Diagnosis: The diagnosis was made on September 27, 2001 after an upper GI endoscopy, a colonoscopy, and contrasting CAT scan. Surgery was performed on October 2, 2001 in which two tumors where resected from the small bowel along with the appendix. An area of mesenteric adenopathy involving the superior mesentery artery was not resectable.

Markers: No base line markers were established prior to the surgery. Post surgery markers include

1. Octreotide scan on 10/30/01 which demonstrated focal radiotracer uptake in the known location of the non-resectable metastasis tumor.
2. CT scans at post operative, 3 months, and six months with unremarkable findings
3. 5-HIAA: 8
4. Serum Serotonin: 544
5. Chromogrania-A: 28.7

Current: Symptomatic with little to no syndrome at present. Minimal flushing exists under normal conditions, extreme flushing occurs under stressful situations. No diarrhea. Normal BP is 117/70, pulse at 76, weight at 235 lb (106.6 kg) and a height of 6 ft 4 in (193 cm).

Treatment: At present, no treatment is being administered.

History: A 54 year old male with a history of stomach problems his whole life. In 1985, worsening abdominal pains developed with irregular bowel movements, mild shortness of breath, sweating (especially nocturnal), and flushing. An extensive workup at that time prove unrevealing.

CAT scan was performed in 1995, which was negative for any tumor in the abdomen.

On September 23, 2001, was admitted to the emergency room after suffering all day with severe abdominal pains, nausea, and constipation. Over the next several days, patient underwent an upper GI series which was negative, colonoscopy which was negative, and a CT scan which demonstrated a large omental mass situated around the mid-abdomen, likely mesenteric.

A laparotomy was performed on October 2, 2001. Upon entering the abdominal cavity there was a mass that measured 1.5 cm felt in the small bowel approximately 2-1/2 feet from the terminal ileum and a second mass that measured .5 cm found approximately 12 inches from the first mass, both of which were resected along with 18 inches of the small bowel. A bulky mass approximately 2.7 cm was palpable deep in the root of the small bowel mesentery, and was not resectable given its proximity and encasement of the SMA.

Review of the pathology showed the 1.5 cm mass to be a carcinoid tumor involving the muscularis propria submucosa and a lamina propria of the small bowel. The .5 cm mass was also a carcinoid tumor and involved the lamina propria of the submucosa.

The patient recovered from surgery and is doing well. There are no headaches, no dizziness, no visual disturbances, no hearing disturbances, no oral lesions. The neck is supple with no difficulties breathing, no chest pain, no subsequent abdominal pain, no diarrhea, limited constipation, no dysuria, and no skin rash. The patient experiences constant itching of the back and extreme back and neck tension.

Prior to surgery, the patient presented with systems of flushing and frequent night sweats that would soak the bed. Patient also experienced two to three days without a bowel movement followed by stool that started as constipated and finished as diarrhea. These have resolved since surgery.

Past Medical:

1. 1970 a left radical mastoidectomy for cholesteatomas. Retained 60% hearing in left ear with modified eardrum.
2. 1998 a right radical mastoidectomy for cholesteatomas with a right ear prosthesis. Retained 80% hearing in right ear.
3. Season allergies, food allergies, and allergic to tobacco smoke.
4. Lethal allergies to stinging insects.
5. Penicillin causes chills.

Social History: Born and raised in North Carolina, and has resided in Virginia since 1971. Has a B.S. degree in Mechanical Engineering, and was a Registered Professional Engineer practicing mechanical, electrical, and plumbing engineering. Last position was with Northrop Grumman Ship Systems. Has not had prolonged chemical exposures.

Has been married for 30 years and they have one son who also lives in Virginia. No tobacco, no alcohol, no illicit habits, no pets, and limited travel.

Family History: Significant for fatal intestinal cancer with prior melanoma in his paternal grandfather and father, and fatal breast cancer in his paternal grandmother with metastasizes to other parts of the body. No other history of carcinoma or cancer.

Medications: None

For more detail on my Carcinoid journey please feel free to contact me by Email at clwj@shentel.net