Differentiating carcinoid syndrome from other diseases: Difference between revisions
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| colspan="2" |Medullary Thyroid Carcinoma | | colspan="2" |Medullary Thyroid Carcinoma | ||
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* Solitary thyroid nodule | |||
* Cervical lymph node involvement | |||
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* Basal serum calcitonin concentrations | |||
* Carcinoembryonic antigen (CEA) concentration | |||
* Thyroid function tests: normal | |||
* germline ''RET'' testing | |||
* Serum calcium | |||
* Plasma fractionated metanephrines | |||
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* Ultrasonography of the neck | |||
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* immunohistochemical staining for calcitonin | |||
* Spindle-shaped and frequently pleomorphic cells without follicle development | |||
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* Fine-needle aspiration (FNA) biopsy | |||
* TNM staging | |||
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Revision as of 20:49, 2 April 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
Carcinoid syndrome must be differentiated from systemic mastocytosis, medullary thyroid carcinoma, irritable bowel syndrome, malignant neoplasms of the small intestine, benign cutaneous flushing, and recurrent idiopathic anaphylaxis.
Differentiating Carcinoid Syndrome from other Diseases
Carcinoid syndrome must be differentiated from:[1]
- Systemic mastocytosis
- Medullary thyroid carcinoma
- Irritable bowel syndrome
- Malignant neoplasms of the small intestine
- Benign cutaneous flushing
- Recurrent idiopathic anaphylaxis
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||||||||||||||||
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Symptoms | Physical examination | ||||||||||||||||||||||||
Lab Findings | Imaging | Histopathology | |||||||||||||||||||||||
Abdominal pain | Diarrhea | Flushing | Dyspnea | Palpitations | Other symptoms | Wheezing | Telangiectasia | Hypotension | Tachycardia | Systolic murmur of tricuspid regurgitation | Other physical findings | Urinary 5-hydroxyindoleacetic acid (5-HIAA) | Serum Chromogranin A (CgA) | Other markers | Abdominal computed tomography (CT) | MRI | Somatostatin receptor scintigraphy [SRS], or Octreoscan | Metaiodobenzylguanidine (MIBG) scintigraphy | Other diagnostic studies |
| |||||
Carcinoid Syndrome[2][3][4][5] | Midgut tumours | +
Mild |
+
|
+ | + | + |
Dermatitis Diarrhea Dementia |
+ | + | + | + | + | + | + |
|
+
|
+ |
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|
|
Pathognomonic radiological sign of midgut NET. | ||||
Bronchial carcinoid | |||||||||||||||||||||||||
Irritable Bowel Syndrome | +
Perioidic |
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- | - | - |
|
- | - | - | - | - | - | - | - | - | - | - |
|
- | - | Rome IV criteria
•Related to defecation •Associated with a change in stool frequency •Associated with a change in stool form (appearance) |
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Malignant neoplasms of small intestine | +/- | +/- | - | - | +/- |
|
- | - | - | +/- | - |
|
- | + | Abdominal CT scan may be diagnostic of small intestine cancer. Findings on CT scan suggestive of small intestine cancer include intrinsic mass with a short segment of bowel wall thickening | MRI and MRI enteroscopy are other advance modalities to diagnose and stage small intestinal cancers | Enteroscopy, capsule endoscopy and double balloon enteroscopy |
|
Biopsy and histopathology | ||||||
Crohn disease[6] |
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+/- | - | - | - |
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- | - | - | - | - |
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- | - |
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Benign cutaneous flushing | |||||||||||||||||||||||||
Systemic mastocytosis | + | + | + | + | - |
|
+/- | +/- | + | - | - |
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- | - |
|
- | - | ||||||||
Recurrent idiopathic anaphylaxis | |||||||||||||||||||||||||
Asthma exacerbation | - | - | - | + | + | + | - | - | + | - | - | - | Chest X ray | ||||||||||||
Acute Urticaria | |||||||||||||||||||||||||
Anaphylaxis | + | -/+ | + | + | + |
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- | -- | - | - | -- |
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- | - | History of exposure to insect stings,food alllergy,rubber latex,food additives,,allergy to medications,physical factors such s excercise and cold | |||||||||
histaminergic Angioedema | |||||||||||||||||||||||||
Drugs causing flushing |
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Medullary Thyroid Carcinoma | - | +/- | +/- | - | - | - | - | - | - | - |
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- | - |
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- | - |
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- |
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References
- ↑ Metcalfe DD (2000). "Differential diagnosis of the patient with unexplained flushing/anaphylaxis". Allergy Asthma Proc. 21 (1): 21–4. PMID 10748948.
- ↑ Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP (August 2018). "Carcinoid syndrome: update on the pathophysiology and treatment". Clinics (Sao Paulo). 73 (suppl 1): e490s. doi:10.6061/clinics/2018/e490s. PMC 6096975. PMID 30133565.
- ↑ Hegyi J, Schwartz RA, Hegyi V (January 2004). "Pellagra: dermatitis, dementia, and diarrhea". Int. J. Dermatol. 43 (1): 1–5. PMID 14693013.
- ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
- ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
- ↑ Hara AK, Swartz PG (2009). "CT enterography of Crohn's disease". Abdom Imaging. 34 (3): 289–95. doi:10.1007/s00261-008-9443-1. PMID 18649092.