Bronchial carcinoid tumor with right lower lobe collapse

Case contributed by Dr Jack Ren

Presentation

Recurring carcinoid tumor.

Patient Data

Age: 80
Gender: Male

Chest X-ray demonstrates collapse of the righter lower lobe with increase opacity in the medial base of the right lung with lose of medial aspect of silhouette of right hemidiaphragm on both PA and lateral projections. There is shift of mediastinum and trachea to the right and elevation of the right hemidiaphragm

There is a mass lesion located below the right main bronchus which is causing partial occlusion of the right main bronchus. The lesion is heterogeneous in nature with hyper-dense spots consistent with calcification. The lesion shows some degree of enhancement following administration of contrast.

Another homogeneous mass lesion with no contrast enhancement locate near the right hilum.

The heterogeneous hyper-density at right lower base with trachea deviate to right indicate collapse of right lower lobe.

Pathohistology

MACROSCOPIC DESCRIPTION
1.  Specimen  container  labeled  'left  tracheal  biopsy'.  A  tan tissue fragment, 3 mm.  

2.  Specimen  container  labeled '(R)  main bronchus  tumor'.  Three tan tissue fragments, admixed with blood  clot, ranging in  size from 5-10 mm. 

MICROSCOPIC DESCRIPTION
1.  Sections show  a single fragment  of bronchial tissue. This comprises respiratory type  epithelium  with attached  fibrous stroma  infiltrated by nests of  epithelioid  cells.  These  cells  have rounded  nuclei,  finely divided  chromatin, and  moderately  abundant  amphophilic  cytoplasm.  The appearances  are  in  keeping a  carcinoid  tumor.  There  is no  mitotic
activity or necrosis to  suggest that this is an  atypical carcinoid, based on a small sample.

2.  Sections  show fragments  of  bronchial tissue,  widely  infiltrated by tumor nests with similar features to  those described for specimen 1.  The growth pattern is also partly trabecular. No necrosis is seen.  Up to two mitoses per  10 high power  fields  are identified.  Definite  evidence to
place the tumor in the atypical carcinoid category is not identified based on these small samples.

DIAGNOSIS
1&2 Left tracheal biopsy and right  main bronchus tumor biopsy - recurrent carcinoid tumor.

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