Freezing Fort Knox: Mesenteric Carcinoid Cryoablation.

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.