Surgical treatment for the patient with the neuroendocrine lung tumor associated with ectopic ACTH-secretion syndrome: case report

Abstract

Among primary neoplasms of the lungs, the proportion of neuroendocrine tumors is up to 20–25%. According to the Surveillance Epidemiology and Results (SEER) database, since 1970 there has been a significant increase in primary carcinoid tumors of various organs with the highest incidence of morbidity in the broncho-pulmonary localization group. Carcinoid tumors of the lung level are approximately 2% of all primary lung tumors, but only 5% of these formations are associated with ACTH production.
 Despite the severity of clinical manifestations and the acceleration of hypercorticoid processes, the topical diagnosis of ACTH-ectopic syndrome often causes certain difficulties. The difficulty in diagnosing ectopic tumors is due to the fact that most of these formations are so small that they can be missed by standard methods of examination (X-ray, ultrasound, MSCT or MRI). After the diagnosis of ACTH-ectopic syndrome is completely optimal method of pathogenetic therapy is a radical removal of the tumor, which leads to the normalization of the functions of the adrenal cortex and the elimination of hypercorticoidism. However, the achievement of this goal in many cases is difficult due to late topical diagnosis, the prevalence of the tumor process and extensive metastasis.
 There is a clinical observation of a patient with a diagnosis of a neuroendocrine lung tumor with ACTH-ectopic syndrome. The importance of the multidisciplinary approach, the methods of differential diagnosis, the features of the perioperative period and the long-term results of treatment are described.