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Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

Hot on PET. Cold on Path. Which is it?

Abdul Hameed Zaid, MD; Kristin Fless, MD
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Saint Barnabas Medical Center, Livingston, NJ


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


Chest. 2016;150(4_S):745A. doi:10.1016/j.chest.2016.08.840
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Bronchial neuroendocrine (carcinoid) tumors (NETs) are uncommon pulmonary tumors characterized by neuroendocrine differentiation and often indolent clinical behavior. The more common typical NETs (TC) are well-differentiated, slowly-growing neoplasms with low mitotic rates, whereas atypical NETs (AC) are have higher mitotic rates and/or necrosis. Biologic behavior of atypical NETs is intermediate between typical NETs and the more aggressive small cell lung cancers, considered high grade NETs. Fluorodeoxyglucose (FDG) PET scans are usually positive in patients with atypical lung NETs (mean standardized uptake value [SUV] ≥ 8) and are only weakly positive in typical tumors (mean SUV < 2.7)1. Histologic criteria for typical NETs include less than 2 mitoses per 10 HPF and lack of necrosis whereas atypical NETs show 2 to 10 mitoses per 10 HPF and/or necrosis2. The Ki-67 proliferative index is more reliable in distinguishing TC from AC than histology as it reduces inter-observer variability3. We present an unusual case of a bronchial NET which was found to be “hot” on FDG PET scan but was found to have a zero mitotic activity.

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