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Carcinoid Syndrome From Primary Bronchial Carcinoid Tumor With Normal Levels of Serotonin and 5-HIAA Resolved With Resection FREE TO VIEW

Gurpreet Johal, MD; Andrea Covey*, MD; Kush Tripathi
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UMKC, Kansas City, MO

Chest. 2012;142(4_MeetingAbstracts):646A. doi:10.1378/chest.1389202
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PRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PM

INTRODUCTION: Primary bronchial carcinoid tumors generally present with obstructive symptoms and are rarely associated with carcinoid syndrome, unlike gastrointestinal tumors. Our patient had typical obstructive symptoms, but also had symptoms of carcinoid syndrome inconsistent with laboratory findings.

CASE PRESENTATION: A 55 year old African American woman presented with shortness of breath and chest pain. She also had flushing, increased anxiety, and severe diarrhea. Past medical history included gastroesophageal reflux disease, genital herpes, 30 pack year smoking history and two hospitalizations for pneumonia. Pulmonary function testing was normal. Initial chest x-ray showed left lower lobe consolidation. CT chest suggested an endobronchial lesion (figure 1). Bronchoscopy with biopsy was performed and found a mass obstructing the left lower lobe bronchus (figure 2). Pathology returned the diagnosis of carcinoid tumor with positive stains for pancytokeratin, synaptophysin, and chromogranin. Serum serotonin and urinary 5-HIAA were within normal ranges. CT abdomen/pelvis showed no evidence of liver or gastrointestinal metastasis. The tumor was excised with negative margins and lymph nodes. The lesion was approximately two centimeters. After resection patient reported resolution of anxiety and diarrhea with significant improvement in hot flushes.

DISCUSSION: Bronchial carcinoid tumors generally present with obstructive symptoms of dyspnea, wheezing, chest pain, and recurrent pneumonia. Carcinoid syndrome is rarely encountered in tumors of less than five centimeters. Plasma or urinary hormone levels are usually elevated in carcinoid syndrome. Though our patient’s symptoms would generally necessitate further imaging with liver MRI, resolution of her symptoms made this unnecessary. To our knowledge, this is the first reported case of bronchial carcinoid tumor associated with carcinoid syndrome with no evidence of metastatic disease or elevated serotonin or 5-HIAA levels.

CONCLUSIONS: We postulate that carcinoid syndrome can manifest despite small tumor size, no evidence of metastasis, and without elevated levels of serotonin or 5-HIAA. Prompt resolution of her symptoms with surgical resection suggests that other bioactive compounds could have contributed to her symptoms.

1) Fink G, Krelbaum T. Pulmonary carcinoid: Presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest. 2001;119: 1647-1651

2) Hemminki K, Li X. Incidence trends and risk factors of carcinoid tumors: A nationwide epidemiologic study from Sweden. Cancer. 2001;92(8): 2204

3) Fraser RS, Muller NL, Colman N, Pare PD. Neuroendocrine neoplasms. Fraser and Pare's Diagnosis of Diseases of the Chest, 4th ed. 1999:1229-50

DISCLOSURE: The following authors have nothing to disclose: Gurpreet Johal, Andrea Covey, Kush Tripathi

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UMKC, Kansas City, MO




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