A Case of Multiple Carcinoid Tumors of the Small Intestine Diagnosed following Investigation of Melena

Abstract

An 82-year-old woman was referred to the department of gastrointestinal medicine at our hospital for further examination after a medical check-up revealed a positive fecal occult blood test, and lower endoscopy conducted at a nearby clinic showed a tumor in the terminal ileum. Abdominal computed tomography (CT) showed a tumor on the left side of the abdomen in addition to the ileal tumor, and the patient was admitted for tests. Frequent melena and progressive anemia were observed on the day after admission, but due to difficulty with endoscopic hemostasis of bleeding from the ileal tumor, the patient was referred to our department for surgery. Tumors were palpated in the terminal ileum and jejunum, and because the neighboring mesenteric lymph nodes had become enlarged, malignant lymphoma with multiple lesions was suspected, and the small intestine was partially resected in two locations. The resected samples revealed a total of 7 tumorous lesions (6 in the jejunum and 1 in the ileum). The histopathological diagnosis was carcinoid tumor of the small intestine for all lesions, but lymph node metastasis could not be determined. Octreotide was administered as adjuvant therapy, and relapse-free survival has been achieved for 3 years. The present case of multiple carcinoid tumors of the small intestine, which are extremely rare in Japan, is reported in the context of the literature.