Peripheral pulmonary carcinoid tumor
Peripheral pulmonary carcinoid tumor refer to a subtype of pulmonary carcinoid tumors that arise within the periphery of the lung. They are considered less common than the more centrally-located bronchial carcinoid tumors.
Many patients tend to be asymptomatic 2. Presentation with carcinoid syndrome is extremely rare 6.
Peripheral pulmonary carcinoid tumors are considered a neuroendocrine tumor of the lung. They can be
- typical pulmonary carcinoid tumors (well-differentiated - common) or
- atypical pulmonary carcinoid tumors (more aggressive - uncommon)
- smoking: the rate of carcinoid tumors is similar between smokers and non-smokers, although there is an increased incidence of atypical subtype amongst smokers 5,6
Most are discovered as an incidental rounded solitary pulmonary nodule. The size at diagnosis can vary but is usually reported to be in the range of 10-30 mm 2. Many have a lobulated margin with an average Hounsfield value on postcontrast imaging of ~50 2. Imaging features are often non-specific and tissue diagnosis is essential in determining diagnosis.
Most peripheral carcinoid tumors tend to involve a subsegmental bronchus 2.
May have a sensitivity of around 75% 7. Although most cases will show uptake on an 18-FDG PET, up to a quarter of false negative has been described 2.
Galliun68-Octreotide-PET / 68Ga-DOTATATE
Usually avid and useful for diagnosis 8.
Treatment and prognosis
Some authors consider there as complex tumors as a whole which require a multidisciplinary approach and long-term follow-up 10.
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- 2. Meisinger QC, Klein JS, Butnor KJ et-al. CT features of peripheral pulmonary carcinoid tumors. AJR Am J Roentgenol. 2011;197 (5): 1073-80. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.10.5954 - Pubmed citation
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- 4. Steinfort DP, Finlay M, Irving LB. Diagnosis of peripheral pulmonary carcinoid tumor using endobronchial ultrasound. Ann Thorac Med. 2008;3 (4): 146-8. Ann Thorac Med (full text) - doi:10.4103/1817-1737.43082 - Free text at pubmed - Pubmed citation
- 5. Ducrocq X, Thomas P, Massard G et-al. Operative risk and prognostic factors of typical bronchial carcinoid tumors. Ann. Thorac. Surg. 1998;65 (5): 1410-4. Pubmed citation
- 6. Fink G, Krelbaum T, Yellin A et-al. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest. 01;119 (6): 1647-51. doi:10.1378/chest.119.6.1647 - Pubmed citation
- 7. Tanaka A, Akamatsu H, Kawabata H, Ariyasu H, Nakamura Y, Yamamoto N. Peripheral pulmonary carcinoid tumor diagnosed by endobronchial-ultrasound-guided bronchoscopy. Respirology case reports. 4 (1): 10-2. doi:10.1002/rcr2.139 - Pubmed
- 8. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics : a review publication of the Radiological Society of North America, Inc. 26 (1): 41-57; discussion 57-8. doi:10.1148/rg.261055057 - Pubmed
- 9. Bhatia K, Ellis S. Unusual lung tumours: an illustrated review of CT features suggestive of this diagnosis. Cancer imaging : the official publication of the International Cancer Imaging Society. 6: 72-82. doi:10.1102/1470-7330.2006.0013 - Pubmed
- 10 .Caplin ME, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, Oberg K, Pelosi G, Perren A, Rossi RE, Travis WD. Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. (2015) Annals of oncology : official journal of the European Society for Medical Oncology. 26 (8): 1604-20. doi:10.1093/annonc/mdv041 - Pubmed
- 11. Hendifar AE, Marchevsky AM, Tuli R. Neuroendocrine Tumors of the Lung: Current Challenges and Advances in the Diagnosis and Management of Well-Differentiated Disease. (2017) Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 12 (3): 425-436. doi:10.1016/j.jtho.2016.11.2222 - Pubmed