Endobronchial carcinoid tumor: Radiological findings of a clinical case

Abstract

We describe the case of a female patient, 21 years old, complaining of dyspnea attacks and wheezing 2 years ago. Chest radiography showed volume loss in the left lower lobe and ipsilateral retrocardiac triangular basal opacity. CT scan showed an extensive solid mass with apex protruding into the left main and lower lobar bronchi, causing distal atelectasis. Histopathological and immunohistochemical study of transbronchial biopsy of the lesion revealed a typical carcinoid tumor, confirmed after tumor resection with total left pneumectomy.Keywords: Carcinoid Tumor. Endobronchial. Pulmonary. Typical. Diagnostic Imaging.case report A female 21-year old patient presenting dyspnea and wheezing attacks for two years. She is overweight, has polycystic ovary syndrome and is currently using oral contraceptives. She does not smoke. The patient reported that three radiographs in the past 6 months revealed consolidation in the left lung base. During this period, treatment regimens for pneumonia were used, without clinical or radiological improvement. On auscultation, rhonchi and wheezing were audible at the base of the left hemithorax. Laboratory tests did not point out any abnormalities.A new chest X-ray showed loss of volume in the left lower lobe with triangular basal retrocardiac opacity, apex directed towards the ipsilateral hilum and base next to the diaphragmatic dome ( Figures 1A and 1B).Computed tomography (CT) imaging showed a solid expansive mass with apex protruding into the left source bronchus ("tip of the iceberg" sign 1 ), causing partial obstruction and distal subsegmentar atelectasis, as well as marked enhancement following intravenous contrast administration (Figures 2A, 2B, 2C and 2D).After bronchofibroscopy, which confirmed the endobronchial lesion, the anatomopathological and immunohistochemical investigation of the transbronchial biopsy material showed a well-differentiated (typical) carcinoid tumor ( Figures 3A, 3B and 3C). A CT scan of the abdomen performed for staging failed to show other neoplastic formations. The therapy selected was left total pneumonectomy, which confirmed the histological finding of tumor in a subsequent investigation.

Predictive Indicators of Survival in Patients With Surgically Resected Lung Carcinoid Tumors at a Greek Medical Center

“…Bronchoscopy plays a key role in the diagnosis of carcinoids, as in most cases, the tumor is centrally located and visible at endoscopy, allowing bronchoscopic biopsy [5]. Τhe gold standard for the radiological detection of lung carcinoids is a computed tomography (CT) scan, in which when bronchial involvement is present, secondary findings can be atelectasis, bronchiectasis, and hyperlucency [6].…”

Abnormal shadow on chest radiograph: a supra – or infradiaphragmatic finding?

“…A well-defined contour, considered to be rather a benign characteristic, do not exclude a malignant lesion (2). Round shape and smooth margins may be present in both hamartoma and carcinoid (3,4). However, the calcification pattern and a lack of bronchiectasis or distal parenchymal disease, correspond better with peripheral hamartoma.…”

Tumores endobronquiales: revisión del abordaje diagnóstico y tratamiento endoscópico

“…En la TAC se observa una masa esférica u ovalada de bordes lobulados y con aumento de la intensidad, muy vascularizada, captando contraste (con excepciones), con calcificaciones excéntricas en el 26 % de los casos (1). Hasta el 85 % de los casos pueden ser multifocales y con complicaciones en el parénquima distal (1,19). También es típico encontrar una masa parenquimatosa que se extiende de forma adyacente y solo una pequeña lesión endoluminal, que se conoce como signo de punta de iceberg (19).…”

“…Hasta el 85 % de los casos pueden ser multifocales y con complicaciones en el parénquima distal (1,19). También es típico encontrar una masa parenquimatosa que se extiende de forma adyacente y solo una pequeña lesión endoluminal, que se conoce como signo de punta de iceberg (19).…”

“…El carcinoma adenoide quístico es el más común de esta estirpe, con dos tercios de los casos, y es el segundo tumor más común de la vía aérea central con prevalencia de 0.04-0.2 % (19).…”