Neuroendokrini tumor gušterače s izraženim karcinoidnim sindromom: prikaz slučaja

Carcinoid is the most common neuroendocrine tumor. It is primarily localized in the ileum and the appendix, whereas other localizations are rare. Only a small number of the carcinoids present with carcinoid syndrome (flushing, diarrhea), usually after tumor has already metastasized. A case of carcinoid tumor of uncommon localization is reported. A 54-year-old male patient presented for evaluation because of weight loss, flushing and diarrhea. Laboratory value of 5-HIAA was 775.5 mmol/l (normal values up to 72.8) and the pancreatic tumor marker CA 19-9 was increased. Ultrasonographic and magnetic resonance find-Rings localized the tumor in the prepapillary pancreatic region and visualized the spread to the liver. The diagnosis was confirmed by pathohistologic evaluation of a liver biopsy specimen. The patient was treated with Sandostatin (octreotide analog), which led to significant relief of the symptoms, although control 5-HIAA values were not reduced.Iako su karcinoidi rijetki, predstavljaju najčešći tip neuroendokrinih tumora, primarno smještenih u tankom crijevu i apendiksu. Mali broj ovih tumora, nakon što metastazira u jetru, prezentira se simptomima karcinoidnog sindroma (rumenjača, proljevi). Prikazan je karcinoid gušterače, neuobičajene lokalizacije za ovu vrst tumora. Bolesnik u dobi od 54 godine upuaen je u kliniku zbog gubitka na težini, rumenjače i proljeva. Vrijednosti 5-HIAA i CA 19-9 bile su izrazito povišene. Ultrazvučno i magnetskom rezonancom prikazan je tumor predpapilarnog područja te uvećana jetra prožeta višestrukim sekundarizmima, a patohistološki nalaz govorio je u prilog neuroendokrinog tumora tipa karcinoida. S obzirom na proširenost procesa odustalo se od kirurškog liječenja te je započeta terapija Sandostatinom uza značajno kliničko poboljšanje, no bez učinka na 5-HIAA

Pheochromocytoma - case report

Prikazan je slučaj feokromocitoma desne nadbubrežne žlijezde u 13-godišnjeg dječaka koji je hospitaliziran zbog hipertenzivne krize. Heteroanamnestički smo doznali za dugotrajne glavobolje, gubitak tjelesne mase, učestala preznojavanja uz polidipsiju i poliuriju. Dijagnoza je postavljena na temelju povišenih vrijednosti kateholamina u urinu, a tumor je lokaliziran ultrazvučno, magnetskom rezonancijom (MR-om) te I131 -metajodobenzilgvanidin (I131 -MIBG) scintigrafijom. Zadovoljavajuća kontrola hipertenzije postignuta je kombinacijom blokatora alfa i beta-adrenergičkih receptora te ACE inhibitora, nakon čega je učinjena desnostrana torakofrenolaparotomija i adrenalektomija, bez većih intraoperativnih i postoperativnih komplikacija. Dječak se prati klinički i laboratorijski, a nalazi zasad upućuju na izlječenje.We present a 13 year-old-boy with pheochromocytoma localized in the right adrenal gland, who was hospitalized due to severe hypertension. For a long period of time he suffered from headaches, loss of weight, excessive sweating with polydipsia and polyuria. The diagnosis was made based on high urinary catecholamine excretion and the tumor was localized by ultrasonography, magnetic resonance imaging (MRI) and radionuclide scanning with iodine 131-labeled metaiodobenzylguanidine (I131 -MIBG scintigraphy). After acceptable control of hypertension was achieved by alpha and beta-adrenergic blocking agents and use of ACE inhibitors, right sided thoracophrenolaparotomy and adrenalectomy was performed, without any major intra-operative or postoperative complications. The boy was followed-up and his clinical and laboratory findings show no abnormalities so far