A case of Malignant Bronchial Carcinoid- presenting as Unilateral hyperlucent lung
Abstract
commonly affect young adults and the middle aged, the same age groups affected by other more
common chronic lung conditions such as pulmonary tuberculosis, COPD or bronchial asthma.
Diagnosis is commonly missed or delayed due to a low index of suspicion. Surgery is the mainstay of
treatment with an excellent outcome. We present a case of Malignant Bronchial Carcinoid Tumor
being treated as Bronchial Asthma for 4months, which later proved to be carcinoid tumor. On perusal
of previous records, CT chest showed unilateral hyper translucency with a suspicious opacity. Repeat
CT chest showed endobronchial mass with post obstructive pneumonitis. HPE following
endobronchial biopsy was suggestive of carcinoid tumor. Diagnosis was confirmed by
immunohistochemistry.
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carcinoids. A higher level of chromogranin A is correlated with tumour burden.
Treatment
Surgery is the therapy of choice for carcinoid tumours, with parenchyma-sparing procedures
recommended for typical carcinoids(10). The aim is to remove the primary tumour and affected lymph
nodes radically, keeping as much of the lung parenchyma as possible. Endoscopic laser resection
also has a role, and this can be performed with a rigid or flexible bronchoscope(14). Because of the
many disadvantages of the rigid bronchoscope like need for general anaesthesia and more chance of
complications, however, most pulmonologists prefer a flexible bronchoscope for laser photoresection.
If complete surgical resection cannot be accomplished, or if metastatic disease is present,
chemotherapy and radiation therapy provide a little hope for cure. Metastatic or locally advanced
carcinoids display very poor responsiveness to a variety of chemotherapeutic regimens similar to
those utilised for treatment of small cell lung carcinoma, with a median overall survival of 20
months(15). Biotherapy with and interferon, octreotide, and lanreotide are mainly being attempted
for symptomatic relief.
Conclusion
Any patient presenting with localized wheeze and diagnosed as COPD or asthma, refractory to
medical treatment should be dealt with high suspicion. Warrants further investigation to confirm the
diagnosis with follow up chest radiographs, CT chests and bronchoscopy. Bronchial carcinoid tumors
should me considered in the differential diagnoses of such patients. Finally we conclude that ‘all that
wheezes are not asthma’ and more particularly when wheezes are localised.
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