Primary hepatic neuroendocrine carcinoma associated with carcinoid syndrome and pellagra: a case report

Carcinoid tumours are slow-growing neuroendocrine neoplasms mainly affecting the gastrointestinal tract, the respiratory tree, ovaries and kidneys. Approximately 20% of patients with carcinoid tumour are affected by carcinoid syndrome, characterised by chronic diarrhoea and/or flushing in the presence of systemically elevated levels of specific markers as serotonin or 5-hydroxyindolacetic acid. Skin manifestations include flushing of the face, neck and anterior surface of the chest but after repeated and prolonged relapses, the skin lesions become fixed, acquiring a bluish-red tint with telangiectasias. Patients may also develop pellagra skin symptoms including erythema, xerosis, scaling, hyperkeratosis and pigmentation, caused by a deficiency of tryptophan, due to its high consumption for serotonin synthesis.