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Bronchial Carcinoid Tumor
A 59-year-old man presented with a cough and 2 episodes of pneumonia during the past 4 months. He had a 45-pack-year history of smoking cigarettes.
A 59-year-old man presented with a cough and 2 episodes of pneumonia during the past 4 months. He had a 45-pack-year history of smoking cigarettes.
The patient reported severe facial flushing and episodes of diarrhea. A chest film showed a solitary nodule in the left upper lobe. A biopsy of the lesion was performed; pathologic examination confirmed the diagnosis of bronchial carcinoid tumor.
Dr Muhammad Wasif Saif of the National Cancer Institute, Bethesda, Md, writes that bronchial carcinoids (also called neuroendocrine tumors) are low-grade malignant neoplasms that can be treated and often cured, particularly in the early stages. They are slow-growing, generally occur in persons younger than 60 years, and may arise from various sites-most commonly, the GI tract. Bronchial carcinoid tumors are uncommon; they represent approximately 5% of all pulmonary neoplasms.
Carcinoid syndrome may be associated with carcinoid tumors. Symptoms include flushing, diarrhea, bronchoconstriction, hypotension, cardiac valvular lesions, arthropathy, and telangiectasia.
Most bronchial carcinoid tumors are pedunculated or sessile growths in central bronchi. Peripheral carcinoids are uncommon; generally asymptomatic; and associated with an advanced pathologic stage, histologically positive lymph nodes, and a significant decrease in survival.1 Metastatic potential is directly related to the size of the primary tumor: lesions of 1 cm or less rarely metastasize; those greater than 2 cm frequently metastasize.
Typically, the prognosis for patients with a carcinoid tumor is excellent. The 5-year survival rate for patients who have had conservative lung resection is between 70% and 90%.1 Radiation therapy is reserved for patients with regionally unresectable disease. Injections of somatostatin analogue may palliate the symptoms of carcinoid syndrome.2
REFERENCES:1. Stefani A, Morandi U, Urgese AL, et al. Carcinoid tumors of the lung. An analysis of 65 operated cases. J Cardiovasc Surg (Torino). 1999;40:607-612.
2. Rubin J, Ajani J, Schirmer W, et al. Octreotide acetate long-acting formulation versus open-label subcutaneous octreotide acetate in malignant carcinoid syndrome. J Clin Oncol. 1999;17:600-606.
