[Carcinoid tumor with revealed by skin manifestation]

Carcinoid tumours are often diagnosed late because a large quantity of vasoactive peptides must be accumulated to express the carcinoid syndrome.

A 54-year-old male was seen for rosacea and intense episodes of vasomotor flush. The rosacea was associated with episodes of diarrhoea. The carcinoid tumour was diagnosed on the basis of raised levels of 5-hydroxyindol acetic acid. Radiology and surgery demonstrated liver, lymph node and mesenteric metastases of the primative carcinoid tumour which could not be located. Treatment combined chemotherapy (5-fluorouracil-streptozotocine) and a somatostatin analogue (octreotide). A good clinical response was obtained with a 1 year follow-up.

This case was discovered in misleading conditions since the rosacea overshadowed the other clinical manifestations of the carcinoid syndrome. Symptomatology resulted from the metastasic carcinoid tumour. Surgery should always be proposed. It is rarely very extensive but does allow reduction of tumour size. The role of medical treatment with a somatostatin analogue should be emphasized. This treatment can be combined with more classical chemotherapy (5-fluorouracil, streptozotocine).