Nodal metastases with unknown primary--an unusual presentation of carcinoid tumor

Carcinoid tumors arise from neuroendocrine cells and produce their symptoms mainly through secreted amines, and by a local desmoplastic response. The critical issue in the management of advanced carcinoid tumors is preservation of quality of life and symptomatic relief. This is because of the characteristic indolent growth which makes survival a secondary consideration, and the relative rarity of the condition. Although systemic therapy has been shown to improve symptoms, true survival benefit has not been established. We present a case of carcinoid tumor that has metastasized to mesenteric nodes, and probably other locations, with an occult primary site. The patient remains completely asymptomatic and continues to enjoy a normal lifestyle. No references were found in the literature concerning the management of asymptomatic, but metastatic carcinoids. This case thus constitutes a unique situation in which further treatment may not be beneficial and may even be harmful. Nevertheless, additional treatment is an important consideration in view of the known poor survival of those with metastatic disease versus localized, resectable tumor. However, the concept of medical therapy to improve survival in an asymptomatic individual, though theoretically attractive, has little precedence. In this article we have tried to address the therapeutic dilemma posed by this unusual clinical scenario.