Pulmonary Carcinoid Tumorlets: A Rare Cause of Chronic Intractable Cough

Abstract

Chronic cough is a common presenting complaint in pulmonary clinics. We present a patient who had undergone extensive work up for chronic intractable cough that was finally diagnosed as diffuse pulmonary carcinoid tumorlets. Pulmonary tumorlet is an incidental finding at histopathologic examination of lung parenchyma that is often located adjacent to bronchogenic tumors or carcinoid tumors or particularly in lung scarred by bronchiectasis or other chronic inflammatory processes. Tumorlets are usually smaller than 5 mm in diameter and are multiple. Tumorlets are composed of small uniform cells that appear cytologically benign; they tend to form compact aggregates or nests and may grow into the mucosa of the airways. Also, tumorlets, like carcinoids, contain neurosecretory granules and have distinctive electron microscopic and immunohistochemical findings. Our case is a 61 year old Caucasian female, non-smoker, was followed in pulmonary clinic because of chronic dry cough which was associated with dyspnea and wheezing. Normal physical examination except for occasional wheezes. Pulmonary function test showed restrictive pattern, FEV1 75%, FEV1/FVC 88% and TLC 67% of predicted. High resolution chest CT had shown multiple non-calcified well circumscribed pulmonary nodules scattered throughout the lungs, the largest 5 mm. She had been treated as a case of asthma. Inhaled bronchodilators and corticosteroids partially improved her symptoms. Later her cough had become intractable with worsening exertional dyspnea. Otolaryngology evaluation and EGD had been inconclusive. Bronchoscopy with bronchoalveolar lavage and multiple transbronchial biopsies came with normal results. VATS biopsy showed multiple small nodules less than 1 cm in the right upper, middle, and lower lobes, predominantly peripheral lesions. The lesions were found to represent carcinoid tumorlets. Usually the lesions are asymptomatic and discovered incidentally on CT scan and can be confused with metastases, however they can present with chronic cough or dyspnea.