Pulmonary Procedures |

Hemoptysis in a Young Patient: An Unusual Cause FREE TO VIEW

Gilmar Zonzin, MD; Vitório Puntel, PhD; Vinicius Agostinho; Silvio Guerra; Priscila Virgens; Mariana Silva; Marina Faria
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Pneumology, Centro Universitário de Volta Redonda, Volta Redonda, Rio de Janeiro, Brazil

Chest. 2014;146(4_MeetingAbstracts):776A. doi:10.1378/chest.1993079
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SESSION TITLE: Bronchology/Interventional Global Case Reports

SESSION TYPE: Global Case Report

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

INTRODUCTION: Carcinoid tumors belong to the group of neuroendocrine tumors whose cells are part of the APUD system, with the place of origin being most frequently in the gastrointestinal tract (more often the appendix). Pulmonary involvement can be seen in about 0.5 % to 2% with no difference between gender, usually in patients above 60 years old, with no correlation with smoking, radiation or chemicals. It may have prognostic variables, from the kindness of a tumor without local infiltration to metastatic and life threatening tumors.

CASE PRESENTATION: MAS, male, 25 years old, resident of interior of Rio de Janeiro, Brazil, workman. Six years before our first consultation, the patient presented minor bleeding with probable origin in the respiratory tract, considered initially a nasal origin. Sporadic, with no relation to climate change, physical exertion or other triggering factors. Denied other signs or symptoms. Was requested chest and sinus radiography, without alterations. Requested a CT of the chest which showed consolidation with aerobronchograms located in the apical and anterior segment of the left lower lobe. Laboratory tests without relevant findings, with negative bacillus alcohol acid resistant, culture for M. tuberculosis in sputum and serum tests for fungi. We opted for conservative treatment. Two years after the initial event, he searched pulmonology service for monitoring, and it was requested new chest CT, which showed nodule with partial bronchial obstruction and onset of the consolidation in the adjacent parenchyma. Again, the position assumed was to maintain observation of the evolution of the framework due to the absence of clinical expression. Elapsed two more years, he presented episodes of bleeding associated with cough and sneezing, more intensely. Searched otolaryngologist who requested laryngoscopy, which showed no abnormalities that could justify the symptoms. He was then referred to our clinic and brought all previously obtained material, including a new request of chest CT. He referred hemoptoics, progressive dyspnea and wheezing. Denied fever, purulent sputum expectoration, weight loss or other constitutional symptoms. Ordered additional tests including ESR (51mm ), DHL (217 UI/L), PCR (26mm ) , CEA (1.4 ng / dL), negative serology for fungi, noreactive Mantoux test. Pulmonary function tests: FVC: 2.36(46%)-2.43(47% )-(change 3%), FEV1:1.59(37%)-1.83 (43 %)-(change15%), FEV1/FVC:67% - 75%, DLCO 23,8( 1%). The previously requested tomography brought showed nodule of 3.9 cm in the left lower lobe with soft tissue attenuation, promoting partial bronchial obstruction and leading to areas of adjacent consolidation. With these results, it was requested bronchoscopy. Evolved unfavorably with intensification of the bleeding, which made us chose hospitalization for monitoring. Bronchoscopy revealed tumor mass partially obstructing the left lower lobe bronchus, infiltratating with bleeding lips. Before the results of the histopathological analysis, he evolved with intensified bleeding, with risk of death.Referred to thoracic surgery. Performed left lower lobectomy, which was uneventful and he had complete recovery. The analysis of material obtained through fiberoptic bronchoscopy as part of the surgery proved to be a typical carcinoid tumor.

DISCUSSION: Carcinoid tumors represent 1% to 2 % of cancers affecting the lung, with higher incidence in age above 60 years. Presents an indolent growth and may remain asymptomatic for several years, with the first manifestations being the presence of hemoptysis and dyspnea.It can produce metastasis, leading to carcinoid syndrome, characterized by a systemic clinical picture. For diagnosis it should take into account the correlation of imaging tests and biopsy either via endoscopic or thoracotomy, depending on the location of the tumor or the physician’s choice. The curative treatment is done surgically with resection of the tumor.

CONCLUSIONS: Pulmonary carcinoid tumors are rare and should be part of the differential diagnosis of lung neoplasms with nonspecific manifestations. When diagnosed, it has a favorable prognosis. The treatment of choice is surgical resection.

Reference #1: SAVIVA, E. V.; DESCOURT, R. Focus on treatment of lung carcinoid tumor. Onco Targets Ther. 2013

Reference #2: American Joint Committee on Cancer. Lung. AJCC Cancer Staging Manual. 7th ed. New York: Springer. 2010

Reference #3: BERTINO, E.M.; CONFER, P.D.; COLONNA, J.E.; ROSS, P.; OTTERSON, G.A. Pulmonary neuroendocrine/carcinoid tumors: A review article. Cancer. 2009

DISCLOSURE: The following authors have nothing to disclose: Gilmar Zonzin, Vitório Puntel, Vinicius Agostinho, Silvio Guerra, Priscila Virgens, Mariana Silva, Marina Faria

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