Primary insular carcinoid of the ovary with carcinoid heart disease: Unfavourable outcome of a case.

INTRODUCTION: Primary ovarian carcinoid is a very rare disease. Carcinoid heart disease occurs in about one-third of patients with carcinoid syndrome. Cardiac involvement may be a cause of death in this syndrome. PRESENTATION OF CASE: We presents the unfavourable outcome of a 78-year-old woman admitted to the hospital complaining severe dyspnea and peripheral oedemas. Because of the presence of a large pericardial effusion with compression of cardiac chambers, an evacuative pericardiocentesis was performed. Computed tomography showed a solid pelvic mass with ascites. She underwent a complete surgical staging. Histological findings revealed an insular carcinoid stage IA. Three weeks later she was readmitted to the hospital and echocardiography demonstrated a right tricuspid valvular involvement with stenosis and severe regurgitation with a 2 cm masses in the posterior mitral leaflet. Hemoculture was positive for Staphylococcus aureus. Patient was not suitable for surgical intervention and decease due to sepsis and because secondary complications of the mitral endocarditis. DISCUSSION: High level of 5-HIAA has a rule in the development and progression of the carcinoid heart syndrome and could lead the right tricuspid valvular involvement. In the case we presented the bacterial endocarditis worsened the cardiac functions and the clinical conditions before she deceased.
CONCLUSION: Ovarian primary carcinoid tumors are very rare tumors that require appropriate preoperative diagnosis. Even if survival is usually excellent, when carcinoid syndrome with heart involvement is present, a high level of attention is mandatory to prevent and limit damage caused by the vasoactive amine secreted by the tumor.