (NETs) arising in the gastrointestinal (GI) tract and pancreas are relatively rare; however, the annual incidence has been increasing. Carcinoid syndrome (CS) is a constellation of symptoms that occur when a GI NET metastasizes to the liver and releases high levels of vasoactive substances into the systemic circulation. CS occurs in 19% of NETs patients at diagnosis and is associated with shorter survival. Carcinoid heart disease (CHD) occurs in over 50% of patients with CS and is associated with poor long-term prognosis. NET-induced valvular fibrosis is a significant cause of mortality and morbidity in these patients. Somatostatin analogs relieve CS symptoms, but they have never been shown to reverse CHD progression or improve overall survival. Surgical therapy for right-sided valve disease is associated with improved symptoms and quality of life and possibly improved survival, despite relatively high morbidity and mortality associated with cardiac intervention. A 65-year-old woman with a metastatic pancreatic NET had typical signs and symptoms of CS. She presented in congestive heart failure and was found to have severe tricuspid regurgitation with characteristic features of CHD on transthoracic echocardiogram (TTE). Following octreotide monotherapy, serial TTEs demonstrated regression of tricuspid valve involvement. The patient improved clinically and remained asymptomatic on subsequent visits. This is the first case of CHD regression with medical therapy supported by serial TTEs. Developing a deeper understanding of cases like this will help us unlock new intervention targets and strategies for treatments in the future.
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Affiliation(s)
- Ermin Nath
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Michael B. Sawyer
- Department of Medical Oncology, Cross Cancer Institute/University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Choy
- Adult Echocardiography Lab, Mazankowski Alberta Heart Institute, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
- Clinical Faculty, Department of Medicine, Division of Cardiology, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
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55
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Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World J Gastrointest Oncol 2020; 12:791-807. [PMID: 32879660 PMCID: PMC7443843 DOI: 10.4251/wjgo.v12.i8.791] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/26/2020] [Accepted: 07/19/2020] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal neuroendocrine tumors are rare slow-growing tumors with distinct histological, biological, and clinical characteristics that have increased in incidence and prevalence within the last few decades. They contain chromogranin A, synaptophysin and neuron-specific enolase which are necessary for making a diagnosis of neuroendocrine tumor. Ki-67 index and mitotic index correlate with cellular proliferation. Serum chromogranin A is the most commonly used biomarker to assess the bulk of disease and monitor treatment and is raised in both functioning and non-functioning neuroendocrine tumors. Most of the gastrointestinal neuroendocrine tumors are non-functional. World Health Organization updated the classification of neuroendocrine tumors in 2017 and renamed mixed adenoneuroendocrine carcinoma into mixed neuroendocrine neoplasm. Gastric neuroendocrine tumors arise from enterochromaffin like cells. They are classified into 4 types. Only type I and type II are gastrin dependent. Small intestinal neuroendocrine tumor is the most common small bowel malignancy. More than two-third of them occur in the terminal ileum within 60 cm of ileocecal valve. Patients with small intestinal neuroendrocrine tumors frequently show clinical symptoms and develop distant metastases more often than those with neuroendocrine tumors of other organs. Duodenal and jejuno-ileal neuroendocrine tumors are distinct biologically and clinically. Carcinoid syndrome generally occurs when jejuno-ileal neuroendocrine tumors metastasize to the liver. Appendiceal neuroendocrine tumors are generally detected after appendectomy. Colonic neuroendocrine tumors generally present as a large tumor with local or distant metastasis at the time of diagnosis. Rectal neuroendocrine tumors are increasingly being diagnosed since the implementation of screening colonoscopy in 2000. Gastrointestinal neuroendocrine tumors are diagnosed and staged by endoscopy with biopsy, endoscopic ultrasound, serology of biomarkers, imaging studies and functional somatostatin scans. Various treatment options are available for curative and palliative treatment of gastrointestinal neuroendocrine tumors.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
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56
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Fust K, Maschio M, Kohli M, Singh S, Pritchard DM, Marteau F, Myrenfors P, Feuilly M. A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome. PHARMACOECONOMICS 2020; 38:607-618. [PMID: 32157590 DOI: 10.1007/s40273-020-00896-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Carcinoid syndrome, a rare condition in patients with neuroendocrine tumours, characterised by flushing and diarrhoea, severely affects patients' quality of life. The current carcinoid syndrome standard of care includes somatostatin analogues, but some patients experience uncontrolled symptoms despite somatostatin analogue therapy. Telotristat ethyl is a novel treatment approved by the European Medicines Agency (EMA) and US FDA that significantly reduces bowel movement frequency in patients with uncontrolled carcinoid syndrome. OBJECTIVE We developed a model to evaluate the 5-year budget impact of introducing telotristat ethyl to standard care in Swedish patients with uncontrolled carcinoid syndrome. METHODS Treatment response in the 12-week phase III TELESTAR trial (NCT01677910) informed telotristat ethyl efficacy; subsequently, health states were captured by a Markov model using 4-week cycles. TELESTAR open-label extension data informed telotristat ethyl discontinuation. The number of treatment-eligible patients was estimated from literature reviews reporting the prevalence, incidence and mortality of carcinoid syndrome. A Swedish database study informed real-world costs related to carcinoid syndrome and carcinoid heart disease costs. Telotristat ethyl market share was assumed to increase annually from 24% (year 1) to 70% (year 5). RESULTS Over the 5-year model horizon, 44 patients were expected to initiate telotristat ethyl treatment. The cumulative net budget impact of adding telotristat ethyl to current standard of care was €172,346; per-year costs decreased from €66,495 (year 1) to €29,818 (year 5). Increased drug costs from adding telotristat ethyl were offset by reduced costs elsewhere. CONCLUSIONS The expected budget impact of adding telotristat ethyl to the standard of care in Sweden was relatively low, largely because of the rarity of carcinoid syndrome.
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Affiliation(s)
- Kelly Fust
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA
| | - Michael Maschio
- Formerly affiliated with Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Michele Kohli
- Formerly affiliated with Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Simron Singh
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - D Mark Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
| | - Florence Marteau
- Ipsen Pharma, 65 Quai Georges Gorse, 92100, Boulogne-Billancourt, France
| | | | - Marion Feuilly
- Ipsen Pharma, 65 Quai Georges Gorse, 92100, Boulogne-Billancourt, France.
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57
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Tran CG, Sherman SK, Howe JR. Small Bowel Neuroendocrine Tumors. Curr Probl Surg 2020; 57:100823. [PMID: 33234227 DOI: 10.1016/j.cpsurg.2020.100823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Scott K Sherman
- Division of Surgical Oncology and Endocrine Surgery, University of lowa Carver College of Medicine, lowa City, lowa
| | - James R Howe
- Division of Surgical Oncology and Endocrine Surgery, University of lowa Carver College of Medicine, lowa City, lowa.
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58
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Gade AK, Olariu E, Douthit NT. Carcinoid Syndrome: A Review. Cureus 2020; 12:e7186. [PMID: 32257725 PMCID: PMC7124884 DOI: 10.7759/cureus.7186] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
Carcinoid syndrome (CS) is a paraneoplastic syndrome caused by the release of serotonin and other substances from well-differentiated neuroendocrine tumors (NETs). The hallmark symptoms of carcinoid syndrome are flushing and diarrhea; atypical signs and symptoms can include wheezing, abdominal pain, valvular heart disease, telangiectasias, pellagra, and the complications of mesenteric fibrosis, including ureteral obstruction, bowel obstruction, and bowel ischemia. These symptoms are mediated by the release of serotonin (5-HT), histamine, kallikrein, prostaglandins, and tachykinins. The diagnosis of CS requires these symptoms and corresponding elevations in lab tests. Treatment options include surgery and medical management with somatostatin analogs.
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Affiliation(s)
- Ajay K Gade
- Internal Medicine, Brookwood Baptist Medical Center, Birmingham, USA
| | - Eva Olariu
- Internal Medicine, Brookwood Baptist Health, Birmingham, USA
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59
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Cardiac Magnetic Resonance for Diagnosis of Neuroendocrine Tumor Metastases to the Right and Left Ventricles with Carcinoid Heart Disease. Case Rep Cardiol 2019; 2019:8746413. [PMID: 31885933 PMCID: PMC6915124 DOI: 10.1155/2019/8746413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/20/2019] [Accepted: 10/04/2019] [Indexed: 12/03/2022] Open
Abstract
A 76-year-old male with a small bowel neuroendocrine tumor with hepatic metastases presented with new onset lower extremity swelling, bloating, and weight gain which ultimately lead to cardiac magnetic resonance (CMR) to evaluate for cardiac involvement of disease. CMR showed right and left ventricular myocardial metastases along with findings suggestive of carcinoid heart disease. The patient had severe tricuspid valve regurgitation necessitating surgical valve repair. The patient underwent bioprosthetic tricuspid valve replacement and debulking of the metastases with surgical pathology confirming neuroendocrine tumor metastases. Follow-up clinical evaluations at 3, 6, and 9 months postoperatively showed improvement in cardiac function and stable hepatic tumor burden. This case demonstrates the utility of CMR to diagnose myocardial metastases and carcinoid heart disease complicated by severe tricuspid regurgitation, which guided surgical management.
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Abstract
Neuroendocrine tumors (NETs) originate from the neuroendocrine cell system in the bronchial and gastrointestinal tract and can produce hormones leading to distinct clinical syndromes. Systemic treatment of patients with unresectable NETs aims to control symptoms related to hormonal overproduction and tumor growth. In the last decades prognosis has improved as a result of increased detection of early stage disease and the introduction of somatostatin analogs (SSAs) as well as several new therapeutic options. SSAs are the first-line medical treatment of NETs and can control hormonal production and tumor growth. The development of next-generation multireceptor targeted and radiolabelled somatostatin analogs, as well as target-directed therapies (as second-line treatment options) further improve progression-free survival in NET patients. To date, however, a significant prolongation of overall survival with systemic treatment in NET has not been convincingly demonstrated. Several new medical options and treatment combinations will become available in the upcoming years, and although preliminary results of preclinical and clinical trials are encouraging, large, preferrably randomized clinical studies are required to provide definitive evidence of their effect on survival and symptom control.
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62
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Saavedra C, Barriuso J, McNamara MG, Valle JW, Lamarca A. Spotlight on telotristat ethyl for the treatment of carcinoid syndrome diarrhea: patient selection and reported outcomes. Cancer Manag Res 2019; 11:7537-7556. [PMID: 31496810 PMCID: PMC6690650 DOI: 10.2147/cmar.s181439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022] Open
Abstract
Neuroendocrine tumors (NETs) are rare cancers with an associated prolonged survival in some patients. A proportion of patients diagnosed with NETs will present with carcinoid syndrome symptoms, characterized by diarrhea, flushing and/or wheezing. This review summarizes the current treatment options for carcinoid syndrome, focusing on the latest novel treatment option, telotristat ethyl. In addition, information on patient-reported outcomes and impact of carcinoid syndrome on quality of life (QOL) and improvement of following treatment with telotristat ethyl are reviewed. This article also provides an overview of the current QOL questionnaires for patients with NETs and addresses unmet needs in this field of patient-reported outcomes.
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Affiliation(s)
- Cristina Saavedra
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK.,Medical Oncology Department, Ramon Y Cajal University Hospital, Madrid, Spain
| | - Jorge Barriuso
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Mairéad G McNamara
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Juan W Valle
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Angela Lamarca
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
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63
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The heart matters: a review of incidental cardiac uptake on Ga-68 DOTA peptide PET-CT scans. Nucl Med Commun 2019; 40:1081-1085. [PMID: 31365503 DOI: 10.1097/mnm.0000000000001064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the frequency and relative significance of incidental cardiac uptake on 68Ga-DOTA-peptide PET-CT scans in patients with neuroendocrine tumours/genetic syndromes expressing somatostatin receptors. METHODS Scans of 1463 patients who underwent 68Ga-DOTA-peptide PET-CT scans in our department between 2013 and 2018 were retrospectively evaluated for the presence of uptake in the heart and/or its appendages. RESULTS out of 1463 patients (1.3%) demonstrated uptake of radio-peptide in the heart and/or its appendages. In 18 out of these 19 patients, the clinicians were unaware of possible cardiac involvement (one patient was a known case of cardiac paraganglioma). The primary neuroendocrine tumours and genetic syndromes associated with those with cardiac uptake of 68Ga-DOTA-peptide were as follows: unknown primary (n = 7), small bowel (n = 6), colon (n = 2), caecum (n = 1), pancreas (n = 1), cardiac paraganglioma (n = 1), Von Hippel Lindau syndrome (n = 1). Amongst the patients with neuroendocrine tumours, demonstrating cardiac uptake of 68Ga-DOTA-peptide, there was no clear association with carcinoid heart disease. DISCUSSION Our results are in agreement with established literature. The exact prognostic implication of cardiac involvement in patients with neuroendocrine tumours as well as other genetic syndromes expressing somatostatin receptors is unknown. We hypothesize that early detection and confirmation of cardiac metastasis(es) in these patients and introduction of different treatment regimes (such as Peptide Receptor Radionuclide Therapy), earlier in the course of the disease would reduce the disease burden on the heart and therefore contribute to better patient outcomes. CONCLUSION Cardiac involvement is a rare and hitherto less well-studied occurrence in neuroendocrine tumours, with an incidence in the range of 1%. To assess the possible prognostic implications, further detailed multicentre studies are required.
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Anthony LB, Kulke MH, Caplin ME, Bergsland E, Öberg K, Pavel M, Hörsch D, Warner RRP, O'Dorisio TM, Dillon JS, Lapuerta P, Kassler-Taub K, Jiang W. Long-Term Safety Experience with Telotristat Ethyl Across Five Clinical Studies in Patients with Carcinoid Syndrome. Oncologist 2019; 24:e662-e670. [PMID: 30651397 PMCID: PMC6693702 DOI: 10.1634/theoncologist.2018-0236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 11/20/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with neuroendocrine tumors (NETs) and carcinoid syndrome experience considerable morbidity and mortality; carcinoid syndrome may be associated with shorter survival. Carcinoid syndrome is linked to tumoral secretion of serotonin and other bioactive substances. The subsequent debilitating diarrhea and urgency to defecate pose significant health risks. In previous studies, telotristat ethyl, a tryptophan hydroxylase inhibitor, was effective and well tolerated in treating carcinoid syndrome diarrhea. We present pooled safety data from five clinical trials with telotristat ethyl in patients with carcinoid syndrome. SUBJECTS, MATERIALS, AND METHODS Adverse events reported during telotristat ethyl treatment were pooled from two phase II and three phase III clinical trials in 239 patients with carcinoid syndrome. Long-term safety of telotristat ethyl and causes of hospitalization and death were reviewed; overall survival was estimated. RESULTS Mean (median; range) duration of exposure and follow-up was 1.3 years (1.1 years; 1 week to 5.7 years), with 309 total patient-years of exposure. Leading causes of hospitalization were gastrointestinal disorders or were related to the underlying tumor and related treatment. Survival estimates at 1, 2, and 3 years were 93%, 88%, and 77%. Nearly all deaths were due to progression or complication of the underlying disease; none were attributable to telotristat ethyl. There was one death in year 4. CONCLUSION Based on long-term safety data, telotristat ethyl is well tolerated and has a favorable long-term safety profile in patients with carcinoid syndrome. IMPLICATIONS FOR PRACTICE Carcinoid syndrome can cause persistent diarrhea, even in patients treated with somatostatin analogs. Across five clinical trials in patients with carcinoid syndrome, telotristat ethyl has been well tolerated and efficacious, providing clinicians with a new approach to help control carcinoid syndrome diarrhea, in addition to somatostatin analog therapy. By reducing the stool frequency in patients with carcinoid syndrome whose diarrhea is refractory to anticholinergics, such as loperamide and atropine/diphenoxylate, and somatostatin analog dose escalation, improvement in quality of life becomes an achievable goal.
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Affiliation(s)
- Lowell B Anthony
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew H Kulke
- Boston University Medical Center, Boston, Massachusetts, USA
| | - Martyn E Caplin
- Neuroendocrine Tumor Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Emily Bergsland
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | - Marianne Pavel
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin, Berlin, Germany
| | - Dieter Hörsch
- Department of Gastroenterology/Endocrinology, Center for Neuroendocrine Tumors, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Richard R P Warner
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine - Endocrinology and Metabolism, University of Iowa, Iowa City, Iowa, USA
| | - Joseph S Dillon
- Department of Internal Medicine - Endocrinology and Metabolism, University of Iowa, Iowa City, Iowa, USA
| | - Pablo Lapuerta
- Lexicon Pharmaceuticals, Inc., The Woodlands, Texas, USA
| | | | - Wenjun Jiang
- Lexicon Pharmaceuticals, Inc., The Woodlands, Texas, USA
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65
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Nguyen A, Schaff HV, Abel MD, Luis SA, Lahr BD, Halfdanarson TR, Connolly HM. Improving outcome of valve replacement for carcinoid heart disease. J Thorac Cardiovasc Surg 2019; 158:99-107.e2. [DOI: 10.1016/j.jtcvs.2018.09.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 12/18/2022]
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66
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Stueven AK, Kayser A, Wetz C, Amthauer H, Wree A, Tacke F, Wiedenmann B, Roderburg C, Jann H. Somatostatin Analogues in the Treatment of Neuroendocrine Tumors: Past, Present and Future. Int J Mol Sci 2019; 20:ijms20123049. [PMID: 31234481 PMCID: PMC6627451 DOI: 10.3390/ijms20123049] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/06/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
In recent decades, the incidence of neuroendocrine tumors (NETs) has steadily increased. Due to the slow-growing nature of these tumors and the lack of early symptoms, most cases are diagnosed at advanced stages, when curative treatment options are no longer available. Prognosis and survival of patients with NETs are determined by the location of the primary lesion, biochemical functional status, differentiation, initial staging, and response to treatment. Somatostatin analogue (SSA) therapy has been a mainstay of antisecretory therapy in functioning neuroendocrine tumors, which cause various clinical symptoms depending on hormonal hypersecretion. Beyond symptomatic management, recent research demonstrates that SSAs exert antiproliferative effects and inhibit tumor growth via the somatostatin receptor 2 (SSTR2). Both the PROMID (placebo-controlled, prospective, randomized study in patients with metastatic neuroendocrine midgut tumors) and the CLARINET (controlled study of lanreotide antiproliferative response in neuroendocrine tumors) trial showed a statistically significant prolongation of time to progression/progression-free survival (TTP/PFS) upon SSA treatment, compared to placebo. Moreover, the combination of SSA with peptide receptor radionuclide therapy (PRRT) in small intestinal NETs has proven efficacy in the phase 3 neuroendocrine tumours therapy (NETTER 1) trial. PRRT is currently being tested for enteropancreatic NETs versus everolimus in the COMPETE trial, and the potential of SSTR-antagonists in PRRT is now being evaluated in early phase I/II clinical trials. This review provides a synopsis on the pharmacological development of SSAs and their use as antisecretory drugs. Moreover, this review highlights the clinical evidence of SSAs in monotherapy, and in combination with other treatment modalities, as applied to the antiproliferative management of neuroendocrine tumors with special attention to recent high-quality phase III trials.
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Affiliation(s)
- Anna Kathrin Stueven
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Antonin Kayser
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Christoph Wetz
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Nuclear Medicine, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Holger Amthauer
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Nuclear Medicine, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Alexander Wree
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Frank Tacke
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Bertram Wiedenmann
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Christoph Roderburg
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Henning Jann
- Charité, Campus Virchow Klinikum and Charité, Campus Mitte, Department of Hepatology and Gastroenterology, Universitätsmedizin Berlin, 10117 Berlin, Germany.
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Agha AM, Lopez-Mattei J, Donisan T, Balanescu D, Iliescu CA, Banchs J, Kim PY, Palaskas NL, Yusuf S, Gladish G, Hassan S. Multimodality imaging in carcinoid heart disease. Open Heart 2019; 6:e001060. [PMID: 31245014 PMCID: PMC6560671 DOI: 10.1136/openhrt-2019-001060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 01/05/2023] Open
Abstract
Neuroendocrine neoplasms arise from the gastrointestinal tract and can lead to carcinoid syndrome. Carcinoid heart disease affects more than half of these patients and is the initial presentation of carcinoid syndrome in up to 20 % of patients. Carcinoid heart disease typically leads to valve dysfunction, but in rare instances, carcinoid tumours can also metastasise to the endocardium and myocardium. Cardiovascular imaging plays an integral role in the diagnosis and prognosis of carcinoid heart disease. The use of multimodality imaging techniques including echocardiography, cardiac MRI, cardiovascular CT and positron emission tomography have allowed for a more comprehensive assessment of carcinoid heart disease. In this review, we discuss the features of carcinoid heart disease observed on multimodality imaging, indications for obtaining imaging studies and their role in carcinoid heart disease management.
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Affiliation(s)
- Ali M Agha
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Diagnostic Radiology, Division of Diagnostic Imaging, he University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Teodora Donisan
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dinu Balanescu
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cezar A Iliescu
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Banchs
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Y Kim
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolas L Palaskas
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed Yusuf
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Greg Gladish
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, he University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saamir Hassan
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Fortier JH, Pizzarotti B, Shaw RE, Levy RJ, Ferrari G, Grau J. Drug-associated valvular heart diseases and serotonin-related pathways: a meta-analysis. Heart 2019; 105:1140-1148. [PMID: 31129607 DOI: 10.1136/heartjnl-2018-314403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Serotonergic appetite suppressants and ergot-derived dopamine agonists have been associated with drug-induced valvular heart disease. The purpose of this meta-analysis is to synthesise the current evidence of a link between several medications affecting sertonergic pathways and valvular heart disease. METHODS PubMed was searched to identify studies evaluating an association between medications with serotonergic activity and cardiac valvular pathology. Case reports, uncontrolled studies and in vitro studies were excluded. Relevant studies were assessed for quality and potential bias; those of adequate quality were included in a quantitative synthesis. Sensitivity analyses were conducted, and potential publication bias was examined. RESULTS There was a consistent, significant relationship between certain medications and heart valve disease, including serotonergic medications (OR 3.30, 95% CI 1.99 to 5.49) and dopaminergic medications (OR 2.56, 95% CI 1.68 to 3.91). Subanalyses, including analyses that limited exposure to a single medication or effects to a single heart valve were also consistently significant. Most studies were retrospective or observational in nature, with a higher risk of selection and presentation biases. There was significant heterogeneity and variability between studies, particularly when it came to dose and duration of exposure. CONCLUSIONS There was a consistent, significant association between many medications that affect serotonergic pathways and valvular heart disease. Although many of these medications have been withdrawn from the market, some small studies suggest that recreational drug 3,4-methylenedioxymethamphetamine and widely prescribed selective serotonin reuptake inhibitors may affect similar pathways.
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Affiliation(s)
- Jacqueline H Fortier
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Robert J Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Giovanni Ferrari
- Department of Surgery, Columbia University, New York City, New York, USA
| | - Juan Grau
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Mamotabo RM. Cases in a series of carcinoid syndrome and carcinoid heart disease. Cardiovasc J Afr 2019; 29:e1-e7. [PMID: 30204224 PMCID: PMC6421557 DOI: 10.5830/cvja-2018-040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/24/2018] [Indexed: 12/05/2022] Open
Abstract
Although carcinoid syndrome is regarded as a rare entity, carcinoid patients with evidence of cardiac involvement show a markedly reduced survival time. Patients with advanced signs of right-sided heart failure represent a subgroup at particularly high risk. Echocardiography remains the gold standard to diagnose or confirm structural cardiac involvement in patients with underlying carcinoid disease. This is the notion that propelled us to report on cases of carcinoid syndrome with cardiac involvement. We also review carcinoid syndrome and carcinoid heart disease, and challenges regarding the diagnosis and management of carcinoid heart disease.
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Affiliation(s)
- R Matshela Mamotabo
- University of KwaZulu-Natal, Durban, South Africa; Mediclinic Heart Hospital, Pretoria, South Africa; London School of Economics and Political Science, London, UK
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Abstract
OBJECTIVE Neuroendocrine tumors (NETs) comprise 41.8% of small intestine malignancies. The NET nomogram is a 15-item prognostic tool that includes relevant factors for guiding management decisions. This is the first external validation of this tool among American patients at a tertiary treatment center. METHODS Patients who underwent surgical intervention from 2005 to 2017 were screened by retrospective chart review. Nomogram scores were calculated following the methods outlined by Modlin et al (Neuroendocrinology. 2010;92:143-157). Validation assessed the association between nomogram scores and survival using Wilcoxon test and Cox regression. RESULTS Among the 121 patients selected, the NET nomogram significantly predicted survival as a continuous variable (P < 0.01) and when dichotomized using 83 points to distinguish low-risk versus high-risk groups (P < 0.01). However, the nomogram was not universally applicable as even at our specialty center, variables such as chromogranin A and urinary 5-hydroxyindoleacetic acid are not routinely collected, whereas others, like tumor grade, do not reflect the most recently updated classifications. CONCLUSION The NET nomogram accurately identified patients at low and high risk of death. However, revision to update prognosticators could improve its usefulness for predicting survival of small intestine NETs.
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Uema D, Alves C, Mesquita M, Nuñez JE, Siepmann T, Angel M, Rego JFM, Weschenfelder R, Rocha Filho DR, Costa FP, Barros M, O'Connor JM, Illigens BM, Riechelmann RP. Carcinoid Heart Disease and Decreased Overall Survival among Patients with Neuroendocrine Tumors: A Retrospective Multicenter Latin American Cohort Study. J Clin Med 2019; 8:jcm8030405. [PMID: 30909590 PMCID: PMC6463128 DOI: 10.3390/jcm8030405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 01/22/2023] Open
Abstract
The background to this study was that factors associated with carcinoid heart disease (CHD) and its impacts on overall survival (OS) are scantly investigated in patients (pts) with neuroendocrine tumors (NETs). In terms of materials and methods, a retrospective multicenter cohort study was conducted of factors associated with CHD in advanced NET pts with carcinoid syndrome (CS) and/or elevated urinary 5-hidroxyindole acetic acid (u5HIAA). CHD was defined as at least moderate right valve alterations. The results were the following: Among the 139 subjects included, the majority had a midgut NET (54.2%), 81.3% had CS, and 93% received somatostatin analogues. In a median follow-up of 39 months, 48 (34.5%) pts developed CHD, with a higher frequency in pts treated in public (77.2%) versus private settings (22.9%). In a multivariate logistic regression, unknown primary or colorectal NETs (Odds Ratio (OR) 4.35; p = 0.002), at least 50% liver involvement (OR 3.45; p = 0.005), and being treated in public settings (OR 4.76; p = 0.001) were associated with CHD. In a Cox multivariate regression, bone metastases (Hazard Ratio {HR} 2.8; p = 0.031), CHD (HR 2.63; p = 0.038), and a resection of the primary tumor (HR 0.33; p = 0.026) influenced the risk of death. The conclusions were the following: The incidence of CHD was higher in pts with a high hepatic tumor burden and in those treated in a public system. Delayed diagnosis and limited access to effective therapies negatively affected the lives of NET patients.
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Affiliation(s)
- Deise Uema
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany.
| | - Carolina Alves
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil.
| | - Marcella Mesquita
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil.
| | - Jose Eduardo Nuñez
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo 01246-000, Brazil.
- Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil.
| | - Tim Siepmann
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany.
| | - Martin Angel
- Instituto Alexander Fleming, C1426ANZ Buenos Aires, Argentina.
| | - Julian F M Rego
- Hospital Universitário Onofre Lopes, Natal 59012-300, Brazil.
| | | | | | | | - Milton Barros
- Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil.
| | - Juan M O'Connor
- Hospital de Gastroenterología Bonorino Udaondo, C1264AAA Buenos Aires, Argentina.
| | - Ben M Illigens
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, 01067 Dresden, Germany.
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02114, USA.
| | - Rachel P Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, Sao Paulo 01509-900, Brazil.
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Joish VN, Shah S, Tierce JC, Patel D, McKee C, Lapuerta P, Zacks J. Serotonin levels and 1-year mortality in patients with neuroendocrine tumors: a systematic review and meta-analysis. Future Oncol 2019; 15:1397-1406. [PMID: 30734573 DOI: 10.2217/fon-2018-0960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Elevated serotonin in patients with neuroendocrine tumors (NETs) may impact heart failure incidence but a quantitative relationship has not been established. Materials & methods: Systematic review and meta-analysis of studies assessing 24-h urinary 5-hydroxyindoleacetic acid (u5-HIAA) and mortality in patients with NETs (2007-2017) with a primary outcome of 1-year mortality risk and 24-h u5-HIAA. Results: We identified 1715 records of which 12 studies including 755 patients (3442 person-years with 376 deaths) were eligible for meta-analysis. Mean u5-HIAA was 149.2 mg/24 h (standard deviation: 96.6) and mortality was 13.0%. The meta-regression equation showed an 11.8% (95% CI: 8.9-17.0%; I2 = 93.0%) increase in 1-year mortality for every ten-unit increase in u5-HIAA. Conclusion: Serotonin measured by its metabolite u5-HIAA is predictive of 1-year all-cause mortality in patients with NETs.
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Affiliation(s)
- Vijay N Joish
- Lexicon Pharmaceuticals, Inc., The Woodlands, TX 77381, USA
| | | | | | | | - Chad McKee
- Lexicon Pharmaceuticals, Inc., The Woodlands, TX 77381, USA
| | - Pablo Lapuerta
- Lexicon Pharmaceuticals, Inc., The Woodlands, TX 77381, USA
| | - Jerome Zacks
- Icahn School of Medicine, Center for Carcinoid and Neuroendocrine Tumors, Mount Sinai Health System, New York, NY 10029, USA
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Ram P, Penalver JL, Lo KBU, Rangaswami J, Pressman GS. Carcinoid Heart Disease: Review of Current Knowledge. Tex Heart Inst J 2019. [PMID: 30833833 DOI: 10.14503/thij-17-65623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.
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Ram P, Penalver JL, Lo KBU, Rangaswami J, Pressman GS. Carcinoid Heart Disease: Review of Current Knowledge. Tex Heart Inst J 2019; 46:21-27. [PMID: 30833833 DOI: 10.14503/thij-17-6562] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Carcinoid heart disease is the collective term for all cardiac manifestations in patients who have carcinoid syndrome. Carcinoid heart disease has a multifactorial pathophysiology, and the right side of the heart is usually involved. Symptoms and signs vary depending upon the affected cardiac components; most typical is right-sided heart failure secondary to diseased tricuspid and pulmonary valves. Despite no single ideal diagnostic test, strong suspicion, coupled with serologic and imaging results, usually enables diagnosis. Advances in imaging, such as speckle-tracking echocardiography and cardiac magnetic resonance, have improved the diagnostic yield. Treatment is challenging, warrants a multidisciplinary approach, and can be medical or surgical depending on the cardiac manifestations. Investigators are exploring the therapeutic use of monoclonal antibodies and new somatostatin analogues. In this review, we cover current knowledge about the pathophysiology, diagnosis, and treatment of carcinoid heart disease.
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75
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Mujtaba SS, Clark S. Quadruple Valve Replacement for Carcinoid Heart Disease. Braz J Cardiovasc Surg 2019; 33:398-403. [PMID: 30184038 PMCID: PMC6122765 DOI: 10.21470/1678-9741-2017-0224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/26/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. METHODS All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours. RESULTS Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases. CONCLUSION Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.
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Affiliation(s)
- Syed Saleem Mujtaba
- Freeman Hospital Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Freeman Hospital Newcastle, United Kingdom of Great Britain and Northern Ireland
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Tsoli M, Chatzellis E, Koumarianou A, Kolomodi D, Kaltsas G. Current best practice in the management of neuroendocrine tumors. Ther Adv Endocrinol Metab 2019; 10:2042018818804698. [PMID: 30800264 PMCID: PMC6378464 DOI: 10.1177/2042018818804698] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/13/2022] Open
Abstract
Neuroendocrine neoplasms are rare tumors that display marked heterogeneity with varying natural history, biological behavior, response to therapy and prognosis. Their management is complex, particularly as a number of them may be associated with a secretory syndrome and involve a variety of options. A number of factors such as proliferation rate, degree of differentiation, functionality and extent of the disease are mostly utilized to tailor treatment accordingly, ideally in the context of a multidisciplinary team. In addition, a number of relevant scientific societies have published therapeutic guidelines in an attempt to direct and promote evidence-based treatment. Surgery remains the treatment of choice with an intention to cure while it may also be recommended in some cases of metastatic disease and difficult to control secretory syndromes. Long-acting somatostatin analogs constitute the main treatment for the majority of functioning tumors, whereas specific evolving agents such as telotristat may be used for the control of carcinoid syndrome and related sequelae. In patients with advanced disease not amenable to surgical resection, treatment options include locoregional therapies, long-acting somatostatin analogs, molecular targeted agents, radionuclides, chemotherapy and recently immunotherapy, alone or in combination. However, the ideal time of treatment initiation, sequence of administration of different therapies and identification of robust prognostic markers to select the most appropriate treatment for each individual patient still need to be defined.
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Affiliation(s)
| | - Eleftherios Chatzellis
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Anna Koumarianou
- Fourth Department of Internal Medicine, Attikon
University General Hospital, Athens, Greece
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Gregory Kaltsas
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
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Haferkamp SF, Cherukuri SV, Valasareddi SL, Skandhan A. Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%. BMJ Case Rep 2018; 11:11/1/e226000. [DOI: 10.1136/bcr-2018-226000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Anaemia can present with symptoms of fatigue, shortness of breath, weakness, malaise, tachycardia and skin pallor. If left untreated, this can progress to life-threatening complications such as arrhythmias, cardiac hypertrophy and myocardial infarction. In this report, a 43-year-old woman, who was ambulatory with no exertional dysponea, presented with weakness, fatigue, bilateral lower extremity oedema and intermittent right sided chest pain for several months. This patient was subsequently found to have a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%. She was admitted to the hospital and treated with seven units of blood. CT scan showed a 9.6 cm uterine fibroid in addition to a 5.9×5.4 cm mass near the right kidney, which was later diagnosed as metastatic carcinoid tumour. This case deserves attention due to the importance of looking for multiple causes of blood loss and the effects of low haemoglobin levels.
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78
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Alsaad AA, Rojas CA. Cardiac CT Angiography in Carcinoid Heart Disease. Radiology 2018; 290:32. [PMID: 30375927 DOI: 10.1148/radiol.2018181966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ali A Alsaad
- From the Department of Medicine, Division of Cardiology, University of Chicago-NorthShore University HealthSystem, 2680 Ridge Ave, Evanston, IL 60202 (A.A.A.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (C.A.R.)
| | - Carlos A Rojas
- From the Department of Medicine, Division of Cardiology, University of Chicago-NorthShore University HealthSystem, 2680 Ridge Ave, Evanston, IL 60202 (A.A.A.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (C.A.R.)
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Das S, Pineda G, Berlin J, Hemphill B, Moslehi J, Nohria A, Fisher G. Hidden Figures: Occult Intra-Cardiac Metastases in Asymptomatic Neuroendocrine Tumor Patients. JOURNAL OF ONCOLOGY AND CANCER RESEARCH 2018; 2:23-27. [PMID: 31388651 PMCID: PMC6684348 DOI: 10.28967/jocr.2018.02.18005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Carcinoid heart disease is a devastating paraneoplastic consequence of unchecked hormone production from neuroendocrine tumors (NET) and often results in right-sided heart failure. While it occurs frequently in NET patients with carcinoid syndrome, cardiac metastases occur much less often and are usually only incidentally found. Gallium-68 dotatate (ga-68) is an imaging tracer which binds to somatostatin receptor 2 with greater avidity than Indium-111, the tracer used commonly in octreotide scans. Ga-68 PET/CT is the most sensitive study for detecting occult NET metastases and has emerged as the current imaging gold standard. We describe two cases from Vanderbilt University Medical Center and Stanford University Medical Center where asymptomatic patients with well-differentiated midgut NET were diagnosed with intra-cardiac metastases using ga-68 PET/CT. Management of these patients was altered based on the findings as they underwent extensive cardiac evaluation and initiation of therapy with octreotide. Fortunately, they have not suffered life-threatening cardiac complications seen in some NET patients, from other published series, such as bradycardia, heart block, syncope and arrhythmias. These possibilities suggest early cardiology evaluation and consideration of other therapies beyond octreotide, such as surgery or PRRT, may be essential for all NET patients found to have intra-cardiac metastases.
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Affiliation(s)
- Satya Das
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gino Pineda
- Division of Hematology and Oncology, Department of Internal Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Jordan Berlin
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Javid Moslehi
- Division of Cardiology, Department of Internal Medicine, Vanderbilt University Medical Center, USA
| | - Anju Nohria
- Division of Cardiology, Department of Internal Medicine, Dana Farber Cancer Institute, USA
| | - George Fisher
- Division of Hematology and Oncology, Department of Internal Medicine, Stanford University Medical Center, Stanford, CA, USA
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Abstract
We present the case of a 35-year-old woman with metastatic neuroendocrine tumor undergoing treatment with long-acting octreotide and Lu-DOTATATE therapy. We present features of carcinoid heart disease on Ga-DOTANOC PET/CT, which revealed dilated right atrium, pericardial effusion, ascites, and congestive hepatopathy apart from the metastatic lesions in the liver. The scan cardiac findings were confirmed by echocardiography. This highlights the significance of identifying such patients early because additional management is required for carcinoid heart disease per se and a cautious approach is needed in administering amino acid infusion during PRRT that can result in fluid overload.
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Pavel M, Gross DJ, Benavent M, Perros P, Srirajaskanthan R, Warner RRP, Kulke MH, Anthony LB, Kunz PL, Hörsch D, Weickert MO, Lapuerta P, Jiang W, Kassler-Taub K, Wason S, Fleming R, Fleming D, Garcia-Carbonero R. Telotristat ethyl in carcinoid syndrome: safety and efficacy in the TELECAST phase 3 trial. Endocr Relat Cancer 2018; 25:309-322. [PMID: 29330194 PMCID: PMC5811631 DOI: 10.1530/erc-17-0455] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022]
Abstract
Telotristat ethyl, a tryptophan hydroxylase inhibitor, was efficacious and well tolerated in the phase 3 TELESTAR study in patients with carcinoid syndrome (CS) experiencing ≥4 bowel movements per day (BMs/day) while on somatostatin analogs (SSAs). TELECAST, a phase 3 companion study, assessed the safety and efficacy of telotristat ethyl in patients with CS (diarrhea, flushing, abdominal pain, nausea or elevated urinary 5-hydroxyindoleacetic acid (u5-HIAA)) with <4 BMs/day on SSAs (or ≥1 symptom or ≥4 BMs/day if not on SSAs) during a 12-week double-blind treatment period followed by a 36-week open-label extension (OLE). The primary safety and efficacy endpoints were incidence of treatment-emergent adverse events (TEAEs) and percent change from baseline in 24-h u5-HIAA at week 12. Patients (N = 76) were randomly assigned (1:1:1) to receive placebo or telotristat ethyl 250 mg or 500 mg 3 times per day (tid); 67 continued receiving telotristat ethyl 500 mg tid during the OLE. Through week 12, TEAEs were generally mild to moderate in severity; 5 (placebo), 1 (telotristat ethyl 250 mg) and 3 (telotristat ethyl 500 mg) patients experienced serious events, and the rate of TEAEs in the OLE was comparable. At week 12, significant reductions in u5-HIAA from baseline were observed, with Hodges-Lehmann estimators of median treatment differences from placebo of -54.0% (95% confidence limits, -85.0%, -25.1%, P < 0.001) and -89.7% (95% confidence limits, -113.1%, -63.9%, P < 0.001) for telotristat ethyl 250 mg and 500 mg. These results support the safety and efficacy of telotristat ethyl when added to SSAs in patients with CS diarrhea (ClinicalTrials.gov identifier: Nbib2063659).
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Affiliation(s)
- Marianne Pavel
- Department of Gastroenterology and HepatologyCharité-Universitätsmedizin, Berlin, Germany
| | - David J Gross
- Neuroendocrine Tumor UnitEndocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marta Benavent
- Laboratorio de Oncología Molecular y Nuevas TerapiasInstituto de Biomedicina de Sevilla, Sevilla, Spain
- Department of EndocrinologyRoyal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Petros Perros
- Department of EndocrinologyRoyal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Raj Srirajaskanthan
- Neuroendocrine Tumour UnitInstitute of Liver Studies, Kings College Hospital, London, UK
| | - Richard R P Warner
- Division of GastroenterologyIcahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew H Kulke
- Medical Oncology/Solid Tumor OncologyDana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lowell B Anthony
- Division of Medical OncologyUniversity of Kentucky, Lexington, Kentucky, USA
| | - Pamela L Kunz
- Department of MedicineStanford University School of Medicine, Palo Alto, California, USA
| | - Dieter Hörsch
- Department of Gastroenterology/EndocrinologyZentralklinik Bad Berka, Bad Berka, Germany
| | - Martin O Weickert
- The ARDEN NET CentreENETS Centre of Excellence, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Wenjun Jiang
- Lexicon PharmaceuticalsInc., The Woodlands, Texas, USA
| | | | - Suman Wason
- Lexicon PharmaceuticalsInc., The Woodlands, Texas, USA
| | | | | | - Rocio Garcia-Carbonero
- Oncology DepartmentHospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), UCM, CNIO, CIBERONC, Madrid, Spain
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82
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Soyano AE, Kassi M, Kasi PM. Neuroendocrine Tumor Involving the Epicardium. Case Rep Oncol 2017; 10:1144-1149. [PMID: 29430241 PMCID: PMC5803682 DOI: 10.1159/000485560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/22/2023] Open
Abstract
Neuroendocrine tumors (NETs) are rare malignancies that usually arise from the digestive tract or lungs. Metastases of NETs to the heart (epicardium) are a rare complication. We present a case of a metastatic NET involving the epicardium.
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Affiliation(s)
- Aixa E Soyano
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Mahwash Kassi
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Pashtoon M Kasi
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
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83
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Yuan SM. Valvular Disorders in Carcinoid Heart Disease. Braz J Cardiovasc Surg 2017; 31:400-405. [PMID: 27982350 PMCID: PMC5144560 DOI: 10.5935/1678-9741.20160079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/16/2016] [Indexed: 12/28/2022] Open
Abstract
Carcinoid heart disease is a rare but important cause of intrinsic right heart valve disorders leading to right heart failure. Occasionally, left-sided heart valves may also be involved. The characteristic cardiac pathological findings of carcinoid heart disease are endocardial thickening as a result of fibrous deposits on the endocardium. Echocardiographic examination and right heart catheterization are very useful for the diagnosis of the lesion. If more cardiac valves are affected, multiple valve replacement should be considered. The management of the pulmonary valve lesion depends on the extent of the diseased valve, either by valvulotomy, valvectomy, or valve replacement. Percutaneous valve implantations in the pulmonary and in the inferior vena cava positions have been advocated for high-risk patients.
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Affiliation(s)
- Shi-Min Yuan
- MMed, PhD. The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Fujian Province, China
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84
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Hammersley D, Shamsi A, Zaman MM, Berry P, Sturridge L. An unusual cause of hypoxia: getting to the heart of the matter. Echo Res Pract 2017; 5:ERP-17-0055. [PMID: 29217649 PMCID: PMC5744623 DOI: 10.1530/erp-17-0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/08/2017] [Indexed: 11/12/2022] Open
Abstract
A 63 year old female presented to hospital with progressive exertional dyspnoea over a 6 month period. In the year preceding her admission, she reported an intercurrent history of abdominal pain, diarrhoea and weight loss. She was found to be hypoxic, the cause for which was initially unclear. A ventilation-perfusion scan identified a right-to-left shunt. Transoesophageal echocardiography (TOE) demonstrated a significant right-to-left intracardiac shunt through a patent foramen ovale (PFO); additionally severe tricuspid regurgitation was noted through a highly abnormal tricuspid valve. The findings were consistent with carcinoid heart disease with a haemodynamically significant shunt, resulting in profound systemic hypoxia. 24 hour urinary 5-Hydroxyindoleacetic acid (5-HIAA) and imaging were consistent with a terminal ileal primary carcinoid cancer with hepatic metastasis. Liver biopsy confirmed a tissue diagnosis. The patient was commenced on medical therapy for carcinoid syndrome. She subsequently passed away while undergoing anaesthetic induction for valvular surgery to treat her carcinoid heart disease and PFO.
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Affiliation(s)
| | | | | | - Philip Berry
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
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85
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Laskaratos F, Rombouts K, Caplin M, Toumpanakis C, Thirlwell C, Mandair D. Neuroendocrine tumors and fibrosis: An unsolved mystery? Cancer 2017; 123:4770-4790. [DOI: 10.1002/cncr.31079] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/02/2017] [Accepted: 09/25/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Krista Rombouts
- Regenerative Medicine and Fibrosis Group, Institute for Liver and Digestive HealthUniversity College London, Royal Free HospitalLondon United Kingdom
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondon United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondon United Kingdom
| | - Christina Thirlwell
- Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondon United Kingdom
- University College London Cancer InstituteUniversity College LondonLondon United Kingdom
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, ENETS Centre of ExcellenceRoyal Free HospitalLondon United Kingdom
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86
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Baxi AJ, Chintapalli K, Katkar A, Restrepo CS, Betancourt SL, Sunnapwar A. Multimodality Imaging Findings in Carcinoid Tumors: A Head-to-Toe Spectrum. Radiographics 2017; 37:516-536. [PMID: 28287937 DOI: 10.1148/rg.2017160113] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Carcinoid tumors are a rare biologically heterogeneous group of neuroendocrine tumors with a spectrum ranging from benign indolent to aggressive metastatic tumors. They belong to the category of amine precursor uptake and decarboxylase tumors, or apudomas. The most common sites for primary locations are the gastrointestinal and respiratory tracts; however, any organ can be involved. The clinical presentation depends on location, aggressiveness, production of biologically active amines and peptides, paraneoplastic syndromes, and tendency for metastasis. Their reported age-adjusted incidence has increased in recent years, partly due to improved detection at radiologic imaging and endoscopy. Not a ll neuroendocrine cell tumors are carcinoids. Numerous systems have been proposed regarding their nomenclature and classification. Cross-sectional and functional imaging plays an important role in diagnosis, lesion characterization, and staging. Awareness of nomenclature, classification, common sites of involvement, and imaging presentation are pivotal for making the diagnosis. Knowledge of the diverse clinical, pathologic, and radiologic spectrum of carcinoid tumors involving various organs of the body is important for diagnosis and patient management. ©RSNA, 2017.
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Affiliation(s)
- Ameya Jagdish Baxi
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Kedar Chintapalli
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Amol Katkar
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Carlos S Restrepo
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Sonia L Betancourt
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
| | - Abhijit Sunnapwar
- From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900 (A.J.B., K.C., A.K., C.S.R., A.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.L.B.)
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87
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Surgical treatment of carcinoid syndrome metastatic disease: Partial hepatectomy with veno-venous bypass and subsequent tricuspid valve replacement. Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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88
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Giraldo M, Harle C, Lopera-Velásquez LM, Dobkowsky W. Tratamiento quirúrgico de la enfermedad metastásica del síndrome carcinoide: hepatectomía parcial usando un bypass veno-venoso y posterior cambio valvular tricúspide. Reporte de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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89
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Surgical treatment of carcinoid syndrome metastatic disease: Partial hepatectomy with veno-venous bypass and subsequent tricuspid valve replacement. Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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90
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Nardozza M, Mele D, Ferrari R. Noninvasive evaluation of right hemodynamics in carcinoid heart disease: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:355-361. [PMID: 27753110 DOI: 10.1002/jcu.22413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/06/2016] [Accepted: 09/01/2016] [Indexed: 06/06/2023]
Abstract
We report the case of a 67-year-old woman with a carcinoid tumor of midgut origin who developed carcinoid heart disease and died because of bowel perforation. Echocardiography allowed the diagnosis, recognizing the typical abnormalities of tricuspid and pulmonary valve leaflets. The sonographic examination also evidenced peculiar alterations of the right heart hemodynamics: end-diastolic reversal of flow at the level of the pulmonary valve, reduced respiratory excursion without enlargement of the inferior vena cava, and biphasic hepatic venous flow without respiratory variation. Echocardiography allowed both the diagnosis and the accurate assessment of the hemodynamic consequences of the disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:355-361, 2017.
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Affiliation(s)
- Marianna Nardozza
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy
| | - Donato Mele
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy
| | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy
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91
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Abstract
The cardiac manifestations of a neuroendocrine tumour are referred to as carcinoid heart disease (CaHD) and are associated with a poor prognosis. Surgical intervention is the only proven therapeutic option and may prolong survival and quality of life. No consensus has been reached internationally with regard to screening for CaHD and the optimal timing for surgery. Although limited evidence is available on this matter, a trend towards early surgery and subsequent reduced mortality has been observed. In this review we provide an overview of the current understanding and propose a protocol to guide cardiologists in the screening for CaHD and the timing of referral to a specialised surgical centre.
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92
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Bertin N, Favretto S, Pelizzo F, Mos L, Pertoldi F, Vriz O. Carcinoid Heart Disease: Starting From Heart Failure. J Investig Med High Impact Case Rep 2017. [PMID: 28634593 PMCID: PMC5468767 DOI: 10.1177/2324709617713511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Carcinoid syndrome is the constellation of symptoms mediated by humoral factors produced by some carcinoid tumors. It consists primarily of vasomotor symptoms, gastrointestinal hypermotility, hypotension, and bronchospasm, due to the production and release of vasoactive substances. Carcinoid heart disease occurs in more than 50% of patients with carcinoid syndrome; in some cases, it represents the initial manifestation of the disease. We report the case of a 75-year-old woman with a metastatic neuroendocrine tumor admitted to the emergency room for fatigue and heart failure. Transthoracic echocardiography showed severe tricuspid and pulmonic regurgitation suggesting carcinoid heart disease. A hypervascular retroperitoneal mass was found on abdominal computed tomography, which seemed to arise from the mesenteric artery, anteriorly to the abdominal aorta. Unfortunately, our patient was neither a candidate for mass resection nor for cardiac surgery due to advanced metastatic disease and poor clinical condition. Additionally, we performed a systematic literature review of carcinoid heart disease focusing on typical echocardiographic findings.
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Affiliation(s)
| | | | | | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | - Olga Vriz
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
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93
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Hassan SA, Banchs J, Iliescu C, Dasari A, Lopez-Mattei J, Yusuf SW. Carcinoid heart disease. Heart 2017; 103:1488-1495. [DOI: 10.1136/heartjnl-2017-311261] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 12/28/2022] Open
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Barnes D, Gutiérrez Chacoff J, Benegas M, Perea RJ, de Caralt TM, Ramirez J, Vollmer I, Sanchez M. Central airway pathology: clinic features, CT findings with pathologic and virtual endoscopy correlation. Insights Imaging 2017; 8:255-270. [PMID: 28197883 PMCID: PMC5359148 DOI: 10.1007/s13244-017-0545-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Objectives To describe the imaging features of the central airway pathology, correlating the findings with those in pathology and virtual endoscopy. To propose a schematic and practical approach to reach diagnoses, placing strong emphasis on multidetector computed tomography (MDCT) findings. Methods We reviewed our thoracic pathology database and the central airway pathology-related literature. Best cases were selected to illustrate the main features of each disease. MDCT was performed in all cases. Multiplanar and volume-rendering reconstructions were obtained when necessary. Virtual endoscopy was obtained from the CT with dedicated software. Results Pathological conditions affecting the central airways are a heterogeneous group of diseases. Focal alterations include benign neoplasms, malignant neoplasms, and non-neoplastic conditions. Diffuse abnormalities are divided into those that produce dilation and those that produce stenosis and tracheobronchomalacia. Direct bronchoscopy (DB) visualises the mucosal layer and is an important diagnostic and therapeutic weapon. However, assessing the deep layers or the adjacent tissue is not possible. MDCT and post-processing techniques such as virtual bronchoscopy (VB) provide an excellent evaluation of the airway wall. Conclusion This review presents the complete spectrum of the central airway pathology with its clinical, pathological and radiological features. Teaching points • Dividing diseases into diffuse and focal lesions helps narrow the differential diagnosis. • Focal lesions with nodularity are more likely to correspond to tumours. • Focal lesions with stenosis are more likely to correspond to inflammatory disease. • Posterior wall involvement is the main feature in diffuse lesions with stenosis.
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Affiliation(s)
- Daniel Barnes
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | | | - Mariana Benegas
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Rosario J Perea
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Teresa M de Caralt
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Ramirez
- Pathology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marcelo Sanchez
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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95
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Stougiannos P, Michas G, Evdoridis C, Arapantoni-Dadioti P, Tolios P, Kaplanis I, Trikas A. Carcinoid heart disease in an elderly female patient: the value of transthoracic echocardiography. Hellenic J Cardiol 2017; 58:65-68. [PMID: 28163144 DOI: 10.1016/j.hjc.2017.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Pavlos Stougiannos
- Department of Cardiology, "Elpis" General Hospital of Athens, Athens, Greece
| | - George Michas
- Department of Cardiology, "Elpis" General Hospital of Athens, Athens, Greece
| | | | | | - Panagiotis Tolios
- Department of Cardiology, "Elpis" General Hospital of Athens, Athens, Greece
| | - Ioannis Kaplanis
- Department of Cardiology, "Elpis" General Hospital of Athens, Athens, Greece
| | - Athanasios Trikas
- Department of Cardiology, "Elpis" General Hospital of Athens, Athens, Greece.
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96
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Carcinoid Disease. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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97
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Kulke MH, Hörsch D, Caplin ME, Anthony LB, Bergsland E, Öberg K, Welin S, Warner RR, Lombard-Bohas C, Kunz PL, Grande E, Valle JW, Fleming D, Lapuerta P, Banks P, Jackson S, Zambrowicz B, Sands AT, Pavel M. Telotristat Ethyl, a Tryptophan Hydroxylase Inhibitor for the Treatment of Carcinoid Syndrome. J Clin Oncol 2017; 35:14-23. [DOI: 10.1200/jco.2016.69.2780] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Preliminary studies suggested that telotristat ethyl, a tryptophan hydroxylase inhibitor, reduces bowel movement (BM) frequency in patients with carcinoid syndrome. This placebo-controlled phase III study evaluated telotristat ethyl in this setting. Patients and Methods Patients (N = 135) experiencing four or more BMs per day despite stable-dose somatostatin analog therapy received (1:1:1) placebo, telotristat ethyl 250 mg, or telotristat ethyl 500 mg three times per day orally during a 12-week double-blind treatment period. The primary end point was change from baseline in BM frequency. In an open-label extension, 115 patients subsequently received telotristat ethyl 500 mg. Results Estimated differences in BM frequency per day versus placebo averaged over 12 weeks were –0.81 for telotristat ethyl 250 mg ( P < .001) and ‒0.69 for telotristat ethyl 500 mg ( P < .001). At week 12, mean BM frequency reductions per day for placebo, telotristat ethyl 250 mg, and telotristat ethyl 500 mg were –0.9, –1.7, and –2.1, respectively. Responses, predefined as a BM frequency reduction ≥ 30% from baseline for ≥ 50% of the double-blind treatment period, were observed in 20%, 44%, and 42% of patients given placebo, telotristat ethyl 250 mg, and telotristat ethyl 500 mg, respectively. Both telotristat ethyl dosages significantly reduced mean urinary 5-hydroxyindole acetic acid versus placebo at week 12 ( P < .001). Mild nausea and asymptomatic increases in gamma-glutamyl transferase were observed in some patients receiving telotristat ethyl. Follow-up of patients during the open-label extension revealed no new safety signals and suggested sustained BM responses to treatment. Conclusion Among patients with carcinoid syndrome not adequately controlled by somatostatin analogs, treatment with telotristat ethyl was generally safe and well tolerated and resulted in significant reductions in BM frequency and urinary 5-hydroxyindole acetic acid.
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Affiliation(s)
- Matthew H. Kulke
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Dieter Hörsch
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Martyn E. Caplin
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Lowell B. Anthony
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Emily Bergsland
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Kjell Öberg
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Staffan Welin
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Richard R.P. Warner
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Catherine Lombard-Bohas
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Pamela L. Kunz
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Enrique Grande
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Juan W. Valle
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Douglas Fleming
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Pablo Lapuerta
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Phillip Banks
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Shanna Jackson
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Brian Zambrowicz
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Arthur T. Sands
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
| | - Marianne Pavel
- Matthew H. Kulke, Dana-Farber Cancer Institute, Boston; Douglas Fleming, Ipsen Bioscience, Cambridge, MA; Dieter Hörsch, Zentralklinik Bad Berka, Bad Berka; Marianne Pavel, Charité-Universitätsmedizin, Berlin, Germany; Martyn E. Caplin, Royal Free Hospital, London; Juan W. Valle, The University of Manchester-The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Lowell B. Anthony, University of Kentucky, Lexington, KY; Emily Bergsland, University of California at San Francisco
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Loyalka P, Schechter M, Nascimbene A, Raman AS, Ilieascu CA, Gregoric ID, Kar B. Transcatheter Pulmonary Valve Replacement in a Carcinoid Heart. Tex Heart Inst J 2016; 43:341-4. [PMID: 27547148 DOI: 10.14503/thij-15-5310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.
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99
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T K, H L, O L, V C, L B. Carcinoid Heart Disease in a Primary Ovarian Carcinoid. ACTA CARDIOLOGICA SINICA 2016; 32:112-5. [PMID: 27122940 DOI: 10.6515/acs20150221a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Ovarian carcinoids are very rare, and only their insular form is associated with carcinoid syndrome. We herein describe a case report of an elderly woman who presented with typical carcinoid syndrome, which is routinely characterized by right-sided heart failure, diarrhoea, flushes, and other common manifestations. Further examination and biochemical testing of the patient confirmed suspected carcinoid tumor. However, the tumor was surprisingly localized in the left ovary. The presence of the patient's severe combined tricuspid valve disease would create impossible surgical management conditions, so we decided to first perform cardio-surgery with tricuspid valve replacement. After tumor removal, levels of hydroxyindolacetic acid did not normalize and although the patient was asymptomatic, a small lesion was detected by tectrotyd scan paravertebrally. Treatment with lanreotide led to complete remission with negative biochemical and imaging signs of tumor. Thus, to summarize, carcinoid tumor even in an atypical localization (ovary) should be considered in elderly female patients with severe combined tricuspid valve disease due to carcinoid syndrome. KEY WORDS Carcinoid syndrome; Ovarian carcinoid; Tricuspid valve.
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Affiliation(s)
- Kolouch T
- Cardiocentre of Faculty Hospital Vinohrady and 3rd Faculty of Medicine
| | - Linkova H
- Cardiocentre of Faculty Hospital Vinohrady and 3rd Faculty of Medicine
| | - Lang O
- Department of Nuclear Medicine
| | | | - Brunerova L
- II. Department of Internal Medicine, Faculty Hospital Kralovské Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic, Europe
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100
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Carcinoid Syndrome-Induced Ventricular Tachycardia. Case Rep Cardiol 2016; 2016:9142598. [PMID: 27088017 PMCID: PMC4819085 DOI: 10.1155/2016/9142598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/23/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction. Carcinoid tumors are rare neuroendocrine malignancies that secrete multiple bioactive substances. These bioactive substances are responsible for the carcinoid syndrome characterized by diarrhea, flushing, syncope, and right-sided valvular heart disease. Previous case reports have described carcinoid syndrome associated with coronary vasospasm and the well-characterized carcinoid heart disease. Case. Our patient is a 73-year-old female with complex past medical history most notable for metastatic carcinoid tumors diagnosed in 2013-05. She initially presented in 2014-09 with syncope and dizziness associated with sinus pause on an event monitor. She received a pacemaker given normal left ventricular function and was discharged. However, she was readmitted with similar symptoms corresponding to multiple episodes of ventricular tachycardia. She was started on high-dose beta blockade and has had no recurrence of arrhythmia over a follow-up period of 12 months. Conclusion. We hypothesize that the patient's ventricular tachycardia was mediated by the multiple bioactive substances secreted by her carcinoid tumors. Her carcinoid tumor biomarkers were elevated and other explanations for arrhythmia were investigated and ruled out. To our knowledge, this is the first case of ventricular tachycardia mediated by carcinoid syndrome and suppressed by beta-blocker. Further investigation into this relationship is needed.
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