Pulmonary Tumors: The Daily PANCE Blueprint

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Pulmonary Tumors: The Daily PANCE Blueprint

A 55-year-old woman presents with episodic flushing, diarrhea, and wheezing. She reports a history of intermittent abdominal pain and has recently noticed an increase in the size of her abdomen. A 24-hour urinary 5-HIAA test shows elevated levels. An abdominal CT scan reveals a small mass in the ileum and hepatic metastases. Which of the following is the most likely diagnosis?

A. Gastroesophageal reflux disease (GERD)
B. Carcinoid tumor
C. Peptic ulcer disease
D. Pancreatic adenocarcinoma
E. Irritable bowel syndrome (IBS)

Answer and topic summary

The answer is B. Carcinoid tumor

The patient’s symptoms of episodic flushing, diarrhea, and wheezing, along with elevated 24-hour urinary 5-HIAA levels and imaging findings of a small mass in the ileum and hepatic metastases, are highly suggestive of a carcinoid tumor. Carcinoid tumors are neuroendocrine tumors that most commonly occur in the gastrointestinal tract, especially in the ileum. They can secrete various substances, including serotonin, leading to the characteristic carcinoid syndrome manifested by flushing, diarrhea, and bronchospasm. The presence of hepatic metastases can exacerbate these symptoms due to increased secretion of bioactive substances into the systemic circulation.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Pulmonary Neoplasms ⇒ Carcinoid tumors

Also covered as part of the Internal Medicine PAEA EOR topic list