John T. Mather Memorial Hospital Medical Center Port Jefferson, NY, United States
Md Refayat Bhuiyan, DO, Faraz Badar, MD John T. Mather Memorial Hospital Medical Center, Port Jefferson, NY
Introduction: We present a case of duodenal carcinoid diagnosed on random endoscopic biopsy in the absence of any tumor lesion.
Case Description/Methods: A 77 year old male presented with weight loss of 40 lbs over a period of 4 months, anorexia, fatigue and constipation. He denied nausea, vomiting, abdominal pain, hematochezia, had bowel movements once every 3 to 4 days and ate only 1 meal a day. Screening colonoscopy 5 years ago revealed non-neoplastic polyps. Past medical history was significant for iron deficiency anemia and family history for colon cancer in father. Most recent hemoglobin was 12.5 g/dL, MCV 73.9 fL and serum iron 42 mcg/dL. Differential diagnoses included esophageal, gastric, or colorectal cancers, celiac disease and angiodysplasias. History of iron deficiency coupled with new weight loss and constipation in setting of family history of colon cancer prompted evaluation with EGD and colonoscopy. Colonoscopy was unremarkable except for sigmoid colon diverticulosis. Grade A esophagitis and antral erythema were seen on EGD. Duodenal exam was normal with no visualized mucosal lesion or mass. Biopsies were taken from antrum and body to rule out gastritis and H.Pylori and from duodenum to rule out Celiac disease. Pathology revealed chronic gastritis in the stomach and a well differentiated carcinoid tumor in the second part of the duodenum. The patient was subsequently referred to surgical oncology for further evaluation and management.
Discussion: Primary duodenal carcinoids are one of the rarest neuroendocrine tumors. They are usually asymptomatic and detected during EGD for unrelated symptoms such as abdominal pain, upper GI bleeding and anemia. They are located either in the first or second part of duodenum or ampulla of Vater. Majority of tumor masses are less than 2 cm in size and this enables performance of endoscopic mucosal resection. Larger lesions are managed operatively with full thickness excision. Our case is unusual because our patient had normal duodenal mucosa and no mass lesion endoscopically, with random biopsy returning positive for well differentiated carcinoid tumor. Although a considerable amount of literature focusing on location and size of duodenal carcinoid tumors has been published, a diagnosis of the disease on a random mucosal biopsy has not been previously reported.
Disclosures: Md Refayat Bhuiyan indicated no relevant financial relationships. Faraz Badar indicated no relevant financial relationships.
Md Refayat Bhuiyan, DO, Faraz Badar, MD. P1980 - An Incidental Diagnosis of Duodenal Carcinoid on Random Endoscopic Biopsy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.