Bronchial carcinoid tumor
Bronchial carcinoid tumors are carcinoid tumors primarily occurring in relation to a bronchus. They were previously incorrectly termed as bronchial adenomas. They usually occur in association with a segmental or larger bronchus.
Typically affects patients from 3rd to 7th decades with the mean age around 45 years 7,10.
Presentation can vary dependent on location. Central neoplasms usually give symptoms due to bronchial obstruction (such symptoms can include pneumonia, atelectasis, bronchiectasis, emphysema or even a lung abscess); if airway obstruction is partial, symptoms such as cough, wheezing and recurrent pulmonary infections can occur. Peripheral tumors on the contrary are generally asymptomatic and they are discovered occasionally. Presentation with the carcinoid syndrome is rather rare (~2-5%) 5,10.
They are neuroendocrine neoplasms that range from low-grade typical carcinoids to more aggressive atypical carcinoids. They can therefore demonstrate a wide spectrum in terms of clinical behavior as well as histology.
Most (~60%) tend to be central within the tracheobronchial tree 3; the vast majority of which arise from the central bronchi, rarely from the trachea 4.
- multiple endocrine neoplasia type 1 13
- Cushing syndrome: due to ACTH-producing carcinoid tumor types 1
Chest radiographic features are often non-specific. They are most frequently seen as round or oval opacities with sharp and often notched margins 2. Associated airway compression with pulmonary atelectasis may be also seen in some cases.
Central lesions are usually seen as:
- a single hilar or perihilar mass which is usually well-defined, round or ovoid
- can be of any size but are typically 2-5 cm
- there is often marked homogeneous contrast enhancement due to high vascularity
- calcification (usually eccentric) can occur but is not a common feature
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- 2. Nessi R, Basso ricci P, Basso ricci S et-al. Bronchial carcinoid tumors: radiologic observations in 49 cases. J Thorac Imaging. 1991;6 (2): 47-53. - Pubmed citation
- 3. Zwiebel BR, Austin JH, Grimes MM. Bronchial carcinoid tumors: assessment with CT of location and intratumoral calcification in 31 patients. Radiology. 1991;179 (2): 483-6. Radiology (abstract) - Pubmed citation
- 4. Anh-Vu H. Ngo, Christopher Michael Walker, Jonathan H. Chung, Julie E. Takasugi, Eric J. Stern, Jeffrey P. Kanne, Gautham P. Reddy, and J. David Godwin. Tumors and Tumorlike Conditions of the Large Airways. American Journal of Roentgenology 2013 201:2, 301-313. AJR
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- 9. Meisinger QC, Klein JS, Butnor KJ et-al. CT features of peripheral pulmonary carcinoid tumors. AJR Am J Roentgenol. 2011;197 (5): 1073-80. doi:10.2214/AJR.10.5954 - Pubmed citation
- 10. Jeung MY, Gasser B, Gangi A et-al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics. 2002;22 (2): 351-65. Radiographics (full text) - Pubmed citation
- 11. Davila DG, Dunn WF, Tazelaar HD et-al. Bronchial carcinoid tumors. Mayo Clin. Proc. 1993;68 (8): 795-803. - Pubmed citation
- 12. Morandi U, Casali C, Rossi G. Bronchial typical carcinoid tumors. Semin. Thorac. Cardiovasc. Surg. 2006;18 (3): 191-8. doi:10.1053/j.semtcvs.2006.08.005 - Pubmed citation
- 13. Scarsbrook AF, Thakker RV, Wass JA et-al. Multiple endocrine neoplasia: spectrum of radiologic appearances and discussion of a multitechnique imaging approach. Radiographics. 2006;26 (2): 433-51. Radiographics (full text) - doi:10.1148/rg.262055073 - Pubmed citation