eMedicine Specialties > Radiology > Chest

Lung, Carcinoid: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Coauthor(s): Sarah Al Ghanem, MBBS, Consulting Staff, Department of Medical Imaging, King Fahad National Guard Hospital, Saudi Arabia; Klaus L Irion, MD, PhD, Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Carolyn M Allen, MB, BCh, MRCP, FRCR, CCST, Consultant Radiologist, Department of Clinical Radiology, North Manchester General Hospital, UK
Contributor Information and Disclosures

Updated: Apr 11, 2008

Intervention

Procedures

Because these tumors are generally resistant to chemotherapy, complete surgical resection is the primary form of therapy.34 Long-term survival for patients with typical carcinoid is excellent but is decreased in those with the atypical subtype. Complete tumor resection with preservation of uninvolved pulmonary parenchyma remains the primary aim in the surgical treatment of this tumor. Most tumors follow a benign course and are amenable to surgery.

Techniques range from radical resection to minimally invasive surgery, including sleeve resection. The treatment of choice is surgical excision. A sleeve resection of part of a bronchus, segmental resection, lobectomy, or pneumonectomy may be required.35,36 Endoscopic tumor ablation techniques have been used. Thoracotomy may be required in rare cases in which the diagnosis cannot be established by imaging means.

Massive hemorrhage after bronchoscopic biopsy has been described and is due to the highly vascular nature of carcinoids. However, the majority of bronchoscopic biopsy procedures are associated with little added morbidity. Percutaneous aspiration or cutting-needle biopsy is indicated for peripheral lung nodules. The procedure may be performed under fluoroscopic or CT guidance. Percutaneous biopsy may also be performed on nodules in patients presenting with Cushing syndrome to analyze the specimen for ACTH. Bronchial lavage results are not usually diagnostic.

Relative contraindications

Relative contraindications to percutaneous lung biopsy include the following: bleeding diathesis, poor respiratory reserve, inability of the patient to cooperate, bullous disease surrounding the lesion, pulmonary hypertension, and previous pneumonectomy.

Complications

Pneumothorax and hemorrhage are the most common complications. The incidence of pneumothorax is 10-30%. Hemoptysis is usually a self-limiting complication.

Medicolegal Pitfalls

  • An early histologic diagnosis of a bronchial carcinoid is desirable because the prognosis is more favorable than the prognosis of patients with bronchogenic carcinoma, which mimics bronchial carcinoid.
  • Fine-needle aspiration (FNA) of suspected carcinoid tumors can occasionally be misdiagnosed as small cell carcinoma. The editor (Kitt Shaffer) has seen several cases in which nodules were diagnosed as small cell carcinomas on the basis of FNA findings, but they did not respond to chemotherapy as expected. Upon resection, the nodules were found to be carcinoid tumors. Most small cell carcinomas may initially respond well to chemotherapy, whereas most carcinoids do not.
 


More on Lung, Carcinoid

Overview: Lung, Carcinoid
Imaging: Lung, Carcinoid
Follow-up: Lung, Carcinoid
Multimedia: Lung, Carcinoid
References
[ CLOSE WINDOW ]

References

  1. Cerilli LA, Ritter JH, Mills SE, Wick MR. Neuroendocrine neoplasms of the lung. Am J Clin Pathol. Dec 2001;116 Suppl:S65-96. [Medline].

  2. Hage R, de la Rivière AB, Seldenrijk CA. Update in pulmonary carcinoid tumors: a review article. Ann Surg Oncol. Jul 2003;10(6):697-704. [Medline].

  3. Huang Q, Muzitansky A, Mark EJ. Pulmonary neuroendocrine carcinomas. A review of 234 cases and a statistical analysis of 50 cases treated at one institution using a simple clinicopathologic classification. Arch Pathol Lab Med. May 2002;126(5):545-53. [Medline].

  4. McMullan DM, Wood DE. Pulmonary carcinoid tumors. Semin Thorac Cardiovasc Surg. Jul 2003;15(3):289-300. [Medline].

  5. Mezzetti M, Raveglia F, Panigalli T. Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification. Ann Thorac Surg. Dec 2003;76(6):1838-42. [Medline].

  6. Pisick E, Skarin AT, Salgia R. Recent advances in the molecular biology, diagnosis and novel therapies for various small blue cell tumors. Anticancer Res. Jul-Aug 2003;23(4):3379-96. [Medline].

  7. Sivrikoz MC, Tulay CM, Döner E, Ozkan R. Synchronous bilateral typical carcinoid tumors of the lung. Thorac Cardiovasc Surg. Feb 2008;56(1):62-4. [Medline].

  8. Doga M, Bonadonna S, Burattin A, Giustina A. Ectopic secretion of growth hormone-releasing hormone (GHRH) in neuroendocrine tumors: relevant clinical aspects. Ann Oncol. 2001;12 Suppl 2:S89-94. [Medline].

  9. Doppman JL, Pass HI, Nieman LK, et al. Detection of ACTH-producing bronchial carcinoid tumors: MR imaging vs CT. AJR Am J Roentgenol. Jan 1991;156(1):39-43. [Medline].

  10. Sivrikoz MC, Tulay CM, Döner E, Ozkan R. Synchronous bilateral typical carcinoid tumors of the lung. Thorac Cardiovasc Surg. Feb 2008;56(1):62-4. [Medline].

  11. Khalifa M, Hruby G, Ehrlich L, et al. Combined large cell neuroendocrine carcinoma and spindle cell carcinoma of the lung. Ann Diagn Pathol. Aug 2001;5(4):240-5. [Medline].

  12. Bini A, Brandolini J, Cassanelli N, Davoli F, Dolci G, Sellitri F, et al. Typical and atypical pulmonary carcinoids: our institutional experience. Interact Cardiovasc Thorac Surg. Mar 18 2008;[Medline].

  13. Flieder DB. Neuroendocrine tumors of the lung: recent developments in histopathology. Curr Opin Pulm Med. Jul 2002;8(4):275-80. [Medline].

  14. Takei H, Asamura H, Maeshima A, et al. Large cell neuroendocrine carcinoma of the lung: A clinicopathologic study of eighty-seven cases. J Thorac Cardiovasc Surg. Aug 2002;124(2):285-92. [Medline].

  15. Sigurdardottir JM, Isaksson HJ, Johannsson KB, Jonsson S, Gudbjartsson T. [Histology does not accurately predict the clinical behaviour of bronchopulmonary carcinoids - results from an Icelandic population-based study]. Laeknabladid. Feb 2008;94(2):125-30. [Medline].

  16. Kantar M, Cetingul N, Veral A, et al. Rare tumors of the lung in children. Pediatr Hematol Oncol. Sep 2002;19(6):421-8. [Medline].

  17. Filosso PL, Ruffini E, Oliaro A, et al. Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotide. Eur J Cardiothorac Surg. May 2002;21(5):913-7. [Medline].

  18. Jeung MY, Gasser B, Gangi A, et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics. Mar-Apr 2002;22(2):351-65. [Medline].

  19. Traub T, Petkov V, Ofluoglu S, et al. 111In-DOTA-lanreotide scintigraphy in patients with tumors of the lung. J Nucl Med. Sep 2001;42(9):1309-15. [Medline].

  20. Virgolini I, Patri P, Novotny C, et al. Comparative somatostatin receptor scintigraphy using in-111-DOTA- lanreotide and in-111-DOTA-Tyr3-octreotide versus F-18-FDG-PET for evaluation of somatostatin receptor-mediated radionuclide therapy. Ann Oncol. 2001;12 Suppl 2:S41-5. [Medline].

  21. Ameri P, Gatto F, Arvigo M, Villa G, Resmini E, Minuto F. Somatostatin receptor scintigraphy in thoracic diseases. J Endocrinol Invest. Nov 2007;30(10):889-902. [Medline].

  22. Ketai L, Hartshorne M. Potential uses of computed tomography-SPECT and computed tomography- coincidence fusion images of the chest. Clin Nucl Med. May 2001;26(5):433-41. [Medline].

  23. Douek PC, Simoni L, Revel D, et al. Diagnosis of bronchial carcinoid tumor by ultrafast contrast-enhanced MR imaging. AJR Am J Roentgenol. Sep 1994;163(3):563-4. [Medline].

  24. Musi M, Carbone RG, Bertocchi C, et al. Bronchial carcinoid tumours: a study on clinicopathological features and role of octreotide scintigraphy. Lung Cancer. Nov 1998;22(2):97-102. [Medline].

  25. Rodriguez JA, Meyers MO, Jacome TH, et al. Intraoperative detection of a bronchial carcinoid with a radiolabeled somatostatin analog. Chest. Mar 2002;121(3):985-8. [Medline].

  26. Marom EM, Sarvis S, Herndon JE 2nd, Patz EF Jr. T1 lung cancers: sensitivity of diagnosis with fluorodeoxyglucose PET. Radiology. May 2002;223(2):453-9. [Medline].

  27. Dubois S, Morel O, Rodien P, Illouz F, Girault S, Cahouet A. A Pulmonary adrenocorticotropin-secreting carcinoid tumor localized by 6-Fluoro-[18F]L-dihydroxyphenylalanine positron emission/computed tomography imaging in a patient with Cushing's syndrome. J Clin Endocrinol Metab. Dec 2007;92(12):4512-3. [Medline].

  28. Adams S, Baum R, Rink T, et al. Limited value of fluorine-18 fluorodeoxyglucose positron emission tomography for the imaging of neuroendocrine tumours. Eur J Nucl Med. Jan 1998;25(1):79-83. [Medline].

  29. Eriksson B, Bergstrom M, Orlefors H, et al. Use of PET in neuroendocrine tumors. In vivo applications and in vitro studies. Q J Nucl Med. Mar 2000;44(1):68-76. [Medline].

  30. Itoh E, Fukuda I, Sata A, et al. Thallium-201 scintigraphy was useful in diagnosing ectopic ACTH syndrome due to bronchial carcinoid. Endocr J. Dec 2001;48(6):697-702. [Medline].

  31. Walther DJ, Peter JU, Bader M. 7-Hydroxytryptophan, a novel, specific, cytotoxic agent for carcinoids and other serotonin-producing tumors. Cancer. Jun 15 2002;94(12):3135-40. [Medline].

  32. Tabarin A, Valli N, Chanson P, et al. Usefulness of somatostatin receptor scintigraphy in patients with occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab. Apr 1999;84(4):1193-202. [Medline].

  33. Mojab K, Barker W, Rodriguez J, Ramos M. Angiographic findings in bronchial adenoma. (Carcinoid type). Am J Roentgenol Radium Ther Nucl Med. Dec 1974;122(4):828-32. [Medline].

  34. Scott WJ. Surgical treatment of other bronchial tumors. Chest Surg Clin N Am. Feb 2003;13(1):111-28. [Medline].

  35. Mahtabifard A, Fuller CB, McKenna RJ Jr. Video-assisted thoracic surgery sleeve lobectomy: a case series. Ann Thorac Surg. Feb 2008;85(2):S729-32. [Medline].

  36. Rizzardi G, Marulli G, Bortolotti L, Calabrese F, Sartori F, Rea F. Sleeve resections and bronchoplastic procedures in typical central carcinoid tumours. Thorac Cardiovasc Surg. Feb 2008;56(1):42-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

neuroendocrine carcinoma, Kulchitsky cell carcinoma, KCC, bronchial carcinoid tumors, bronchial adenomas, typical carcinoids, atypical carcinoids, small-cell carcinomas, Kulchitsky cells, argentaffin cells, pulmonary carcinoids, primary pulmonary neoplasms, lung neoplasms, lung cancers, pulmonary cancers

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Institute of Ultrasound in Medicine, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sarah Al Ghanem, MBBS, Consulting Staff, Department of Medical Imaging, King Fahad National Guard Hospital, Saudi Arabia
Disclosure: Nothing to disclose.

Klaus L Irion, MD, PhD, Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK
Klaus L Irion, MD, PhD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Carolyn M Allen, MB, BCh, MRCP, FRCR, CCST, Consultant Radiologist, Department of Clinical Radiology, North Manchester General Hospital, UK
Carolyn M Allen, MB, BCh, MRCP, FRCR, CCST is a member of the following medical societies: Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Medical Editor

Kitt Shaffer, MD, PhD, Director of Undergraduate Medical Education, Associate Professor, Department of Radiology, Cambridge Health Alliance
Kitt Shaffer, MD, PhD is a member of the following medical societies: American Roentgen Ray Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

W Richard Webb, MD, Professor, Department of Radiology, University of California at San Francisco
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Barry H Gross, MD, Professor, Department of Radiology, University of Michigan Medical School; Professor, University of Michigan Cancer Center
Barry H Gross, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Michigan State Medical Society, Physicians for Social Responsibility, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.