2010 Volume 35 Issue 1 Pages 72-77
We report a case of a minute rectal carcinoid associated with a huge metastatic retroperitoneal carcinoid. A 65–year–old man was hospitalized because of constipation. Abdominal computed tomography (CT) showed a 130–mm diameter giant tumor with intratumoral necrosis, occupying the pelvic cavity and compressing the rectum. Colonoscopy revealed the primary lesion to be a small, yellowish, submucosal rectal tumor of 8 mm diameter with central collapse, located in the lower rectum. With no alternative diagnostic measures available, a percutaneous biopsy was performed and a diagnosis of carcinoid was made. We performed Hartmann's procedure of the primary tumor with lymph node dissection. Histologically, the retroperitoneal tumor did not display cytologic atypia, but did exhibit extensive necrosis, and was identified as a typical carcinoid by chromogranin A and synaptophysin immunohistochemical markers. For pelvic tumors of unknown origin, the alimentary tract must be examined to rule out the possibility of metastatic carcinoids.
