Carcinoid syndrome caused by a pulmonary carcinoid mimics intestinal manifestations of ulcerative colitis:A case report

BACKGROUND Pulmonary carcinoids are rare,low-grade malignant tumors characterized by neuroendocrine differentiation and relatively indolent clinical behavior.Most cases present as a slow-growing polypoidal mass in the major bronchi leading to hemoptysis and pulmonary infection due to blockage of the distal bronchi.Carcinoid syndrome is a paraneoplastic syndrome caused by the systemic release of vasoactive substances that presents in 5%of patients with neuroendocrine tumors.Due to such nonspecific presentation,most patients are misdiagnosed or diagnosed late and may receive several courses of antibiotics to treat recurrent pneumonia before the tumor is diagnosed.CASE SUMMARY We report the case of a 48-year-old male who presented with cough,dyspnea,a history of recurrent pneumonitis,and therapy-refractory ulcerative colitis that completely subsided after the resection of a pulmonary carcinoid.CONCLUSION We report and emphasize pulmonary carcinoid as a differential diagnosis in patients with nonresponding inflammatory bowel diseases and recurrent pneumonia.

Long-term outcomes of surgical treatment for pulmonary carcinoid tumors： 20 years＇ experience with 131 patients

Background Bronchial carcinoids are rare malignant neuroendocrine neoplasms. Some issues regarding surgical treatment of bronchial carcinoids remain controversial, including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy. Methods This retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010. Results Eighty-nine （67.9%） of the patients were male, and the mean age was 46 years, ranging from 17 to 81 years. Preoperative fiberoptic bronchoscopy was performed in all patients. Endoscopic biopsy was performed in 100 patients with central tumors, and 70 （70%） patients were diagnosed as bronchial carcinoid. The resections performed consisted of 31 pneumonectomie, 32 Iobectomies, 26 bilobectomies, 34 sleeve Iobectomies, six bronchoplastic procedures without lung resection, and two segmentectomies. During a median of 87 months follow-up, there were nine recurrences including three local recurrences and 6 distant recurrences. No bronchial recurrences were observed. The 3-, 5- and 10-year overall survival rates of pneumonectom and bronchoplastic surgery （including sleeve Iobectomy and bronchoplastic procedure without lung resection） were 93.2%, 81.0% and 69.4%, 97.5%, 91.9% and 70.0%, respectively. Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors. Conclusions Bronchoplastic surgery should be considered whenever possible for central carcinoids. Systematic lymphadenectomy is recommended for bronchial carcinoid patients. Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid.

Adjuvant therapy for lung neuroendocrine neoplasms

Pulmonary neuroendocrine neoplasms(NENs)represent a minority of lung cancers and vary from slower growing pulmonary carcinoid(PC)tumors to aggressive small cell lung cancer(SCLC).While SCLC can account for up to 15%of lung cancer,PCs are uncommon and represent about 2%of lung cancers.Surgical resection is the standard of care for early-stage PCs and should also be considered in early stage large cell neuroendocrine carcinoma(LCNEC)and SCLC.Adjuvant treatment is generally accepted for aggressive LCNEC and SCLC,however,less well established for PCs.Guidelines admit a lack of trials to support a high-level recommendation for adjuvant therapy.This manuscript will discuss the role for adjuvant therapy in NENs and review the available literature.