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Three Years History of Repeated Pneumonias on the Same Location Associated to Bronchial Typcal Carcinoid Tumor
Lung Cancer SESSION TITLE: Lung Cancer SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM
Three Years History of Repeated Pneumonias on the Same Location Associated to Bronchial Typcal Carcinoid Tumor Mara Rubia Lima MD* Ana Moreira MD José Moreira MD Spencer Camargo MD Bruno Hochhegger MD Jackeline Souza MD Manoela Klein MD Felipe Sanches MD Camila Zuconi; and Gabriela Buffon UFCSPA, Porto Alegre, Brazil INTRODUCTION: Repeated pneumonias on the same location and unilateral wheeze suggest airway obstruction that may be due to carcinoid tumors which are neuroendocrine neoplasias of low grade malignancies accounting for 0.4 to 3% of all lung cancers. According to histopathology, there are Typical (85% of cases, unilateral, intraluminal and proximal bronchi) and Atypical (asymptomatic, peripheral location and ability to metastases) carcinoid tumors. CASE PRESENTATION: September 2014: a life long non-smoker, 38 year old female patient arrives at the emergency room, refering chest pain, productive cough and purulent sputum that started three days ago. On physical examination, good general condition, wheezes on the right lung, fever 39 C. Diagnosed with pneumonia, started antibiotic. Chest x-rays from 2011 and 2012 show pneumonia in the right lower lobe. Before 2011, no respiratory symptoms, and no comorbidities. Computed Tomography (CT) shows obstruction of the intermediate lobe, atelectasis of right lower lobe and midlle lobe. Fiberbronchoscopy revealed vegetating lesion occluding the intermediate bronchus. Performed biopsy of this lesion without major bleeding, the anatomopathological exam and immunohistochemistry showed typical carcinoid tumor. Patient was discharged five days after bilobectomy and bronchoplasty with lung reexpansion and mild pain on surgical incision remaining asymptomatic at follow up visits. Normal lung function tests. DISCUSSION: Carcinoid tumor has no sex preference, occurs between the 4th and 6th decade of life, and 60-80% of the patients are non-smokers. The central location accounts for unilateral wheeze, cough, chest pain and obstruction, which can lead to recurrent pneumonia in the same location requiring fiberbronchoscopy. When the diagnosis is early, surgeri shows better prognosis. CONCLUSIONS: The lesson brought by this case is that carcinoid tumor should be evaluated by bronchoscopy in young non smoker patients with repeated pneumonias in the same location, unilateral wheezing, and images of central obstruction. Surgery provides an effective treatment for this tumor.
Reference #2: Steuer, Conor E. MD; Behera, Madhusmita PhD; Kim, Sungjin MS; Chen, Zhengjia PhD; Saba, Nabil F. MD; Pillai, Rathi N. MD; Owonikoko, Taofeek K. MD, PhD; Khuri, Fadlo R. MD; Ramalingam, Suresh S. MD Atypical Carcinoid Tumor of the Lung: A Surveillance, Epidemiology, and End Results Database Analysis. Journal of Thoracic Oncology:March 2015 - Volume 10 - Issue 3 - p 479-485 Reference #3: Matthew H. Kulke. Neuroendocrine Tumors Clinical Presentation and Management of Carcinoid Tumors. Hematology/Oncology Clinics of North America Volume 21, Issue 3, June 2007, Pages 433-455 Matthew H. Kulke DISCLOSURE: The following authors have nothing to disclose: Mara Rubia Lima, Ana Moreira, José Moreira, Spencer Camargo, Bruno Hochhegger, Jackeline Souza, Manoela Klein, Felipe Sanches, Camila Zuconi, Gabriela Buffon No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.02.273
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
261A
LUNG CANCER
Reference #1: Machuca TN, Cardoso PF, Camargo SM, Signori L, Andrade CF, Moreira AL, Moreira J, Felicetti JC, Camargo JJ. Surgical treatment of bronchial carcinoid tumors: A single-center experience. Lung Cancer. 2010 Nov; 70(2):158-62.
Three Years History of Repeated Pneumonias on the Same Location Associated to Bronchial Typcal Carcinoid Tumor Mara Rubia Lima MD* Ana Moreira MD José Moreira MD Spencer Camargo MD Bruno Hochhegger MD Jackeline Souza MD Manoela Klein MD Felipe Sanches MD Camila Zuconi; and Gabriela Buffon UFCSPA, Porto Alegre, Brazil INTRODUCTION: Repeated pneumonias on the same location and unilateral wheeze suggest airway obstruction that may be due to carcinoid tumors which are neuroendocrine neoplasias of low grade malignancies accounting for 0.4 to 3% of all lung cancers. According to histopathology, there are Typical (85% of cases, unilateral, intraluminal and proximal bronchi) and Atypical (asymptomatic, peripheral location and ability to metastases) carcinoid tumors. CASE PRESENTATION: September 2014: a life long non-smoker, 38 year old female patient arrives at the emergency room, refering chest pain, productive cough and purulent sputum that started three days ago. On physical examination, good general condition, wheezes on the right lung, fever 39 C. Diagnosed with pneumonia, started antibiotic. Chest x-rays from 2011 and 2012 show pneumonia in the right lower lobe. Before 2011, no respiratory symptoms, and no comorbidities. Computed Tomography (CT) shows obstruction of the intermediate lobe, atelectasis of right lower lobe and midlle lobe. Fiberbronchoscopy revealed vegetating lesion occluding the intermediate bronchus. Performed biopsy of this lesion without major bleeding, the anatomopathological exam and immunohistochemistry showed typical carcinoid tumor. Patient was discharged five days after bilobectomy and bronchoplasty with lung reexpansion and mild pain on surgical incision remaining asymptomatic at follow up visits. Normal lung function tests. DISCUSSION: Carcinoid tumor has no sex preference, occurs between the 4th and 6th decade of life, and 60-80% of the patients are non-smokers. The central location accounts for unilateral wheeze, cough, chest pain and obstruction, which can lead to recurrent pneumonia in the same location requiring fiberbronchoscopy. When the diagnosis is early, surgeri shows better prognosis. CONCLUSIONS: The lesson brought by this case is that carcinoid tumor should be evaluated by bronchoscopy in young non smoker patients with repeated pneumonias in the same location, unilateral wheezing, and images of central obstruction. Surgery provides an effective treatment for this tumor.
Reference #2: Steuer, Conor E. MD; Behera, Madhusmita PhD; Kim, Sungjin MS; Chen, Zhengjia PhD; Saba, Nabil F. MD; Pillai, Rathi N. MD; Owonikoko, Taofeek K. MD, PhD; Khuri, Fadlo R. MD; Ramalingam, Suresh S. MD Atypical Carcinoid Tumor of the Lung: A Surveillance, Epidemiology, and End Results Database Analysis. Journal of Thoracic Oncology:March 2015 - Volume 10 - Issue 3 - p 479-485 Reference #3: Matthew H. Kulke. Neuroendocrine Tumors Clinical Presentation and Management of Carcinoid Tumors. Hematology/Oncology Clinics of North America Volume 21, Issue 3, June 2007, Pages 433-455 Matthew H. Kulke DISCLOSURE: The following authors have nothing to disclose: Mara Rubia Lima, Ana Moreira, José Moreira, Spencer Camargo, Bruno Hochhegger, Jackeline Souza, Manoela Klein, Felipe Sanches, Camila Zuconi, Gabriela Buffon No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.02.273
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
261A
LUNG CANCER
Reference #1: Machuca TN, Cardoso PF, Camargo SM, Signori L, Andrade CF, Moreira AL, Moreira J, Felicetti JC, Camargo JJ. Surgical treatment of bronchial carcinoid tumors: A single-center experience. Lung Cancer. 2010 Nov; 70(2):158-62.