1/65. adenocarcinoma of the colon with neuroendocrine features and secretory diarrhea.We report the case of a 63-yr-old man who had severe secretory diarrhea associated with colonic adenocarcinoma, with a prominent signet ring cell component and numerous endocrine cells as demonstrated by positive chromogranin-A staining. Improvement in the secretory diarrhea by the somatostatin analog Sandostatin suggested that the diarrhea was related to a functional neuroendocrine tumor within the colonic tumor, the first case to be reported in the literature.- - - - - - - - - - ranking = 1keywords = neuroendocrine, carcinoma (Clic here for more details about this article) |
2/65. 5-fluorouracil-induced small bowel toxicity in patients with colorectal carcinoma.BACKGROUND: diarrhea and oral mucositis are the most frequently reported gastrointestinal side effects caused by 5-fluorouracil (5-FU). diarrhea may be severe in 10-30% of patients and is schedule-dependent. 5-FU-induced gastrointestinal toxicity predominantly affects the upper and the lower gastrointestinal tract. The current study describes 5-FU-induced small bowel toxicity as an entity that to the authors' knowledge has not been reported previously in patients with colon carcinoma receiving 5-FU-based therapy. methods: The authors report a series of six patients with colorectal carcinoma who developed acute small bowel toxicity after treatment with 5-FU and leucovorin. RESULTS: Six patients developed a clinical picture of acute abdominal pain and diarrhea. Small bowel damage was documented by laparotomy in two patients, by colonoscopy in one patient, and by abdominal computed tomography scan in three patients. The course was complicated by recurrence of symptoms in one patient who was rechallenged with 5-FU and leucovorin, but the remaining four patients were rechallenged safely with lower doses of 5-FU and leucovorin after the acute toxicity episode. A possible explanation for this toxicity is 5-FU-induced vasospasm and/or decrease in fibrinolytic activity that results in decreased mucosal blood flow. CONCLUSIONS: 5-FU-induced small bowel toxicity is a potentially severe toxicity that may occur in patients with colon carcinoma or other malignancies who are receiving 5-FU-based therapy. [See editorial on pages 1099-100, this issue.] copyright 1999 american cancer society.- - - - - - - - - - ranking = 0.16251915170186keywords = carcinoma (Clic here for more details about this article) |
3/65. Overview of chronic diarrhea caused by functional neuroendocrine neoplasms.Eight different neoplastic disorders can cause chronic diarrhea attributable to humoral-mediated diarrhea. These include pancreatic endocrine tumor (PET) syndromes (gastrinomas, VIPomas, glucagonomas, somatostatinomas, PET's releasing calcitonin), carcinoid syndrome, medullary thyroid cancer, and systemic mastocytosis. Because these disorders are an uncommon cause of all chronic diarrheas (<1%), they are not often considered in the differential diagnosis, leading to a delay in diagnosis. This is problematic not only because all are treatable, but also because the neoplasm is frequently malignant. In this article, the characteristics and pathogenesis of the diarrhea, important clinical and diagnostic laboratory features, and treatment of each disorder are briefly reviewed, with an emphasis on recent insights.- - - - - - - - - - ranking = 0.70713191331322keywords = neuroendocrine (Clic here for more details about this article) |
4/65. Thymic carcinoid and parathyroid hyperplasia detection with 99mTc-MIBI men type 1.We report a case of a 35-year-old male, with a history of diarrhea, renal lithiasis with frequent expulsions of calculus and hypercalcemia during the last 2 years. The patient was studied and diagnosed with a multiple endocrine neoplasia type I (men I), familiar (mother with men I). A scintigraphic study with 99mTc-MIBI was performed in order to localize hyperfunctioning parathyroid glands because of biochemical diagnosis of primary hyperparathyroidism. Double phase 99mTc-MIBI scan detected one hyperfunctioning parathyroid gland and a large anterior mediastinal mass. Subsequent, plain radiograph and CT of the chest showed a soft-tissue mass in that localization. Punch biopsy of the lesion guided by CT revealed malignant cells of neuroendocrine tumor. The tumor was removed and histologically confirmed as a carcinoid within a thymus in a men type I syndrome. men I patients can benefit from the examination with this agent which can potentially localize not only parathyroid endocrine pathology but also unknown associated tumors.- - - - - - - - - - ranking = 0.17678297832831keywords = neuroendocrine (Clic here for more details about this article) |
5/65. A case of diarrhea and orthopnea in a 57-year-old female.A 57-year-old female patient with known cardiac disease developed a 4 to 6 week history of diarrhea, followed by onset of orthopnea and subsequent right-sided cardiac failure. On hospital admission she was found to have pure tricuspid regurgitation, without evidence of cardiac ischemia, pulmonary embolism, bacterial endocarditis or pericardial disease. A 24-hour urine collection for 5-HIAA was elevated, and a subsequent octreotide scan documented abnormal uptake in the pelvic cul-de-sac. Bilateral ovarian masses were found at laparotomy, which on pathological examination were found to be a benign left ovarian cystic teratoma, and a right carcinoid tumor of the ovary. This patient presented with systemic complaints of diarrhea, and orthopnea and right sided heart failure that on evaluation were ultimately found to be due to a unilateral primary carcinoid tumor of the ovary, which accounts for less than 0.1% of all ovarian carcinomas, and only 5% of all carcinoids. Treatment of this malignant carcinoid syndrome presentation consisted of debulking of the tumor and continuation of her diuretics and digoxin. diarrhea and orthopnea ceased within 2 weeks after her oophorectomy. On evaluation 6 weeks and 6 months postoperatively, her cardiac function was stable, though unchanged. 5-HIAA levels were within normal limits, demonstrating the curative function of surgery in patients with unilateral ovarian carcinoid without evidence of metastases, as well as preserved cardiac function in otherwise stable patients.- - - - - - - - - - ranking = 0.023217021671695keywords = carcinoma (Clic here for more details about this article) |
6/65. Untractable diarrhea due to late onset celiac disease of the adult following pancreatoduodenectomy.This case describes a rare cause of severe diarrhea that may occasionally plague the postoperative course of pancreatic resections. Although exceedingly rare this complication has already been described in another two patients undergoing pancreatoduodenectomy with diagnosis of duodenojejunal adenocarcinoma. Surgeons dedicated to pancreatic resections as well as pancreatologists caring for these patients should retain this possibility in their cultural background. diarrhea, due to either exocrine insufficiency or interruption of sympathetic nerves to the small intestine, is a common complaint after pancreatoduodenectomy. A 54-year-old white female after a pancreatoduodenectomy with standard lymphatic clearance developed intractable diarrhea leading to severe cachexia. Recognition of the underlying occult celiac disease and institution of the appropriate dietary regimen allowed quick and expeditious recovery.- - - - - - - - - - ranking = 0.023217021671695keywords = carcinoma (Clic here for more details about this article) |
7/65. pheochromocytoma producing vasoactive intestinal peptide.The syndrome of watery diarrhea associated with hypokalemia and achlorhydria was originally described in 1958. Subsequently, this syndrome was shown to be caused by a neuroendocrine tumor secreting vasoactive intestinal peptide (VIP), and such tumors are almost always pancreatic in origin. We describe the case of a 78-year-old woman with gradual onset of hypokalemia, watery diarrhea, and weight loss. After a left adrenal mass was discovered, the patient chose medical therapy over surgical intervention. Initially her condition responded, then gradually became refractory to medical therapy. She had elevated levels of VIP, pancreatic polypeptide, dopamine, and vanillylmandelic acid. Subsequently, the patient underwent surgical excision of the mass that was found to be a VIP-producing pheochromocytoma. After surgery her diarrhea subsided, and her electrolytes and affected neuroendocrine hormone levels normalized.- - - - - - - - - - ranking = 0.35356595665661keywords = neuroendocrine (Clic here for more details about this article) |
8/65. Severe CPT-11-induced diarrhea in presence of FK-506 following liver transplantation for hepatocellular carcinoma.BACKGROUND: The treatment of malignancies in transplanted patients has become an emerging issue. The anticancer agent CPT-11 is hydrolysed to the active metabolite SN-38 and many drugs interact with its metabolism and toxicity. PATIENT AND methods: We studied the clinical and pharmacological interactions between CPT-11 and FK506 in a liver transplant patient. Serial plasma samples of FK506, CPT-11, SN-38 and SN-38 glucuronide were assayed by high-performance liquid chromatography. RESULTS: While no CPT-11 toxicity was observed pre-operatively, several post-operative cycles of CPT-11 were complicated with severe diarrhea. No change in FK506 plasma concentrations was noted in the presence of CPT-11 but the pharmacokinetics of CPT-11 was altered in the presence of FK506. SN-38 glucuronidation was reduced for up to 12 hours following CPT-11 infusion. This increase in plasmatic exposure to unbound SN-38 might account for diarrhea. CONCLUSION: The starting dose of CPT-11 should be reduced in FK506-treated liver transplant patients.- - - - - - - - - - ranking = 0.092868086686779keywords = carcinoma (Clic here for more details about this article) |
9/65. Vasoactive intestinal polypeptide-secreting tumor (vipoma) with liver metastases: dramatic and durable symptomatic benefit from hepatic artery embolization, a case report.neuroendocrine tumors often manifest an excess production of hormones that create severe metabolic abnormalities resulting in significant patient morbidity, independent of the tumor burden itself. VIPomas are rare neuroendocrine tumors arising from the pancreas and are associated with secretory diarrhea and electrolyte disturbances. We present a patient with vipoma and hepatic metastases who had greater than 10 loose stools a day for 4 yr since diagnosis, despite debulking surgery, multiple antidiarrheal medications, large doses of octreotide, and targeted radioisotope injections. The patient required several hospitalizations for treatment of dehydration and electrolyte disturbances, despite receiving daily intravenous fluids at home. hepatic artery embolization (HAE) immediately stopped the patient's diarrhea and provided a return to normal formed stools without any other symptom-support measures. One year after HAE, the patient remains asymptomatic and has returned to a productive life. HAE can be a very effective and durable treatment modality for patients with metastatic VIPomas (or other neuroendocrine tumors) and who are clinically symptomatic from the effects of hormone hypersecretion.- - - - - - - - - - ranking = 0.35356595665661keywords = neuroendocrine (Clic here for more details about this article) |
10/65. Investigation into the usefulness and adverse events of CDDP, 5-fU and dl-leucovorin (PFL-therapy) for advanced colorectal cancer.Biochemical modulation of 5-fluorouracil (5-FU) has been verified the evidence of significant improvement of survival and quality of life in patients with advanced colorectal carcinoma. We investigated the therapeutic and adverse drug reaction of intensive chemotherapy using cisplatin (CDDP), 5-FU and dl-leucovorin (LV) (PFL-therapy), which may be producing dual biochemical modulation effect of 5-FU for advanced colorectal carcinoma. Administration schedule was 13 mg/m2 of CDDP, 300 mg/m2 of 5-FU, and 30 mg/body of dl-LV for 5 consecutive days. This regimen was repeated at 3-week intervals in hospital. Sixteen patients were enrolled in this study, most of whom had a history of previous chemotherapy as adjuvant treatment, and the response rate was 25%, with four patients having "partial response" and eight "no change". In respect to performance status, 46% of patients who completed the protocol were markedly improved in spite of their poor performance status before treatment. Moreover, when patients were classified into two groups based on changes of the serum level of CEA, "responder in CEA level" showed better prognosis than "non-responder in CEA level". Major toxicities were nausea, hyperglycemia and neutropenia. Three patients experienced Grade 4 hematological side effect, but these complications resolved quickly in all patients except for one patient. PFL-therapy is effective for advanced colorectal cancer with large tumor burden and showed the same prognostic result as the American and European trials in spite of smaller number of treatment cycles and a history of previous chemotherapy. We will be able to demonstrate the usefulness of this regimen for Japanese patients with advanced colorectal cancers after adding new cases to the present report.- - - - - - - - - - ranking = 0.046434043343389keywords = carcinoma (Clic here for more details about this article) |
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