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The Old Endoscopy Quiz (and Answer) of the Month
August 2006

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Question:


Click on this image to start the slide show!

This middle aged man came to a colonoscopy as a CT-scan done for nephrologic reasons had shown enlarged lymph nodes in the abdomen. This is the finding in the rectum. If You feel need for some other piece of information, just click here. What is this tumour?

Answer:

    A Malignant Rectal Carcinoid Tumour.


    A malignant carcinoid tumour in the gastric body (corpus) on the smaller curvature


    A malignant carcinoid tumour in the rectum

    		 Carcinoid tumours are neuroendocrine malignant tumours with a characteristic pathologic appearance occuring in the gastrointestinal channel. About 4000 new cases of this disease is found in USA every year, main age of the patients is near 60. The etiology of this disease is not known. Small carcinoid tumours are often found in the appendix (about 40% of all cases), about one third is found in the small intestine. Carcinoid tumours are malignant, however small tumours in the appendix rarely cause metastatic lesions. A few percent of all malignant tumours in the stomach are carcinoid tumours. Small, clinically quite innocent, carcinoid tumours can be found in the stomach associated with atrophic gastritis. Carcinoid tumours in the colorectal area are twice as common in the the rectum than in the colon. Carcinoid tumours produce several active substanses like serotonin, histamine and other vasoactive peptides. If these substances are not inactivated in the liver they can cause a syndrome called carcinoid syndrome, the main symptom of which is flushing attacks, abdominal cramps, diarrhea and elevated blood pressure. Carcinoid syndrome is most often a sign of disseminated disease with mestastatic tumours in the liver. Surgery is the treatment of choice if possible. Symptoms in disseminated disease with carcinoid syndrome can be relieved by medical therapy.

Correct answers and comments were emailed by

    Christos Zavos, Thessaloniki, Greece
    Amrani Khalil, Constantine, Algeria
    Marek Kujawiak, Stargard, Poland
    Urias Cuartas, Augusta, USA
    Cevale Karslioglu Sgouros, Istanbul, Turkey
    Bassam Adil, RAK, UAE
    Robert Popken, Carvoeiro, Portugal
    Konturek, Erlangen, Germany
    ISIL TUZCUOGLU, MANÝSA, TURKEY
    Qayium, Stockholm, Sweden
    SHARAF KARIM, NAESTVED, DENMARK
    Albert J. Chang, Los Angeles, CA, USA
    Rimma Shaposhnikov, Los Angeles, CA, USA

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