Endobronchial Carcinoid Tumor Research Articles

Complete Regression of Endobronchial Carcinoid Tumor after an Endoscopic Biopsy.

An 80-year-old woman who had been diagnosed with an endobronchial carcinoid tumor visited our hospital for treatment with an endoscopic technique. However, a bronchoscopic examination at our hospital showed spontaneous regression of the tumor at the orifice of the right middle lobar bronchus. Chest computed tomography five months later revealed no local recurrence. This is the second report of an endobronchial carcinoid tumor vanishing after an endoscopic biopsy.

Endobronchial resection as a bridge to curative resection in patient with poor preoperative lung function secondary to an airway blocking endobronchial carcinoid tumour

We present a 70-year-old gentleman with chronic cough with haemoptysis found to have left lower zone collapse on imaging. The bronchoscopy showed an endobronchial mass histologically of a non-secreting atypical carcinoid. Poor baseline lung function excluded surgical resection, and instead, he successfully underwent a bronchoscopic debulking procedure which improved his FEV1 to 84% and DLCO 83% predicted. Unfortunately, the tumour regrew, but the calculated percentage predicted postoperative for FEV1 (64%), and DLCO (65%) enabled definitive surgical resection to take place. Surgical resection remains the definite curative option for localised endobronchial atypical carcinoid tumours. Achieving this in proximal endobronchial carcinoid tumour is a challenge. We described an endoscopic tumour debulking procedure as a bridge for curative surgical resection in a patient with an inoperable proximal atypical carcinoid tumour due to poor predicted postoperative lung function. We highlighted the need to assess predicted postoperative lung function with functional and quantitative perfusion methods to aid surgical planning. Debulking the tumour by endoscopy can be used as a conduit to curative surgical resection in bronchial carcinoid tumour. The choice of calculating the percentage predicted values by either or both methods must be individualised based on tumour location and the probability of converting a lobectomy to a pneumonectomy. This precautionary approach could evaluate the postoperative lung function and morbidity and mortality risk if considering a pneumonectomy. Endoscopic debulking can be a successful bridge to a curative surgical resection aided by comprehensive preoperative lung function tests to predict postoperative lung values

M123 ATYPICAL CARCINOID - AN UNUSUAL ASTHMA MIMIC

Asthma presents with symptoms of variable airflow flow obstruction such as wheezing, shortness of breath, cough, and exercise intolerance. We describe a case of an atypical endobronchial carcinoid tumor masquerading as asthma.

Diagnostic Yield and Bleeding Complications Associated With Bronchoscopic Biopsy of Endobronchial Carcinoid Tumors.

Bronchial carcinoid often appears hypervascular on bronchoscopic visualization and may be associated with hemoptysis. The diagnostic yield and bleeding complications associated with bronchoscopic biopsy of bronchial carcinoid tumors remain unclear. Patients with bronchial carcinoid tumors that were bronchoscopically visualized and biopsied at our tertiary referral medical center, over an 8-year period from 2010 to 2017, were retrospectively identified and reviewed to assess diagnostic yield and bleeding complications. Correlations with patient characteristics and carcinoid tumor features were analyzed. Forty-nine patients were included (57% female). Tumors were predominantly (71%) located in proximal airways (mainstem and lobar bronchi). Bronchoscopic biopsy was diagnostic in 45 patients (92%). Thirteen patients (27%) experienced moderate (n=12, 25%) or severe (n=1, 2%) bleeding. Among these, 6 tumors (46%) had a vascular appearance and 4 patients (31%) had experienced recent hemoptysis. However, neither vascularity nor hemoptysis was associated with bleeding at biopsy (P=0.68 and 0.73, respectively). Carcinoid tumors were classified as typical in 79% and atypical in 21% with no difference in diagnostic yield or bleeding risk (P=0.28 and 0.92, respectively). Tumor size was also not associated with increased diagnostic yield or bleeding risk (P=0.54 and 0.39, respectively). Bronchoscopic biopsy of endobronchial carcinoid is associated with a high diagnostic yield and severe bleeding is rarely encountered. Diagnostic yield and bleeding seemed independent of vascular tumor appearance or history of recent hemoptysis.

DIPNECH: A UNIQUE PRESENTATION OF A RARE DISEASE

SESSION TITLE: Diffuse Lung Disease 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a very rare disease that consists of a proliferation of scattered single cells, small nodules, or linear proliferations of pulmonary neuroendocrine cells (1). The entity has been described as a precursor to pulmonary carcinoid tumors (2), is thought to be more common in middle-aged women, and can be associated with slowly-progressive cough or shortness of breath with exertion (1,3). CASE PRESENTATION: We present a case of a 42-year-old female with a complicated pulmonary history including a childhood diagnosis of asthma, two spontaneous pneumothoraces, chronic daily cough, dyspnea on exertion, and a seven-year history of incidentally-noted pulmonary nodules. An initial workup for her nodules was negative for fungal or autoimmune etiologies. An interval CT scan was obtained and showed an increase in nodule size which was further evaluated with a PET-CT. While none of the lung nodules were PET-avid, a hypermetabolic thyroid nodule was incidentally noted, which was biopsied and found to be papillary thyroid cancer. Pulmonary function testing was obtained for her dyspnea and showed mild restriction with no evidence of obstruction and normal diffusion capacity. After a non-diagnostic CT-guided biopsy of a right middle lobe lung nodule led to an iatrogenic pneumothorax requiring chest tube placement, she eventually underwent video assisted thoracoscopic surgery and right middle and lower lobe wedge resections. Biopsy showed the presence of a typical carcinoid tumor as well as neuroendocrine hyperplasia consistent with DIPNECH. DISCUSSION: This case represents an atypical presentation of a rare disease. Though pulmonary nodules, shortness of breath, and cough are common findings in DIPNECH, the occurrence of spontaneous pneumothoraces is not. Few case reports have described spontaneous pneumothoraces in patients with large endobronchial carcinoid tumors; however, this patient had no evidence of endobronchial obstruction and thus represents a unique presentation of the disease (4,5). This case also demonstrates the importance of maintaining a broad differential in the approach to patients presenting with dyspnea, cough, and pulmonary nodules. While the DIPNECH is very rare, appropriate diagnosis and close follow-up is important given the association of DIPNECH with subsequent development of carcinoid tumors (6). CONCLUSIONS: The differential for diffuse pulmonary nodules in the setting of chronic cough or dyspnea is incredibly broad. After more common etiologies like metastatic disease, granulomatous disease, autoimmune, and infectious disorders are ruled out, one should consider the diagnosis of DIPNECH, particularly in a middle-aged female with chronic, otherwise-unexplained respiratory symptoms and especially with an associated diagnosis of a carcinoid tumor (2). Reference #1: Travis WD, Brambilla EW, Burke AP, et al. WHO Classification of Tumours of the Lung, Pleura, Thymus, and Heart, IARC Press, Lyon 2015. Reference #2: Gorshtein, A., Gross, D. J., Barak, D., Strenov, Y., Refaeli, Y., Shimon, I. and Grozinsky-Glasberg, S. (2012), Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia and the associated lung neuroendocrine tumors. Cancer, 118: 612–619. https://doi.org/10.1002/cncr.26200. Reference #3: Nassar A. A., Jaroszewski D. E., Helmers R. A., Colby T. V., Patel B. M., Mookadam F. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia—a systematic overview. American Journal of Respiratory and Critical Care Medicine. 2011;184(1):8–16. https://doi.org/10.1164/rccm.201010-1685pp. DISCLOSURES: No relevant relationships by Carleen Risaliti, source=Web Response No relevant relationships by Kyle Stinehart, source=Web Response

A 14-year-old boy with endobronchial carcinoid tumor presenting with asthma

Introduction Bronchial carcinoid tumors seldom occur in children, sometimes mistaken for a minor disease and diagnosed slowly. Materials and Methods: We report on a patient who diagnose tumors slowly because confused with asthma. Results This case describes a 14-year-old boy, presenting with asthma-like symptoms throughout 3 years. He was treated as asthma but wax and wane. Chest x-ray showed an hyperlucent left lung, so we rechecked high resolution computed tomography (HRCT) for unilateral hyperinflation diseases diagnosis. It was found 1×1㎝ nodule in left main bronchus. We did bronchoscopy and discovered a round mass in the left bronchus, 2∼3㎝ away from carina. In the biopsy, it was bronchial carcinoid tumor, so we resected tumor. Discussion Because symptoms of bronchial carcinoid tumors are various, it can often be misdiagnosed firstly. It is confused with asthma, pneumonia and foreign body. An additional examination were necessary when respiratory symptoms persist.

Surgical options in the treatment of endobronchial carcinoid tumor

Abstract Endobronchial carcinoid tumors (ECT) are the most common pulmonary neuroendocrine tumor in the pediatric population. We report two cases of ECT in children who presented with recurrent pneumonia and bronchial asthma-like symptoms. Rigid bronchoscopy revealed an endobronchial mass with biopsy confirming the diagnosis. Both children underwent surgical resection with an uneventful post-operative course. Neither of children required adjuvant chemotherapy nor radiotherapy and with a mean of follow-up of 8 years with no recurrence. Physicians should be aware that children with recurrent pneumonia and asthma-like symptoms may have ECT. Appropriate investigations including CT scan, bronchoscopy, and biopsy would ensure early diagnosis and surgery.

Two-Stage Surgery Without Parenchyma Resection for Endobronchial Carcinoid Tumor

The aim of the study was to evaluate the efficacy of a combined approach of endoscopic resection followed by pure bronchoplasty without any pulmonary resection in patients with endobronchial carcinoids. We applied a two-stage technique, endoscopic resection first followed by pure bronchoplasty, to 25 patients (10 men, 15 women) with endobronchial carcinoid tumors. The median age was 32.4 years (range, 19 to 64). The indications for this technique were pure endobronchial carcinoid without lymph node involvement. Tumor was located on the right side in 18 patients (72%), and on the left in 7 patients (28%). Flexible bronchoscopy was carried out in all patients as the first-stage procedure for debulking and searching for a true pedicle of the tumor. Different types of pure bronchoplasty were performed as the second-stage surgery with systematic mediastinal lymph node dissection. The resection was complete (R0) in all cases. Tumors were pathologically staged as pT1aN0 in 18 patients, pT2N0 in 5, and pT3N0 in 2 patients; 23 tumors were typical and only two were atypical carcinoids. Morbidity was 28.0% (only minor complications), with no mortality. Overall 5-year and 10-year survival was 100.0% and 91.8%, respectively. No recurrence of the primary tumor was observed in any case. Two-stage surgery consisting of endoscopic resection and pure bronchoplasty without lung parenchyma resection is an effective technique for the treatment of endobronchial carcinoid, with an excellent oncologic outcome.

Bilateral Choroidal Metastases from Endobronchial Carcinoid Treated with Somatostatin Analogues.

Objective:To describe a patient with bilateral multifocal choroidal metastases from an endobronchial carcinoid treated with a somatostatin analogue.Method:A 60-year-old woman presenting with photopsia in the left eye underwent an extensive ophthalmic examination, including fluorescein angiography, OCT and ultrasound.Results:Fundoscopy revealed a small retinal tear in the left eye, for which she received laser treatment. In addition, choroidal masses were detected in both eyes. Her medical history of a pneumectomy for a bronchial carcinoid six years earlier together with recent elevated chromogranin A blood levels prompted a diagnosis of choroidal metastases. Subsequently, a Gallium-68 DOTANOC positron emitting tomography/computer tomography scan revealed a spinal cord metastasis and mediastinal as well as mesenterial lymph node invasion. Systemic treatment with Sandostatin®, a somatostatin analogue was started. Up until two years after the initial presentation and treatment, these choroidal lesions remained stable without any signs of growth.Conclusion:Endobronchial carcinoid tumors have an indolent nature and long-term follow-up is recommended for early detection of metastases. Although treatment with somatostatin analogues rarely induces complete tumor regression, tumor stabilization and prevention of symptoms related to hormone secretion is achieved. This well-tolerated systemic treatment provides a worthy alternative treatment for choroidal metastasis compared to classic radiotherapy without any risk of radiation or laser-related visual loss.

Endobronchial Carcinoid and Concurrent Carcinoid Syndrome in an Adolescent Female.

Endobronchial carcinoid tumors are the most common intrabronchial tumors in children and adolescents. Common signs and symptoms include persistent cough and wheezing not responsive to bronchodilators, hemoptysis, and recurrent fever. Diagnosis is frequently made by imaging and direct visualization with flexible bronchoscopy; surgery remains the gold standard treatment, and lung-sparing resections should be performed whenever possible. Though carcinoid syndrome—characterized by flushing, palpitations, wheezing, shortness of breath, and diarrhea—has been found in association with adult bronchial carcinoid tumors, to our knowledge only one previous study has reported the presence of carcinoid syndrome in a pediatric patient with an endobronchial carcinoid. Here, we report a case of a 14-year-old girl with chronic cough found to have an endobronchial carcinoid tumor and signs and symptoms consistent with carcinoid syndrome.

Endobronchial Carcinoid Tumour with Extensive Ossification: An Unusual Case Presentation.

Carcinoid tumour is a well-known primary endobronchial lung neoplasm. Although calcifications may be seen in up to 30% of pulmonary carcinoid tumours, near complete ossification of these tumours is an unusual finding. Such lesions can prove diagnostically challenging at the time of intraoperative frozen section as the latter technique requires thin sectioning of the lesion for microscopic assessment. We present an unusual case of endobronchial carcinoid tumour with extensive ossification in a 45-year-old male. Preliminary intraoperative diagnosis was achieved through the alternative use of cytology scrape smears. The final diagnosis was confirmed after decalcification of the tumour. The prognostic implications of heavily ossified carcinoid tumours remain elusive. Long-term clinical follow-up of these patients is recommended.

PHACES syndrome associated with carcinoid endobronchial tumor

PHACES syndrome consists of the constellation of manifestations including posterior fossa anomalies of the brain (most commonly Dandy-Walker malformations), hemangiomas of the face and scalp, arterial abnormalities, cardiac defects, eye anomalies and sternal defects. We present a case with a possible PHACES syndrome including sternal cleft and supraumbilical raphé, precordial skin tag, persistent left superior vena cava and subtle narrowing of the aorta with an endobronchial carcinoid tumor. All these anomalies were discovered on chest multi-detector CT. This is a unique case of PHACES syndrome associated with carcinoid tumor. Review of the literature revealed 3 cases of PHACES syndrome with glial tumor. The authors tried to find the relationship between PHACES syndrome and carcinoid tumors or gliomas, which all derive from the neural crest cells.

Resection of synchronous ipsilateral giant bullae and bronchial carcinoid tumor

Synchronous bronchial carcinoid tumor and giant bullae are rare entities. In this article, we report a 62-year-old male presenting with dyspnea, cough and chest pain. No improvement was achieved with medical treatment. Examinations revealed right lower lobe endobronchial carcinoid tumor and upper lobe giant bullae. Simultaneous bullectomy and bronchotomy and carcinoid tumor resection through right thoracotomy, as well as postoperative tracheostomy were performed. The patient who had 2 lt/ minute oxygen was discharged on the 16 th postoperative day without any complication. Radiological, apprearance, clinical situation and pulmonary functions were improved and better quality of life was observed at six months after surgery. Forced expiratory volume in 1 second (FEV1) increased from 0.90 liter (29% predicted) to 1.13 liter (37% predicted). Patient continued to smoke and died due to cor pulmonale one year after discharge.

Endobronchial carcinoid tumor in a 15years old patient

Abstract Endobronchial carcinoid tumor is an extremely rare neoplasm in children and adolescence. Herein, a case of endobronchial carcinoid tumor in a 15 year old female presented with recurrent chest infection for a long time and after a careful examination and investigation, the case was diagnosed.

Association of Carcinoid Tumor and Sarcoidosis

The association of systemic sarcoidosis with malignant neoplasms has been reported by several publications although there is controversy as to whether sarcoidosis predisposes patients to certain types of tumors or whether it is the tumors that cause a sarcoid reaction. The relationship between endobronchial carcinoid tumor and sarcoidosis is uncommon. We report the case of a 43-year-old male who was hospitalized due to hemoptysis. Thoracic CT revealed a pulmonary mass in the right upper lobe (RUL) as well as hypermetabolic lymphadenopathies seen with PET-CT. The endobronchial biopsies were compatible with carcinoid tumor. The patient underwent lobectomy of the RUL with mediastinal lymphadenectomy. Histology demonstrated type I endobronchial carcinoid tumor and sarcoid granulomas, both in the RUL surgical piece as well as in the mediastinal lymph nodes.

Asociación de tumor carcinoide y sarcoidosis

The association of systemic sarcoidosis with malignant neoplasms has been reported by several publications although there is controversy as to whether sarcoidosis predisposes patients to certain types of tumors or whether it is the tumors that cause a sarcoid reaction. The relationship between endobronchial carcinoid tumor and sarcoidosis is uncommon. We report the case of a 43-year-old male who was hospitalized due to hemoptysis. Thoracic CT revealed a pulmonary mass in the right upper lobe (RUL) as well as hypermetabolic lymphadenopathies seen with PET-CT. The endobronchial biopsies were compatible with carcinoid tumor. The patient underwent lobectomy of the RUL with mediastinal lymphadenectomy. Histology demonstrated type I endobronchial carcinoid tumor and sarcoid granulomas, both in the RUL surgical piece as well as in the mediastinal lymph nodes.

Primary Epithelial Myoepithelial Carcinoma of Lung, Reporting of a Rare Entity, Its Molecular Histogenesis and Review of the Literature

Primary epithelial myoepithelial carcinoma of lung is a rare entity and is thought to arise from the submucosal bronchial glands distributed throughout the lower respiratory tract. Because of the rarity of this tumor, we describe one case of epithelial myoepithelial carcinoma arising in the bronchus intermedius and presenting as an endobronchial mass. A 57-year-old male patient presented with an incidental finding of an endobronchial mass located in the lumen of the right lower lobe bronchus and caused near total luminal occlusion of the bronchus. An endobronchial carcinoid tumor was entertained clinically. Subsequently the patient underwent an uneventful videothoracoscopic lobectomy of lower and middle lobes of the right lung. Morphologically and immunohistochemically the tumor was characterized by two cell populations with epithelial and myoepithelial cells forming duct-like structure. The final diagnosis of epithelial myoepithelial carcinoma of lung was rendered.

Un cas de tumeur carcinoïde typique diagnostiqué sur un « syndrome du lobe supérieur »

A 53-year-old woman presented with progressive cough related to an endobronchial carcinoid tumour. The location of the tumour in the right upper lobe bronchus could be described as an "upper lobe syndrome" by analogy with the "middle lobe syndrome" or Brock's syndrome. Surgical management consisted of lobectomy and lymph node dissection. This established the diagnosis of typical carcinoid tumour. There was no mediastinal nodal invasion. Three months after surgery all symptoms had disappeared.

A Case of Endobronchial Carcinoid Tumor Treated by Flexible Bronchoscopic Resection

Bronchial carcinoid tumor accounts for less than 5% of all primary lung tumors in adults. Although surgical resection is the treatment of choice, here we report a case of bronchial carcinoid tumor treated with flexible bronchoscopic resection. A 19-year-old-man presented with a history of wheezing with dyspnea for six months. A simple chest x-ray showed no abnormal findings, but a pulmonary function test showed a moderate obstructive lung disease pattern without a bronchodilator response. A computed tomogram of the thorax revealed an enhanced 15×12 mm nodule in the left main bronchus. Bronchoscopic examination showed a polypoid mass with a stalk in the left main bronchus, which almost completely occluded the left main bronchus. Histopathology of the resected specimen revealed a bronchial carcinoid tumor. We treated the carcinoid tumor with a flexible bronchoscopic resection. During the follow up period of 6 months, the previous tumor didn't relapse. Initial bronchoscopic resection should be considered when bronchial carcinoid tumor can be approached by bronchoscopy.

Endobronchial Carcinoid Tumor in an HIV-infected Patient

Endobronchial carcinoid is an uncommon pulmonary neoplasm. In this brief report, we present a case of an HIV-infected patient with an incidentally identified endobronchial carcinoid. This case illustrates the importance of a broad differential diagnosis for lung lesions in HIV-infected patients.