Endocrine Abstracts

Carcinoid tumors (CT) seldom develop in the head and neck area. Several authors doubt the existence of authentic neuroendocrine tumors in the nose. Most of the CT arise in the larynx.

Clinical case: A 54 years old woman, who had a right-sided nasal obstruction, rhinorrhea, and sometimes purulent discharge in 2016. In 2002 she had hyperthyroidism by Graves disease and treated for two years with remission after that. The examination of the nose revealed a dark red bleeding mass filling the area from the right nasal cavity to the nasopharynx. The biochemical and serum hormonal values were in a normal range. Urine 5 -HIIAA was 2,5 mg/24 h. MRI T1 and T2-weighted images revealed a mass fo 4.1 × 4.2 cm, slightly higher signal in T2 and isointense in T1, that extended into the right nasal cavity and ethmoidal sinus. A biopsy was performed, which revealed CT. Octreoscan with SPECT showed an intense nasal uptake. Right internal maxillary artery embolization was performed. In the next two days, the tumor was resected through a right lateral rhinotomy. Histopathological examination revealed neuroendocrine tumor low grade, ki67 < 2%. Positive immunohistochemical staining to CD56, synaptophysin and chromogranin A, and a negative one to CK. The resection was almost total, with no octreoscan uptake. The post MRI revealed a minimal residual lesion. Lanreotide treatment was introduced after surgery; the dose was 120 mg every four weeks the first year and every 8 weeks after that. No secondary effects or biochemical alterations were observed.

Discussion: A limited number of cases have been reported for CT arising in the nose. As in our case, the majority of typical carcinoids are non-functional. The patients mainly complain of local symptoms such as nasal congestion. Surgery is considered to be the first-line treatment for localized disease. In the case of a close margin of the lesion or a residual tumor, the recommendation was radiotherapy or chemotherapy for more advanced disease. We confirm that the tumor expresses somatostatin receptors. We treated the residual tumor with lanreotide with no progression of the disease after three years of follow-up. The somatostatin analogs may be a useful adjuvant therapy for stable residual disease. We have done a review of the published cases