Figure 1
chest radiography
A primitive lung carcinoid tumor
SectionChest imaging
Case TypeClinical Cases
AuthorsPicano E, Zangani M, Iacconi C, Caramella D.
Connected authors
68 years, male
Clinical History
A 68 year old man was referred to our department for a pre-surgical chest radiography (colon resection).
Imaging Findings
After a period of fever and abdomen distension, the patient underwent a colonoscopy that demonstrated a cancer of the sigma. Pre-surgical chest radiography showed pulmonary nodules that were initially interpreted as metastases. The patient underwent Hartmann resection and pathological analysis of the surgical specimen was conclusive for adenocarcinoma. Lymph node infiltration was not documented.
For this reason a pulmonary transbronchial needle-biopsy was requested. Cellular elements reactive for TTF-1 were obtained, raising the suspicion for a primary lung neoplasia with a neuroendocrine differentiation. A CT-guided biopsy confirmed the suspicion of a primitive neuroendocrine lung neoplasm.
For this reason a pulmonary transbronchial needle-biopsy was requested. Cellular elements reactive for TTF-1 were obtained, raising the suspicion for a primary lung neoplasia with a neuroendocrine differentiation. A CT-guided biopsy confirmed the suspicion of a primitive neuroendocrine lung neoplasm.
Discussion
Primary lung carcinoid tumours appear at chest radiographs most often as a well-defined hilar or perihilar masses with associated distal parenchymal disease. At CT, carcinoid tumours appear as a spherical or ovoid nodule or mass with a well-defined and slightly lobulated border. They are typically located close to central bronchi, often near the bifurcation area. Calcifications are usually not visible on chest radiographs, but on CT images calcifications or ossification can be seen in up to 30% of tumours in punctuate or diffuse pattern. Carcinoids tend to be hypervascularized and may demonstrate intense enhancement. This is particularly helpful for distinguishing the tumour from obstructive atelectasis or an adjacent mucus plug. Also, in a dynamic contrast-enhanced CT study, typical and atypical carcinoid show high enhancement, that is, more than 30 HU of net enhancement. Both typical and atypical carcinoids may be associated with hilar or mediastinal lymphadenopathy due to reactive hyperplasia from recurrent pneumonia or lymph node metastasis (the latter is more frequently associated with atypical carcinoids).
Differential Diagnosis List
Primitive lung carcinoid tumors
Final Diagnosis
Primitive lung carcinoid tumors
References
[1] Chong, Kyung Soo Lee, Myung Chung et al. (2006) Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. RadioGraphics 26:41-58. (PMID: 16418242)
[2] Tae Hoon Kim, Sang Jin Kim, Young Hoon Ryu et al. (2004) Pleomorphic carcinoma of lung: comparison of CT features and pathologic findings. Radiology 232:554-559. (PMID: 15215543)
[3] Forster BB, Müller NL, Miller RR, Nelems B, Evans KG (1989) Neuroendocrine carcinomas of the lung: clinical, radiologic and pathologic correlation. Radiology 170:441-445. (PMID: 2536187)
Case information
| URL: | https://www.eurorad.org/case/7271 |
| DOI: | 10.1594/EURORAD/CASE.7271 |
| ISSN: | 1563-4086 |
