Intraluminal bronchial carcinoid resection by bronchoscopy

Abstract

Pulmonary carcinoid tumour is an uncommon malignant neoplasm derived from the surface or glandular epithelium of the conducting or transitional airways. It is a neuroendocrine neoplasm that arises from the enterochromaffin cells of the amine precursor uptake and decarboxylation system of bronchial mucosa. They represent 1-2 % of all pulmonary neoplasms [1, 2, 3, 4]. The carcinoid tumours can be divided into two clinicopathological types, typical and atypical. They behave like low grade malignant tumours and have a high rate of resectability and better prognosis [5]. The prognosis depends on size of tumour, histological type, nodal involvement and the presence of metastasis. Majority of carcinoids are located centrally within the trachea and mainstem bronchi and are reachable with flexible bronchoscope [3, 4, 5]. Curative surgical resection with focus on lung sparing or bronchoplastic surgery is the treatment of choice [1, 2, 5]. Endobronchial laser resection via rigid or flexible bronchoscope can photocoagulate and vaporize lesions. The potassium titanyl phosphate (KTP), argon dye, yttrium aluminium pevroskite (YAP), neodymium-yttrium aluminium garnet (Nd:YAG) and diode lasers are suitable for use in fibreoptic bronchoscopes. The Nd:YAG laser is currently preferred for airway resection because of its predictable effect on living tissue (photocoagulation or vaporization), depending on the amount of energy applied [6,7]. At 980 nm diode laser shows a smaller optical penetration depth than the Nd:YAG laser at 1064 nm. Thus with identical application parameters, higher temperatures are produced with the diode in most tissues at superficial and interstitial applications. Most experts use flexible bronchoscope for laser photoresection [6]. We report a case of bronchial carcinoid in the left main bronchus causing collapse of left lung. The endobronchial resection via diode laser resulted in complete removal of obstruction with an excellent result.