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Neuroendocrine Tumor With Focal Bronchiectasis; A Rare Cause of Chronic Cough FREE TO VIEW

Marvi Bikak, MD; Amber Oberle, MD; Thomas Birdas, MD; Khalil Diab, MD
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Indiana University, Indianapolis, IN

Chest. 2015;148(4_MeetingAbstracts):582A. doi:10.1378/chest.2249075
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SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Chronic cough accounts for 40% of outpatient pulmonary visits. Asthma, allergic rhinitis, non-asthmatic eosinophilic bronchitis, and gastroesophageal reflux are the most common causes. Other etiologies such as bronchiectasis, pulmonary fibrosis, and primary or metastatic lung tumors are less common. We herein describe a case of chronic cough secondary to bronchiectasis caused by a parenchymal well differentiated neuroendocrine tumor.

CASE PRESENTATION: A 67 year old female and lifetime non-smoker presented to pulmonary clinic with a chronic cough for the past 23 years. It was described as frequently productive of white sputum without constitutional symptoms or dyspnea. Over the past two decades of work up, she has been treated with proton pump inhibitors, nasal decongestants, anti-histamines, and oral corticosteroids without significant benefit. Physical examination was unremarkable other than a noticeable cough in clinic. A contrasted CT scan of the chest revealed cylindrical bronchiectasis in the right middle lobe with an area of atelectasis/scarring and otherwise normal lung parenchyma (figure). Pulmonary function tests were unremarkable. Post-immunization antibody titers after 23-valent pneumococcal vaccine administration were normal. Work up for cystic fibrosis and infectious etiology was also negative. This prompted invasive diagnostic testing with bronchoscopy and bronchoalveolar lavage which revealed no endobronchial lesions, bacterial or fungal elements, and negative cytology. Due to the persistence of debilitating symptoms and the presence focal bronchiectasis, she was referred to thoracic surgery for a right middle lobectomy. A video-assisted right middle lobectomy was done. Pathology revealed a 1.1cm intraluminal well differentiated neuroendocrine tumor. Upon follow up in clinic, her cough had completely resolved.

DISCUSSION: Bronchiectasis is an uncommon cause of unrelenting cough, however cough is present in about 98% of cases with bronchiectasis. It is most commonly implicated in patients with impaired immune function and recurrent infections, however a large number of cases remain idiopathic in non-cystic fibrosis patients. Neuroendocrine tumors account for only 1-2% of all pulmonary tumors and are a rare cause of chronic cough when present endobronchially. Parenchymal neuroendocrine tumors are most commonly detected incidentally upon surgical resection and are a very infrequent cause of chronic cough or bronchiectasis. This is a very rare case of a chronic cough caused by a parenchymal neuroendocrine tumor associated with bronchiectasis.

CONCLUSIONS: Neuroendocrine tumors should be considered in those with isolated bronchiectasis with a persistent cough and a negative standard workup.

Reference #1: Rosado de Christenson ML, Abbott GF, Kirejczyk WM, et al. Thoracic carcinoids: radiologic-pathologic correlation. Radiographics 1999; 19:707-736

DISCLOSURE: The following authors have nothing to disclose: Marvi Bikak, Amber Oberle, Thomas Birdas, Khalil Diab

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