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Lung Cancer |

Recurrent Pneumonia Caused by Bronchial Carcinoid in a Young Patient

Reena Gurung, MD; Soophia Naydenov, MD
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St. Luke's Hospital, Chesterfield, MO


Chest. 2014;146(4_MeetingAbstracts):651A. doi:10.1378/chest.1989108
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Abstract

SESSION TITLE: Cancer Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchial Carcinoid (BC) is a rare pulmonary tumor derived from neuroendocrine cells attributing to 1-2% of lung malignancies. We report a rare case of BC in a young male who presented with recurrent pneumonia.

CASE PRESENTATION: A 31-year-old Caucasian male presented with two-week history of shortness of breath, night sweats, cough and wheezing. Pertinent history included four episodes of pneumonia in the last two years and 20 pack-year of smoking. Chest computed tomography (CT) showed 1.6 cm nodule in the proximal right lower lobe (RLL) bronchus with multiloculated fluid collections suggestive of empyema (Fig1). Bronchoscopy revealed an endobronchial lesion obstructing the proximal segment of the RLL (Fig2), which was biopsied. Pathology showed solid nests of uniform small cells with round nuclei and relatively abundant amphophilic cytoplasm, suspicious for carcinoid; strongly positive Synaptophysin and Chromogranin immunohistochemical stains confirmed the diagnosis. QuantiFERON- TB Gold returned negative. Patient was treated with antibiotics and scheduled for lobectomy.

DISCUSSION: BC occurs more commonly in females and frequently in the fifth decade of life. (1) Typical clinical features are cough, hemoptysis and occasionally post-obstructive pneumonia. Rarely, it has been associated with paraneoplastic endocrine symptoms such as Carcinoid and Cushing syndrome. (2) Delay in diagnosis as in our case is common due to its indolent nature. The bronchoscopic finding of the firm tumor growing into the lumen of the bronchus serves the most important diagnostic tool. (1) FDG-PET and Somatostatin receptor scintigraphy have low sensitivity and specificity respectively, hence are not routinely recommended for diagnostic purpose. (2) BC is divided into Typical and Atypical depending on the degree of mitoses and necrosis, identifying which requires tumor en bloc and may not always be feasible on biopsy specimen. Classification is essential for prognostication; favorable outcomes reported for typical carcinoid. Surgery is the mainstay of treatment; for typical carcinoid, conservative resection of the tumor whereas for atypical, total or partial resection of the affected lung with lymph node dissection is recommended.

CONCLUSIONS: BC should be considered in the differential of young adults without history of airway disease presenting with frequent pneumonia. Evaluation with chest CT and flexible bronchoscopy should be obtained for early diagnosis and treatment.

Reference #1: Gustafsson, et al. Bronchopulmonary neuroendocrine tumors. Cancer. 2008;113(1):5-21.

Reference #2: Young, et al. Wheezing and exertional dyspnea in a 25-year-old mountaineer. Chest. 2008;133(3):820-5.

DISCLOSURE: The following authors have nothing to disclose: Reena Gurung, Soophia Naydenov

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