Medical Imaging Quiz-Case 47 (original) (raw)
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Atypical diagnosis for typical lung carcinoid
BMC Pulmonary Medicine
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.
Typical lung carcinoids: review of classification, radiological signs and nuclear imaging findings
Clinical and Translational Imaging, 2020
Purpose In this comprehensive review we present an overview of the main aspects of classification, radiological signs and nuclear imaging findings of typical lung carcinoids (TCs). Methods A literature search on the PubMed literature database was conducted using the terms "positron emission tomography-PET", "PET/CT", "FDG", "18F-fluorodeoxyglucose", "MDCT-Contrast-enhanced multi-detector computed tomography" "typical lung carcinoid" "SRS-Somatostatin receptor scintigraphy", "68 Ga DOTA-peptides" alone and in combination, extending until December 2019. Results TCs are rare tumours, accounting for only 1-2% of all pulmonary neoplasms. They tend to occur usually in the fourth-to-sixth decade of life and are characterized by mitotic count of less 2/2 mm 2 and absent necrosis. Contrast-enhanced multi-detector computed tomography (MDCT) is the most largely used imaging modality for the localization, characterization and staging of lung TCs. Nuclear medicine imaging assists MDCT in the diagnosis of these rare tumour entities, especially by somatostatin receptor scintigraphy, PET imaging with Gallium-68-tetrazacyclododecanetetraacetic acid (68 Ga DOTApeptides) and with 18F-fluorodeoxyglucose (18F-FDG). Conclusions TCs of lung are rare lung tumours placed within a defined classification system. MDCT morphological features combined with functional nuclear medicine imaging are an important tool for the detection of these rare neoplasms and contribute to their characterisation and staging. Therefore, MDCT and nuclear medicine parameters could give a preliminary orientation before the pathological examination, on the biological behaviour and the prognostic outcome of TCs.
Pathological variations of lung masses
Indian Journal of Pathology and Oncology, 2020
Introduction: Lung is a common place for the spread of tumors from within or other parts of the body. Lung shadows with a diameter less than or larger than 3 cm are termed lung nodule or mass respectively. Aims: To study the histopathological spectrum of lung masses and efficacy of computerized tomography guided FNAC/biopsy in diagnosis of lung masses. Materials and Methods: Forty (40) cases picked up as lung masses on conventional screening & CT scan were subjected to CT guided FNAC/Biopsy and their pathological variations were studied. Results: A total of 40 cases were studied. The mean age of the patients was 60.57 years with 25 (62.5%) males and 15 (37.5%) females. 65% of lesions were in right lung. Malignant lesions were more common and accounted for 27 (67.5 %) cases and benign in 8 (20%) cases. Amongst the malignant lesions, adenocarcinoma was seen in 16 (59.25%), squamous cell carcinoma in 10 (37.03%) and small cell carcinoma in 1 (3.70%) case. Conclusion: FNAC is a simple, relatively safe, rapid, reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. FNAC not only distinguishes between benign and malignant lesions but also helps in tumor typing of lung cancer.
Diagnostic Challenges in Atypical Pulmonary Carcinoid
2016
Atypical pulmonary carcinoid is a very rare and aggressive neuroendocrine tumor with a very poor prognosis and a high incidence of metastasis. We report a case of atypical pulmonary carcinoid diagnosed by resected secondary parotid tumor. A 67-year-old man was extensively investigated almost one year for a suspicion of lung tumor that could not be biopsied during bronchoscopy due to peripheral location of the lesion. At the presentation to our service , the patient had multiple diffuse distant metastases, which raised diagnostic diffi culties. The fi nal diagnosis was made by histopatological and immunohistochemical exam from the secondary parotid cancer. The key of the diagnosis could be the attentive clinical examination. The preoperative diagnosis can be extremely diffi cult, needle aspirate or small biopsy being most of the times insuffi cient for diagnosis. Rezumat Carcinoidul pulmonar atipic este o tumoră neuroendocrină agresivă, foarte rară, cu prognostic prost şi incidenţă c...
Elsevier eBooks, 2018
Background: Pulmonary carcinoid tumor is a low-grade malignant neoplasm comprised of neuroendocrine cells. The aim of this study was to determine the clinical features; radiological and bronchoscopic findings, as well as treatment in patients. The hospital records of 21 patients with pulmonary carciniod tumor, who admitted to NRITLD between 1995 and 2001, were evaluated. Results: 19 patients had typical and 2 had atypical carcinoid tumor. Male to female ratio was 1.1. The mean age ± SD was 39.33±16.31.Cough (80.9%) was the most common presenting symptom. 16 patients had abnormal chest radiography. The diagnosis was made using bronchoscopy and biopsy. Most of the tumors arose in main bronchi. Surgery with or without endobronchial laser therapy was the treatment of our patients. Lobectomy (47.3%) was the most common procedure. surgery with or without laser therapy has a favorable outcome in pulmonary carcinoid tumors.
Lung Carcinoid Tumor: A Case Report
2021
Case Report Introduction: primary carcinoid tumors of the lung are rare tumors, they account approximately 0.5 to 5% of all lung malignancies and roughly 20 to 30% of all carcinoid tumors. Early diagnosis is extremely important in order to allow the surgical excision which still the main treatment. Presentation of case: We describe a case of a twenty years old woman, who complained from intermittent dry cough with bloody sputum for six months, clinical examination showed left basithoracic condensation syndrome, chest Xray revealed homogeneous dense opacity of the left paracardiac fold. CT scan showed a left mediastino-pulmonary lesion process which comes into contact with the left ventricle with infiltration of its wall, it includes the proximal part of the left lower lobe bronchus (LLLB), with reduction of its caliber, without mediastinal lymphadenopathy or pleuropericardial effusion. The bronchoscopy with biopsy of the endobronchial lesion was performed; the histopathology study c...
Primary typical pulmonary carcinoid tumor: an incidental finding
Comparative Clinical Pathology, 2017
Bronchopulmonary carcinoid tumors are rare tumors (only 0.5 to 2.5% of all pulmonary tumors) that arise from neuroendocrine cells known as Kulchitsky cells. They are characterized by slow growth and rarely metastasize beyond the lungs. However, they can occur in the central or peripheral parts of the lung. Secondary locations can be asymptomatic, but central carcinoids often present with obstructive signs including: recurrent pneumonias and hemoptysis. We report a rare, asymptomatic case of a primary bronchopulmonary carcinoid in a 62-year-old man. A 62year-old man presented with history of intermittent right upper quadrant pain, especially after a high fat meal, for 6 months. Systemic examination was unremarkable. Ultrasonography of gall bladder showed cholelithiasis, and he was scheduled for cholecystectomy. On preoperative cardiology consult, the chest X-ray showed an incidental homogenous opacity in the right middle zone without any respiratory symptoms. Patient underwent fiber optic bronchoscopy and biopsy. Histopathologic examination showed monomorphic tumoral cells forming small nests, rosette-like arrangements, and cords with salt and pepper, stippled appearance nuclei. Patient underwent right middle lobectomy. The postoperative period was uneventful, and the patient was disease-free in the following 25 months. Carcinoid syndrome is very rare in patients with bronchopulmonary carcinoid tumors. Overall prognosis for patients with typical bronchopulmonary carcinoid tumors is favorable. If diagnosed in the early stages, the chances for radical treatment success are increased.
We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcome. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2mm 2 , necrosis, lymphatic invasion and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlate with clinical outcome. Based on our analysis, we consider that the separation of low and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of over grading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcome.
We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcomes. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2 mm 2 , necrosis, lymphatic invasion, and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlated with clinical outcomes. Based on our analysis, we consider that the separation of low-and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of overgrading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcomes. Crown
Synchronous bilateral typical pulmonary carcinoid tumors
European Journal of Cardio-Thoracic Surgery, 2003
A 73-year-old woman was admitted with bilateral pulmonary nodules, one on each side, which were suspected to be metastases of an unknown primary tumor. Enucleation of the lesion in the upper right lobe was performed. The histological examination showed a typical carcinoid tumor. A subsequent octreotid scan revealed high suspicion of a carcinoid in the left lower lobe as well. Formal right upper lobectomy and left lower lobectomy were performed in staged procedures. The radiological 1 year control with CT-scan demonstrated no further pathological lesions. To the best of our knowledge this is the first description of curable synchronous pulmonary carcinoid tumors. q