Mesenteric metastases of small bowel carcinoid


Abdominal pain.

Patient Data

Age: 55 years
Gender: Male

There is a 2.8 x 1. 5 cm avidly enhancing mass in the left side of the abdomen within the jejunal  mesentery. It enhances uniformly and avidly with contrast.  The lesion exhibits a desmoplastic like reaction leading to a characteristic “spoke-like” appearance of mesenteric vessels. Due to the demoplastic reaction, the adjacent jejunal bowel loops are angulated and retracted towards the lesion. Affected jejunal loops show focal dilatation and enhancement with significant thickening. No appreciable calcifications within it.  

Jejunal branch of SMA leading to the mass appears hypertrophied with increased perilesional vascularity.  No wall thickening or obstruction of small bowel proximal to it. 

There are multiple discrete and enhancing lymph nodes along the branches of SMA with the largest 9mm in SAD. 

No focal liver lesions. Visualized lung bases are free of deposits 

Case Discussion

Appearances are of secondary mesenteric metastases of small bowel carcinoid.

Carcinoids are low-grade malignant neoplasms. They are arising from the submucosal neuroendocrine enterochromaffin cells. 

The most common location is the appendix, next are small bowel and colorectal sites. 

The primary lesion is typically a round small lesion with a smooth outline.

Secondary mesenteric lesions are typically central lesions with a spoke-like arrangement of adjacent small bowel loops due to desmoplastic reaction. thickened valvulae conniventes are also seen. 

Small bowel carcinoids more commonly metastasize than appendicular and gastric ones. 

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