Differentiating carcinoid syndrome from other diseases: Difference between revisions
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| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* Gross [[bloody diarrhea]] +/- | * Gross [[bloody diarrhea]] +/- | ||
* [[Weight loss]] | * [[Weight loss]] | ||
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* | * | ||
* [[Weight loss]] | * [[Weight loss]] | ||
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| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign cutaneous flushing]] | | colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign cutaneous flushing]] | ||
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| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* [[Maculopapular rash]] | * [[Maculopapular rash]] | ||
* [[Pruritus]] | * [[Pruritus]] | ||
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| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* Diffuse [[musculoskeletal pain]] | * Diffuse [[musculoskeletal pain]] | ||
* [[Neuropsychiatric symptoms]] | * [[Neuropsychiatric symptoms]] | ||
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* Serum [[Tryptase]] levels | * Serum [[Tryptase]] levels | ||
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| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anaphylaxis]] | | colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anaphylaxis]] | ||
| + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| -/+ | | style="background: #F5F5F5; padding: 5px;" | -/+ | ||
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* [[Vomiting]] | * [[Vomiting]] | ||
* [[Hives|Generalized hives]], | * [[Hives|Generalized hives]], | ||
* [[Pruritus]] | * [[Pruritus]] | ||
* [[Itching]] | * [[Itching]] | ||
| +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* Swollen [[lips]]-[[tongue]]-[[uvula]] | * Swollen [[lips]]-[[tongue]]-[[uvula]] | ||
* [[Periorbital edema]], | * [[Periorbital edema]], | ||
* [[Conjunctival|Conjunctival swelling]] | * [[Conjunctival|Conjunctival swelling]] | ||
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* plasma [[tryptase]] | * plasma [[tryptase]] | ||
* Plasm[[Histamine|a histamine]] levels | * Plasm[[Histamine|a histamine]] levels | ||
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* [[Enzyme linked immunosorbent assay (ELISA)|enzyme-linked immunosorbent assays (ELISAs)]] for quantification of allergen-specific [[IgE]] levels | * [[Enzyme linked immunosorbent assay (ELISA)|enzyme-linked immunosorbent assays (ELISAs)]] for quantification of allergen-specific [[IgE]] levels | ||
* | * | ||
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|History of exposure to [[Insect allergy|insect]] stings,food alllergy,rubber latex,food [[Additives|additives,]],allergy to medications,physical factors such s excercise and cold | |History of exposure to [[Insect allergy|insect]] stings,food alllergy,rubber latex,food [[Additives|additives,]],allergy to medications,physical factors such s excercise and cold | ||
|- | |- | ||
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Histaminergic [[Angioedema]] | | colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Histaminergic [[Angioedema]] | ||
| +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
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* Generalized [[pruritus]] | * Generalized [[pruritus]] | ||
* [[Throat]] tightness | * [[Throat]] tightness | ||
* [[Hoarse voice]] | * [[Hoarse voice]] | ||
* [[Difficulty swallowing]] | * [[Difficulty swallowing]] | ||
| + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* [[Urticaria]] | * [[Urticaria]] | ||
* Localized [[swelling]] of [[skin]] | * Localized [[swelling]] of [[skin]] | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| - | | style="background: #F5F5F5; padding: 5px;" |- | ||
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* [[Bowel|Bowel wall]] edema | * [[Bowel|Bowel wall]] edema | ||
* Circumferential thickening of the [[Small bowel|small bowel wall]] with [[ascites]] or incomplete [[obstruction]] | * Circumferential thickening of the [[Small bowel|small bowel wall]] with [[ascites]] or incomplete [[obstruction]] | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* [[CBC|CBC with differential,]] | * [[CBC|CBC with differential,]] | ||
* [[Electrolyte|Electrolytes]] | * [[Electrolyte|Electrolytes]] | ||
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* Serum tota[[Tryptase|l tryptase]] | * Serum tota[[Tryptase|l tryptase]] | ||
* Allergen-specific [[IgE immunoassay|IgE immunoassays]] | * Allergen-specific [[IgE immunoassay|IgE immunoassays]] | ||
| - | | style="background: #F5F5F5; padding: 5px;" |- | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| - | | style="background: #F5F5F5; padding: 5px;" | - | ||
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* Take proper clinical history of previous similar episodes | * Take proper clinical history of previous similar episodes | ||
* Medication history | * Medication history |
Revision as of 16:04, 5 May 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
Carcinoid syndrome must be differentiated from systemic mastocytosis, medullary thyroid carcinoma, irritable bowel syndrome, malignant neoplasms of the small intestine, benign cutaneous flushing, and recurrent idiopathic anaphylaxis.
Differentiating Carcinoid Syndrome from other Diseases
Carcinoid syndrome must be differentiated from:[1]
- Systemic mastocytosis
- Medullary thyroid carcinoma
- Irritable bowel syndrome
- Malignant neoplasms of the small intestine
- Benign cutaneous flushing
- Recurrent idiopathic anaphylaxis
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | ||||||||||||||||||||||||
Lab Findings | Imaging | Histopathology | |||||||||||||||||||||||
Abdominal pain | Diarrhea | Flushing | Dyspnea | Palpitations | Other symptoms | Wheezing | Telangiectasia | Hypotension | Tachycardia | Systolic murmur of tricuspid regurgitation | Other physical findings | Urinary 5-hydroxyindoleacetic acid (5-HIAA) | Serum Chromogranin A (CgA) | Other markers | Abdominal computed tomography (CT) | Abdominal MRI | Somatostatin receptor scintigraphy [SRS], or Octreoscan | Metaiodobenzylguanidine (MIBG) scintigraphy | Other diagnostic studies | Transthoracic echocardiography | |||||
Carcinoid Syndrome[2][3][4][5][6][7][8][9][10] | Neuroendocrine tumor of midgut [11][12][13][14] | +
Mild |
+
|
+ | + | + |
Metastatic tumors in the liver: Right upper quadrant pain, hepatomegaly, and early satiety |
+ | +/- | +/- | + | + | - | + | + |
|
|
|
+
|
+ |
|
|
|
|
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Neuroendocrine tumor of lung[15][16][17][18] | + | + | + | + | + |
|
+ | +/- | +/- | + | + | - | + | + |
|
Sensitive for detection of liver metastases if present | + | + |
|
- | Typical low-grade:bland cells containing regular round nuclei with finely dispersed chromatin and inconspicuous small nucleoli.Mitotic figures are scarce and necrosis is absent.
Intermediate-grade atypical: presence of Neuroendocrine morphology and either necrosis or 2 to 10 mitoses per 10 HPF |
| |||
Irritable Bowel Syndrome | +
Perioidic |
|
- | - | - | - | - | - | - | - | - | - | - | - | - | - |
|
- | - | Rome IV criteria
•Related to defecation •Associated with a change in stool frequency •Associated with a change in stool form (appearance) |
|||||
Malignant neoplasms of small intestine | +/- | +/- | - | - | +/- |
|
- | - | +/- | - | * Abdominal mass | - | + | Abdominal CT scan may be diagnostic of small intestine cancer. Findings on CT scan suggestive of small intestine cancer include intrinsic mass with a short segment of bowel wall thickening | MRI and MRI enteroscopy are other advance modalities to diagnose and stage small intestinal cancers | - | - | Enteroscopy, capsule endoscopy and double balloon enteroscopy |
|
Biopsy and histopathology | |||||
Crohn disease[19] | +/- | - | - | - |
|
- | - | - | - | - |
|
- | - |
|
- | - |
|
- |
|
|
|||||
Benign cutaneous flushing | - | - | + | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | |||
Systemic mastocytosis | + | + | + | + | - | +/- | +/- | + | - | - | - | - | - | - | |||||||||||
Asthma exacerbation | - | - | - | + | + | + | - | - | + | - | - | - | Chest X ray | ||||||||||||
Anaphylaxis | + | -/+ | + | + | + | +/- | - | + | + | - | - | - | - | - | - |
|
- | - | History of exposure to insect stings,food alllergy,rubber latex,food additives,,allergy to medications,physical factors such s excercise and cold | ||||||
Histaminergic Angioedema | +/- | +/- | + | + | + |
|
+ | - | + | + | - | - | - | - |
|
- | - | - |
|
- | - | - |
| ||
Medullary Thyroid Carcinoma | - | +/- | +/- | +/- | - | - | - | - | - | - | - | - |
|
- | - | - |
|
- |
|
|
References
- ↑ Metcalfe DD (2000). "Differential diagnosis of the patient with unexplained flushing/anaphylaxis". Allergy Asthma Proc. 21 (1): 21–4. PMID 10748948.
- ↑ Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP (August 2018). "Carcinoid syndrome: update on the pathophysiology and treatment". Clinics (Sao Paulo). 73 (suppl 1): e490s. doi:10.6061/clinics/2018/e490s. PMC 6096975. PMID 30133565.
- ↑ Hegyi J, Schwartz RA, Hegyi V (January 2004). "Pellagra: dermatitis, dementia, and diarrhea". Int. J. Dermatol. 43 (1): 1–5. PMID 14693013.
- ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
- ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
- ↑ Bora, ManashKumar; Vithiavathi, S (2012). "Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient". Lung India. 29 (1): 59. doi:10.4103/0970-2113.92366. ISSN 0970-2113.
- ↑ Yazıcıoğlu A, Yekeler E, Bıcakcıoğlu P, Ozaydın E, Karaoğlanoğlu N (December 2012). "Synchronous bilateral multiple typical pulmonary carcinoid tumors: a unique case with 10 typical carcinoids". Balkan Med J. 29 (4): 450–2. doi:10.5152/balkanmedj.2012.081. PMC 4115868. PMID 25207053.
- ↑ Krausz Y, Keidar Z, Kogan I, Even-Sapir E, Bar-Shalom R, Engel A, Rubinstein R, Sachs J, Bocher M, Agranovicz S, Chisin R, Israel O (November 2003). "SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours". Clin. Endocrinol. (Oxf). 59 (5): 565–73. PMID 14616879.
- ↑ van der Lely, Aart J.; Herder, Wouter W. de (2005). "Carcinoid syndrome: diagnosis and medical management". Arquivos Brasileiros de Endocrinologia & Metabologia. 49 (5): 850–860. doi:10.1590/S0004-27302005000500028. ISSN 0004-2730.
- ↑ Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, Shih YT, Yao JC (April 2017). "Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study". Lancet Oncol. 18 (4): 525–534. doi:10.1016/S1470-2045(17)30110-9. PMC 6066284. PMID 28238592.
- ↑ Sjöblom SM (September 1988). "Clinical presentation and prognosis of gastrointestinal carcinoid tumours". Scand. J. Gastroenterol. 23 (7): 779–87. PMID 3227292.
- ↑ Ganeshan D, Bhosale P, Yang T, Kundra V (October 2013). "Imaging features of carcinoid tumors of the gastrointestinal tract". AJR Am J Roentgenol. 201 (4): 773–86. doi:10.2214/AJR.12.9758. PMID 24059366.
- ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
- ↑ Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD (May 2005). "Current status of gastrointestinal carcinoids". Gastroenterology. 128 (6): 1717–51. PMID 15887161.
- ↑ Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM (July 2008). "Bronchopulmonary neuroendocrine tumors". Cancer. 113 (1): 5–21. doi:10.1002/cncr.23542. PMID 18473355.
- ↑ Jeung, Mi-Young; Gasser, Bernard; Gangi, Afshin; Charneau, Dominique; Ducroq, Xavier; Kessler, Romain; Quoix, Elisabeth; Roy, Catherine (2002). "Bronchial Carcinoid Tumors of the Thorax: Spectrum of Radiologic Findings". RadioGraphics. 22 (2): 351–365. doi:10.1148/radiographics.22.2.g02mr01351. ISSN 0271-5333.
- ↑ Nessi R, Basso Ricci P, Basso Ricci S, Bosco M, Blanc M, Uslenghi C (April 1991). "Bronchial carcinoid tumors: radiologic observations in 49 cases". J Thorac Imaging. 6 (2): 47–53. PMID 1649924.
- ↑ Melmon KL, Sjoerdsma A, Mason DT (October 1965). "Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors". Am. J. Med. 39 (4): 568–81. PMID 5831899.
- ↑ Hara AK, Swartz PG (2009). "CT enterography of Crohn's disease". Abdom Imaging. 34 (3): 289–95. doi:10.1007/s00261-008-9443-1. PMID 18649092.