25673              MULTIPLE CARCINOID TUMOURS OF THE ILEUM

The patient was a woman aged 63 who fell while descending some stairs.  On examination in casualty there was external rotation of the right leg with swelling of the upper thigh.  She was unable to move the limb.  The heart was enlarged.  X-ray showed intertrochanteric fracture of the right femur.  A blade plate was inserted.  She was discharged after a month.  Six years later there was intermittent vomiting for two days.  The vomitus became faeculent and after one vomiting bout some of this material was inhaled.  She immediately became cyanosed, breathless and shocked, and died in the Casualty Department after further severe faeculent vomiting.  At postmortem 20 cms of small bowel near the ileo-caecal junction were infarcted and surrounded by fibrinous adhesions.  The heart was enlarged on the left side, but the right ventricle, pulmonary valve and pulmonary arteries were normal.

The specimen consists of some 40 cms of small bowel.  The muscle coat is moderately and diffusely thickened and the mucosa shows marked congestion and areas of exudate consequent upon early infarction.  Multiple small carcinoid tumours varying in size up to 2 cms in diameter are present in the mucosa of the bowel.  Their cut surface is yellow-brown and the characteristics invagination of the muscle coat is evident.  Some of the tumours are ulcerated.  A large firm fleshy lymph node is present in the mesentery.  Histology shows that the tumours are characteristic carcinoids.  Invasion of the muscle coat is conspicuous.  Metastatic carcinoid tumour is present in the mesenteric node.