Lung Cancer: Global Case Report Poster - Lung Cancer |

Bronchial Carcinoid: An Unusual Cause of Recurrent Respiratory Tract Infection in a Child FREE TO VIEW

Rashmi Das, MD; Pravakar Mishra, MD; Manoranjan Dash, MD
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All India Institute of Medical Sciences, Bhubaneswar, India

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):693A. doi:10.1016/j.chest.2016.08.788
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SESSION TITLE: Global Case Report Poster - Lung Cancer

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchial carcinoid tumors are uncommon group of pulmonary neoplasms that are characterized by neuroendocrine differentiation and relatively indolent clinical behavior. Although referred to as bronchial adenoma, this tumor is recognized as malignant neoplasm because of its potential to metastasize. These tumors are thought to be derived from peptide and amine producing neuroendocrine cells that have migrated from the embryological neural crest. Carcinoid can arise at a number of sites of the body including thymus, GI tract, lungs and ovary but the most common site is the GI tract. Bronchial carcinoid accounts approximately 1-2% in adults but may be a most common primary neoplasm in children typically presenting in late adulthood.

CASE PRESENTATION: A 13-yr-old boy presented with recurrent episodes of cough and fever for one year. There was no past history or contact with tuberculosis. He was treated with multiple antibiotics from outside without any effect. Family history of bronchial asthma was present. General physical examination was normal. The only finding on clinical examination was occasional crepitations over left supramammary area. Routine laboratory tests were normal. Chest x-ray showed mild haziness in left upper lobe (Figure 1A). Spirometry revealed mixed obstructive and restrictive pattern. CT scan (contrast) showed a soft tissue density enhancing lesion with non-enhancing areas in left upper lobe. Bronchoscopy revealed a growth in the left upper lobe bronchus (Figure 1B). Bronchoalveolar lavage and biopsy was taken. Histopathology study from the biopsy showed well differentiated low-grade neuroendocrine tumor consistent with the diagnosis of a typical carcinoid (Figure 2). He underwent surgical resection of the tumour and got asymptomatic thereafter.

DISCUSSION: Bronchial carcinoids are uncommon group of pulmonary neoplasms that are characterized by neuroendocrine differentiation and relatively indolent clinical behavior.1 Although referred to as bronchial adenoma, these tumors are recognized as malignant neoplasms because of their potential to metastasize.2 They account for 10% of all carcinoid tumors. Overall, 75% of bronchial carcinoids arise from the lobar bronchi, 10% in main-stem bronchi, and 15% in the periphery of lungs. Around 90% are well differentiated (typical). Atypical carcinoids have a higher malignant potential than typical.2 Average age of presentation of typical bronchial carcinoid is 40-50 years. Symptoms arise from bronchial obstruction and include persistent cough, hemoptysis, and recurrent pneumonitis. Surgical resection is the primary mode of therapy.

CONCLUSIONS: In any child presenting with recurrent respiratory tract infection with an unusually prolonged course, extensive work up is needed to find out rare causes like bronchial carcinoids. This case emphasizes the fact that bronchial carcinoids have good prognosis once diagnosed and treated at an early stage.

Reference #1: Chong S, Lee KS, Chung MJ. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics 2006;26:41-58.

Reference #2: Hasleton PS. Histopathology and prognostic factors in bronchial carcinoid tumours. Thorax 1994;49:S56-62.

DISCLOSURE: The following authors have nothing to disclose: Rashmi Das, Pravakar Mishra, Manoranjan Dash

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