Treatment of a malignant bronchial carcinoid affecting the mediastinum and left atrium by radical two stage resection with cardiopulmonary bypass and somatostatin infusion

Malignant cancer affecting the heart is rare and treatment is problematic. It is most often found in conjunction with cancers of the liver and intestines, and less often with lung cancers. The type of cancer is important in both diagnosis and treatment because the cancers will respond differently. Those associated with the liver and intestines cause an increased production of an enzyme, 5 hydroxyindole acetic acid, that converts a substrate into serotonin, a substance that can decrease production of the hormone somatostatin. The increase in the enzyme can be detected in urine. Lung cancers do not usually cause this increase. Release of a large amount of serotonin during tumor removal can have adverse effects on the patient and somatostatin must be given to counter these effects. When the cancer originates in the lungs, symptoms are often absent. Treatment usually involves complete surgical removal of tumors and surrounding tissues. This case study examined the diagnosis and treatment of a lung tumor that invaded the left atrium in a 63-year-old woman who complained of a persistent cough and flushing of the face. Diagnostic imaging uncovered the tumor. The tumor appeared to have invaded heart tissue, but not to have spread elsewhere. Surgical removal was performed. A urine sample did not test positive for increased enzyme activity. During surgery, the tumor was found to have invaded the left atrium. As removal was attempted, the patient's blood pressure dropped dramatically, and somatostatin had to be infused for the surgery to be completed. Examination of the tumor found it was atypical. It secreted directly into the heart, which caused the blood pressure drop. This case indicates that somatostatin should be available for all tumor operations involving the heart, even when urine sample are negative for 5 hydroxyindole acetic acid. (Consumer Summary produced by Reliance Medical Information, Inc.)