Differentiating carcinoid syndrome from other diseases: Difference between revisions
No edit summary |
No edit summary |
||
Line 111: | Line 111: | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| | | | ||
* 68-Ga DOTATATE PET scan | * 68-Ga DOTATATE [[PET scan]] | ||
* Positron emission tomography-computed tomography (PET-CT) using 18-fluoro-dihydroxyphenylalanine | * [[Positron emission tomography-computed tomography]] ([[PET-CT]]) using 18[[-fluoro-dihydroxyphenylalanine]] | ||
* Ki-67 labeling index | * Ki-67 labeling index | ||
* Endoscopy for metastatic Neuroendocrine tumour with an unknown primary site. | * [[Endoscopy]] for [[metastatic]] [[Neuroendocrine tumour]] with an unknown primary site. | ||
| | | | ||
* Valve thickening with retraction and reduction in the mobility of the tricuspid valve | * Valve thickening with retraction and reduction in the mobility of the [[Tricuspid valves|tricuspid valve]] | ||
* | * | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Line 166: | Line 166: | ||
| + | | + | ||
| | | | ||
* Chest X ray: round or oval [[Opacity|opacities]] from 2-5cm with sharp and notched margins | * [[Chest X ray]]: round or oval [[Opacity|opacities]] from 2-5cm with sharp and notched margins | ||
* Chest CT : Hilar or Perihilar Masses, Endobronchial Nodules,Related to Bronchial Obstruction:peripheral atelectasis and postobstructive | * [[Chest]] [[CT]] : [[Hilar]] or Perihilar Masses, Endobronchial [[Nodules]],Related to [[Bronchial|bronchial Obstruction]]:peripheral [[atelectasis]] and postobstructive [[pneumonia]] | ||
* Pulmonary funcation test | * [[PFTs|Pulmonary funcation test]] | ||
* Bronchoscopy | * [[Bronchoscopy]] | ||
* 68-Ga DOTATATE PET scan | * [[68-Ga DOTATATE PET scan]] | ||
* Fluorodeoxyglucose PET scans for atypical lung NETs . | * Fluorodeoxyglucose [[PET scan|PET scans]] for atypical [[lung]] [[Neuroendocrine|NETs]] . | ||
| - | | - | ||
|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. | |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. | ||
Line 218: | Line 218: | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| | | | ||
* Bristol stool form scale should to record stool consistency | * [[Bristol stool]] form scale should to record [[stool]] consistency | ||
* Abdominal radiograph to assess for | * [[Abdominal|Abdomina]]<nowiki/>l [[Radiographic|radiograph]] to assess for [[Stool|stoo]]<nowiki/>l accumulation and determine the severity. | ||
* Age-appropriate colorectal cancer screening in all patients | * Age-appropriate [[colorectal cancer]] [[screening]] in all [[patients]] | ||
| - | | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
Line 257: | Line 257: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| - | | - | ||
|[[Endoscopy|Enteroscopy]], [[capsule endoscopy]] and double balloon enteroscopy | |[[Endoscopy|Enteroscopy]], [[capsule endoscopy]] and double balloon [[enteroscopy]] | ||
| | | | ||
| | | | ||
Line 315: | Line 315: | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| | | | ||
* CBC | * [[CBC]] | ||
* Blood chemistry including electrolytes | * [[Blood chemistry tests|Blood chemistry]] including [[Electrolyte|electrolytes]] | ||
* Renal function tests | * [[Kidney function|Renal function tests]] | ||
* liver enzymes | * [[liver enzymes]] | ||
* | * [[Blood glucose]] | ||
* ESR | * [[ESR]] | ||
* CRP | * [[CRP]] | ||
* Serum iron | * [[Serum iron]] | ||
* Vitamin D & vitamin B12 levels | * [[Vitamin D]] & [[vitamin B12 levels]] | ||
* | * [[Stool D/R]] and [[Culture media|culture]] for [[ova]] and [[parasites]], | ||
* ''C. difficile'' toxin | * [[Clostridium difficile|''C. difficile'' toxin]] | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Line 418: | Line 418: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|Chest X ray | |[[Chest X ray]] | ||
| | | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Line 452: | Line 452: | ||
| - | | - | ||
| | | | ||
* plasma tryptase | * plasma [[tryptase]] | ||
* | * Plasm[[Histamine|a histamine]] levels | ||
* Take proper clinical history and medication history | * Take proper clinical history and medication history specially [[beta blockers]],[[Angiotensin Converting Enzyme Inhibitor|ACE-inhibitors,]][[opioids]] | ||
* Skin testing with allergen extracts | * [[Skin testing]] with [[Allergens|allergen extracts]] | ||
* 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 | ||
* | * | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 492: | Line 492: | ||
| - | | - | ||
| | | | ||
* CBC with differential, | * [[CBC|CBC with differential,]] | ||
* | * [[Electrolyte|Electrolytes]] | ||
* Liver function tests | * [[Liver function tests]] | ||
* C-reactive protein | * [[C-reactive protein (CRP)|C-reactive protein]] | ||
* Erythrocyte sedimentation rate | * [[ESR|Erythrocyte sedimentation rate]] | ||
* Levels of the complement protein C4 | * Levels of the [[Complement System|complement protein C4]] | ||
* Serum | * Serum tota[[Tryptase|l tryptase]] | ||
* Allergen-specific IgE immunoassays | * Allergen-specific [[IgE immunoassay|IgE immunoassays]] | ||
| - | | - | ||
| - | | - | ||
Line 545: | Line 545: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
* Ultrasonography of the neck | * [[Ultrasonography]] of the [[neck]] | ||
Fo[[Metastasis|r metastasis]] | |||
* Chest computed tomography | * [[Chest]] [[computed tomography]] | ||
* Neck CT | * [[Neck]] [[CT]] | ||
* Three-phase contrast-enhanced liver CT | * Three-phase contrast-enhanced [[Liver (2)|liver]] [[CT-scans|CT]] | ||
* Axial MRI | * Axial [[MRI]] | ||
* Bone scintigraphy. | * Bone [[scintigraphy]]. | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | |
Revision as of 16:20, 2 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 |
| |||||
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 |
+ | +/- | +/- | + | + | - | + | + |
|
|
|
+
|
+ |
|
|
|
|
Pathognomonic radiological sign of midgut NET. |
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 |
|
Lung neuroendocrine tumor can be a/s with:
| ||
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 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.