Robin Spiller, editor Right pelvic mass in a patient with a radically resected carcinoid of the appendix CLINICAL PRESENTATION A 22-year-old male patient with a radiologically detected right pelvic mass presented without any symptoms. Two years before he underwent appendectomy due to acute appendicitis else- where, and a carcinoid was incidentally diagnosed. Our revised histological report confirmed a conventional carcinoid of the appendix, excluding a goblet cell carcinoid (adenocarcinoid). The tumour infiltrated the whole wall thickness without serosal invasion; margins were negative; the macroscopic size of the tumour had been omitted in the original pathology report. Immunohistochemical chromogranin-A, neuron specific eno- lase, and synaptophysin were positive. Follow-up was negative over the two subsequent years. Then abdominal ultrasound showed a 2 cm nodule on the medial side of the ascending colon on the transverse umbilical line. Somatostatin receptor scintigraphy was only positive at that site (fig 1). A CT scan showed a 4 cm mass in the right iliac fossa, near the caecum (fig 2). A colonoscopy was performed, and an extrinsic compression in the distal part of ileum was demonstrated. Plasma CgA and urinary 5-hydroxyindoleacetic acid were normal. QUESTION What is the diagnosis? See page 1259 for the answer. N Fazio, 1 F Luca, 2 L Monfardini, 3 G Pelosi, 4 L Bodei, 5 K Lorizzo, 1 G Di Meglio, 1 B Gibelli, 6 D Ravizza, 7 G Bonomo, 3 C M Grana, 5 S Baio, 5 M Squadroni, 1 G Paganelli, 5 F de Braud 1 1 Medical Oncology, European Institute of Oncology, Milan, Italy; 2 Abdominopelvic Surgery, European Institute of Oncology, Milan, Italy; 3 Radiology, European Institute of Oncology, Milan, Italy; 4 Pathology, European Institute of Oncology, Milan, Italy; 5 Nuclear Medicine, European Institute of Oncology, Milan, Italy; 6 Endocrinology, European Institute of Oncology, Milan, Italy; 7 Endoscopy, European Institute of Oncology, Milan, Italy Correspondence to: Dr N Fazio, Medical Oncology, European Institute of Oncology, 20141 Milan, Italy; nicola.fazio@ieo.it Competing interests: None. Patient consent: Obtained. NF, FL, LM, GP, LB, KL, GdiM, BG, DR, GB, CMG, SB and MS are members of the IEO NET Study Group, European Institute of Oncology, Milan, Italy. Gut 2009;58:1200. doi:10.1136/gut.2008.167452 Figure 1 Somatostatin receptor scintigraphy, 24 h post-injection. An area of focal uptake of 111 In-pentetreotide is visible on the right side of the umbilical line, both on whole-body (black arrow) and on tomographic (dotted arrow) images. Figure 2 Pelvic CT scan: a mass is visible on the right side, near the caecum (white arrow). Editor’s quiz: GI snapshot 1200 Gut September 2009 Vol 58 No 9 group.bmj.com on March 4, 2013 - Published by gut.bmj.com Downloaded from