SESSION TYPE: Cancer Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Antibodies against tumor necrosis factor alpha (TNF-α) are approved for treatment of luminal and fistulizing Crohn’s disease. Anti -TNFα are shown to have increase hematologic malignancy and a few trials shows increase solid organ malignancies. There is no published data for increase risk of pulmonary carcinoid in crohn’s disease. Here we are reporting a case of pulmonary carcinoid tumor developing in a Crohn’s disease patient on adalimumab therapy.
CASE PRESENTATION: A 19-year-old male, with six years history of Crohn's disease referred to pulmonary medicine for abnormal chest CT scan findings. His CT chest showed right hilar mass and bilateral pulmonary nodules. Of importance, he was treated with adalimumab, intermittently, for the past year. The treatment was discontinued approximately a month before presentation. Patient underwent an Endoscopic bronchial ultrasound (EBUS) with multiple biopsies, which revealed an obstruction of the posterior segment of the right upper lobe, due to extrinsic compression. Biopsies were positive for typical carcinoid tumor. Imaging studies did not show a primary tumor in the GI tract. An ocreotide scan showed uptake limited to the right lung, with no uptake in the abdominal cavity confirming the diagnosis of primary carcinoid of lung. Patient was referred to oncologist and decision was made to discontinue adalimumab with gastroenterologist agreement and to monitor progression of carcinoid with repeat imaging in 3 months.
DISCUSSION: The increase risk of intestinal neoplasms with Crohn’s disease (CD) has been reported. West et al. discovered a statistically significant increase in the incidence of carcinoid tumors in Crohn’s patients perhaps resulting from distant cytokine effects. While some case reports and author concluded that overall immunosuppression due to anti -TNFα medications, cyclosporine, HIV could led to the development of carcinoid. This is the second case of primary pulmonary carcinoid tumor of lung associated with crohn’s disease on anti-TNFα therapy. First case was reported by Betterridge et al recently, in which patient remains off anti-TNF α therapy.
CONCLUSIONS: This case reports occurrence of primary lung carcinoid in crohn’s patient on adalimumab. It’s unclear if this is an incidental finding or there is increased risk of carcinoids in crohn’s patients due to immunosuppression caused by anti-TNFα inhibitors or cytokines effects of disease itself. Further studies are needed to establish if indeed there is a etio-pathogenic agent.
1) Betteridge JD et al:Pulmonary carcinoid tumor in a patient on adalimumab for Crohn's disease. Inflamm Bowel Dis. 2012 Mar 22
2) West NE et al:Carcinoid tumors are 15 times more common in patients with Crohn's disease. Inflamm Bowel Dis. 2007
DISCLOSURE: The following authors have nothing to disclose: Amitesh Agarwal, Oliveira Eduardo
No Product/Research Disclosure InformationCleveland Clinic Florida, Weston, FL