Presentation
Incidental finding on chest radiograph.
Patient Data
Selected images of the chest demonstrating a well-defined homogeneous soft tissue mass located in the right lower lobe, touching the pleural surface.
Selected images of PET-CT confirms the lesions to have increased tracer uptake.
Under CT guidance, local anesthetic (1% lignocaine) was injected to skin and to the overlying pleura. A 19G co-axial needle was inserted into the right lower lobe lesion. Through this, a 20G core biopsy needle was used to take 3 samples of the lesion. These were placed in formalin and sent to pathology for further assessment. There were no immediate complications. The patient is to recover in the department and have a delayed post-procedure chest x-ray.
MICROSCOPIC DESCRIPTION: 1. Sections of lung show a circumscribed partially encapsulated
tumor composed of nests and trabeculae surrounded by limited vascularized stroma. The tumor cells are cohesive and show mildly enlarged round to elongate nuclei, granular chromatin, inconspicuous nucleoli and vacuolated cytoplasm. No mitoses are seen. There is no evidence of necrosis. The overlying pleura is uninvolved. No lymphovascular invasion identified. The resection margin is clear of tumor. The tumor appear similar to the right lung tumor resected previously.
By immunohistochemistry the tumor cells are CD56+, synaptophysen+, chromogranin+. The Ki67 index is ~2%.
2. The sections show five lymph nodes with reactive changes only. No evidence of metastatic malignancy.
3. Sections show two pieces of unremarkable fibrofatty tissue. No evidence of malignancy is seen.
4. Sections show one lymph node with anthracosis pigment and reactive changes only. No evidence of malignancy is seen.
DIAGNOSIS: 1. Anterior segment left lower lobe: Typical carcinoid tumor
Case Discussion
This patient had a previous history of carcinoid tumor resection and now presented with another mass on the same side. The histology confirmed a carcinoid tumor. The radiographic features are nonspecific but favored carcinoid recurrence in this setting.
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