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. 2017 Sep;4(1-2):53-60.
doi: 10.1159/000479794. Epub 2017 Aug 31.

Freezing Fort Knox: Mesenteric Carcinoid Cryoablation

Erik Soule  1 , Arya Bagherpour  1 , Jerry Matteo  1
Affiliations

Freezing Fort Knox: Mesenteric Carcinoid Cryoablation

Erik Soule et al. Gastrointest Tumors. 2017 Sep.

Abstract

Background: Neuroendocrine malignancy is indolent, yet relentless in its propensity to metastasize to the liver, where it may cause bizarre paraneoplastic syndromes. The pathophysiologic mechanism behind this predilection for hepatic metastasis is twofold: the portal venous system drains the most likely primary sites for neuroendocrine tumors, and the relatively immunosuppressed environment within the hepatic parenchyma is permissive for tumor growth. The standard of care for patients with metastatic neuroendocrine tumor is surgical resection of at least 90% of the tumor burden.

Methods: This report describes CT-guided percutaneous cryoablation of an inoperable mesenteric carcinoid tumor that had previously demonstrated hepatic metastases utilizing hydrodissection to safely and effectively prevent further metastasis while priming the immune system to eradicate this malignancy systemically.

Results: CT-guided percutaneous cryoablation is minimally invasive, has intrinsic analgesic properties, and may contribute to sensitization of the immune system against tumor antigens.

Conclusion: Percutaneous cryoablation with hydrodissection can be used to target intraabdominal malignancy in poor surgical candidates. This procedure is safe, effective, and minimally invasive.

Keywords: Abscopal effect; Carcinoid tumor; Cryoablation; Mesenteric tumor; Metastasis; Neuroendocrine tumor.

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Figures

Fig. 1
Fig. 1
Mesenteric carcinoid tumor cryoablation. a Preoperative abdominal CT image demonstrating a calcified mesenteric mass surrounded by bowel loops, ventral hernia, and an anterior window to access the mass percutaneously. b Postoperative abdominal CT image demonstrating hypodensity in the region of the mass without evidence of ablation to surrounding bowel and contrast used for hydrodissection. c One-month follow-up CT confirming >90% tumor coverage with minimal rim enhancement. d Preoperative abdominal CT image with measurements of the lesion. e Four-month follow-up CT with measurements revealing a 20–25% decrease in tumor size.
Fig. 2
Fig. 2
Probe placement and hydrodissection. a Initial cryoprobe embedded in the mass. b First 21-gauge needle lateral to the mass hydrodissecting the bowel away from the target zone anterolaterally. c Second 21-gauge needle medially hydrodissecting additional bowel loops. d Third 21-gauge needle hydrodissecting posteromedially. e Second cryoprobe embedded in the inferior portion of the mass. f CT image obtained during the freeze cycle demonstrating expanding ice ball within the mesenteric mass.
See this image and copyright information in PMC

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