Case Report
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World J Gastrointest Surg. Mar 27, 2010; 2(3): 89-94
Published online Mar 27, 2010. doi: 10.4240/wjgs.v2.i3.89
Minute liver metastases from a rectal carcinoid: A case report and review
Hirofumi Yamamoto, Hideyuki Hemmi, Jin-Yu Gu, Mitsugu Sekimoto, Yuichiro Doki, Masaki Mori
Hirofumi Yamamoto, Hideyuki Hemmi, Mitsugu Sekimoto, Yuichiro Doki, Masaki Mori, Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University; Osaka 565-0871, Japan
Jin-Yu Gu, the 3rd Department of General Surgery, the 2nd Affiliated Hospital of Harbin Medical University, Baojian Road 246, Nangang District, Harbin 150086, Heilongjiang Province, China
Author contributions: All authors contributed to this work; Yamamoto H wrote the manuscript; Hemmi H examined the past references; Gu JY performed the English editing; Sekimoto M performed the operation surgery; Doki Y and Mori M designed the study and revised the manuscript.
Correspondence to: Hirofumi Yamamoto, MD, PhD, Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita City, Osaka, 565-0871, Japan.
Telephone: +81-6-68793251 Fax: +81-6-68793259
Received: August 12, 2009
Revised: September 7, 2009
Accepted: September 14, 2009
Published online: March 27, 2010

We here report a 43-year-old male patient with minute liver metastases from a rectal carcinoid. Hepatic nodules were diagnosed during surgery, although they were not diagnosed by preoperative computed tomography or ultrasound examination. The rectal carcinoid was resected together with liver metastases and the patient has had no disease recurrence for 5 years following postoperative treatment of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU). In 2003, a health check examination indicated presence of occult blood in his stool. Barium enema study revealed a rectal tumor in the lower rectum and colonoscopy showed a yellowish lesion with a size of 30 mm in diameter. Pathological examination of the biopsy specimen indicated that the rectal tumor was carcinoid. Although preoperative imaging examinations failed to detect liver metastases, 2 min nodules were found on the surface of liver during surgery. A rapid pathological examination revealed that they were metastatic tumors from the rectal carcinoid. Low anterior resection was performed for the rectal tumor and the pathological report indicated that there were 4 metastatic lymph nodes in the rectal mesentery. The patient received treatment by HAIC using 5-FU plus oral administration of HCFU and survived for 5 years.

We also review world-wide current treatments and their efficacy for hepatic metastases of carcinoid tumors.

Keywords: Hepatic arterial infusion chemotherapy, Rectal carcinoid, Liver metastasis, 5-Fluorouracil