Atypical Diagnosis for Typical Lung Carcinoid

Roberto Piro; Roberto Tonelli; Sofia Taddei; Alessandro Marchioni; Giovanni Musci; Enrico Clini; Nicola Facciolongo

Disclosures

BMC Pulm Med. 2019;19(168) 

In This Article

Abstract and Introduction

Background: The diagnosis of lung typical carcinoid tumors results challenging when limited size and unfavorable sampling location is associated. It has been reported that bronchoscopy with endobronchial ultrasound (EBUS) significantly increases the diagnostic yield of peripheral nodules smaller than 2 cm.

Case presentation: A 70-year-old Caucasian male complained of persistent fever and cough despite several antibiotic courses and steroid treatment. Chest radiology revealed the presence of a small single nodular opacity in the left upper lobe, whose standardized maximum uptake value (SUV) at fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) was significantly high (4.5). The patient underwent bronchial endoscopy but any appreciable sign of endobronchial or intramural involvement was detected. Only radial ultrasound-guided bronchoscopy (R-EBUS) allowed transbronchial sampling whose pathological analysis revealed a typical carcinoid tumor. The patients underwent surgical lobectomy and clinic-radiological follow was started.

Conclusions: With this case we aim at stressing the importance of ultrasound in the diagnostic process of lung small peripheral carcinoid, especially if they present without mucosal or sub mucosal involvement.

Introduction

Carcinoid tumors are low-grade neuroendocrine malignancies that usually affect the gastrointestinal tract.[1] According to the mitosis number (below or above 2 mitoses/2 mm2) and the absence/presence of architectural disruptions and necrosis found on histopathology, they are classified as typical and atypical carcinoid tumors respectively.[2] Pulmonary location is reported as the second commonest site with higher prevalence in the central bronchial tract.[3] When situated in peripheral lung regions an accurate diagnosis may result more difficult due to unfavorable sampling position and often require surgical excision.[4] Furthermore these lesions are usually size-limited and highly vascularized with the bronchial mucosa that overlays the carcinoid relatively spared: these features contribute to make the diagnosis even more challenging.[5] It has recently been reported that bronchoscopy with endobronchial ultrasound (EBUS) significantly increases the diagnostic yield in the evaluation of peripheral nodules smaller than 2 cm.[6] Here we report the case of lung peripheral typical carcinoid tumor that was not identified at the fiber optic preliminary endoscopic investigation and whose diagnosis was made possible only through radial endobronchial ultrasound-guided bronchoscopy (R-EBUS).

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