Difference between revisions of "Pulmonary carcinoid tumourlet"

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'''Pulmonary carcinoid tumourlet''', also '''carcinoid tumourlet''', is a small benign proliferation of Kulchitsky cells.  It can be understood as a smaller version of the ''[[typical lung carcinoid tumour]]''.
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Lung carcinoid tumourlet - low mag.jpg
| Width      =
| Caption    = Lung carcinoid tumourlet. [[H&E stain]].
| Synonyms  = carcinoid tumourlet
| Micro      = cells with salt and pepper chromatin, usually nested architecture, no necrosis, minimal mitotic activity (see below), must be through the bronchial basement membrane
| Subtypes  =
| LMDDx      = [[pulmonary neuroendocrine cell hyperplasia]], [[typical carcinoid lung tumour]], [[atypical lung carcinoid tumour]], [[pulmonary meningothelial-like nodule]]
| Stains    =
| IHC        = Ki-67 ~2% (0-7%)
| EM        =
| Molecular  =
| IF        =
| Gross      = <5 mm by definition
| Grossing  =
| Site      = [[lung]] - see ''[[lung tumours]]''
| Assdx      =
| Syndromes  = [[Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia]]
| Clinicalhx = often an incidental finding
| Signs      =
| Symptoms  =
| Prevalence = not common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Pulmonary carcinoid tumourlet''', also '''carcinoid tumourlet''', is a small benign proliferation of Kulchitsky cells.   
 
The entity is separated from the ''[[typical lung carcinoid tumour]]'' by size. Carcinoid tumourlets are < 5 mm, typical lung carcinoid tumours are >=5 mm.  


==General==
==General==
Line 5: Line 38:
**Essentially a small [[typical carcinoid lung tumour|typical carcinoid]].
**Essentially a small [[typical carcinoid lung tumour|typical carcinoid]].
*Arise from ''Kulchitsky cells'' of the bronchial epithelium.<ref name=pmid9064089>{{Cite journal  | last1 = Ramón Capilla | first1 = M. | last2 = Arnau Obrer | first2 = A. | last3 = Navarro Ibáñez | first3 = R. | last4 = Galbis Caravajal | first4 = J. | last5 = Traves Zapata | first5 = V. | last6 = Cantó Armengod | first6 = A. | title = [Pulmonary tumorlet. Report of 5 cases]. | journal = Arch Bronconeumol | volume = 32 | issue = 9 | pages = 489-91 | month = Nov | year = 1996 | doi =  | PMID = 9064089 }}</ref>
*Arise from ''Kulchitsky cells'' of the bronchial epithelium.<ref name=pmid9064089>{{Cite journal  | last1 = Ramón Capilla | first1 = M. | last2 = Arnau Obrer | first2 = A. | last3 = Navarro Ibáñez | first3 = R. | last4 = Galbis Caravajal | first4 = J. | last5 = Traves Zapata | first5 = V. | last6 = Cantó Armengod | first6 = A. | title = [Pulmonary tumorlet. Report of 5 cases]. | journal = Arch Bronconeumol | volume = 32 | issue = 9 | pages = 489-91 | month = Nov | year = 1996 | doi =  | PMID = 9064089 }}</ref>
*May be seen in the context of [[diffuse idiopathic pulmonary neuroendocrine cell hyperplasia]].


==Microscopic==
==Microscopic==
Features:
Features:
*Nests of cells - classic pattern.
*Neuroendocrine cells - usually in nests (classic pattern).
**Salt and pepper chromatin - '''key feature'''.
**Salt and pepper chromatin - '''key feature'''.
*Nuclei round or ellipsoid.
*Size criterion: <5 mm.<ref name=pct_ucsf>URL: [http://pathhsw5m54.ucsf.edu/case7/image75.html http://pathhsw5m54.ucsf.edu/case7/image75.html]. Accessed on: 23 January 2012.</ref><ref name=pmid23205296>{{Cite journal  | last1 = He | first1 = P. | last2 = Gu | first2 = X. | last3 = Wu | first3 = Q. | last4 = Lin | first4 = Y. | last5 = Gu | first5 = Y. | last6 = He | first6 = J. | title = Pulmonary carcinoid tumorlet without underlying lung disease: analysis of its relationship to fibrosis. | journal = J Thorac Dis | volume = 4 | issue = 6 | pages = 655-8 | month = Dec | year = 2012 | doi = 10.3978/j.issn.2072-1439.2012.06.11 | PMID = 23205296 }}</ref>
*Size criterion: <5 mm.<ref name=pct_ucsf>URL: [http://pathhsw5m54.ucsf.edu/case7/image75.html http://pathhsw5m54.ucsf.edu/case7/image75.html]. Accessed on: 23 January 2012.</ref><ref name=pmid23205296>{{Cite journal  | last1 = He | first1 = P. | last2 = Gu | first2 = X. | last3 = Wu | first3 = Q. | last4 = Lin | first4 = Y. | last5 = Gu | first5 = Y. | last6 = He | first6 = J. | title = Pulmonary carcinoid tumorlet without underlying lung disease: analysis of its relationship to fibrosis. | journal = J Thorac Dis | volume = 4 | issue = 6 | pages = 655-8 | month = Dec | year = 2012 | doi = 10.3978/j.issn.2072-1439.2012.06.11 | PMID = 23205296 }}</ref>
*Must be through the bronchial basement membrane.<ref name=pmid20729444>{{Cite journal  | last1 = Koo | first1 = CW. | last2 = Baliff | first2 = JP. | last3 = Torigian | first3 = DA. | last4 = Litzky | first4 = LA. | last5 = Gefter | first5 = WB. | last6 = Akers | first6 = SR. | title = Spectrum of pulmonary neuroendocrine cell proliferation: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, tumorlet, and carcinoids. | journal = AJR Am J Roentgenol | volume = 195 | issue = 3 | pages = 661-8 | month = Sep | year = 2010 | doi = 10.2214/AJR.09.3811 | PMID = 20729444 }}</ref>


DDx:  
DDx:  
*[[Typical carcinoid lung tumour]].
*[[Pulmonary neuroendocrine cell hyperplasia]] - proliferation confined by bronchial basement membrane.<ref name=pmid20729444>{{Cite journal  | last1 = Koo | first1 = CW. | last2 = Baliff | first2 = JP. | last3 = Torigian | first3 = DA. | last4 = Litzky | first4 = LA. | last5 = Gefter | first5 = WB. | last6 = Akers | first6 = SR. | title = Spectrum of pulmonary neuroendocrine cell proliferation: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, tumorlet, and carcinoids. | journal = AJR Am J Roentgenol | volume = 195 | issue = 3 | pages = 661-8 | month = Sep | year = 2010 | doi = 10.2214/AJR.09.3811 | PMID = 20729444 }}</ref>
*[[Typical carcinoid lung tumour]] - must be >= 5 mm.
*[[Pulmonary meningothelial-like nodule]] - whorled appearance, ''not'' associated with an airway.


===Images===
===Images===
<gallery>
Image: Lung carcinoid tumourlet - very low mag.jpg | CT - very low mag. (WC)
Image: Lung carcinoid tumourlet - low mag.jpg | CT - low mag. (WC)
Image: Lung carcinoid tumourlet - intermed mag.jpg | CT - intermed. mag. (WC)
Image: Lung carcinoid tumourlet - high mag.jpg | CT - high mag. (WC)
Image: Lung carcinoid tumourlet - alt - high mag.jpg | CT - high mag. (WC)
Image: Lung carcinoid tumourlet - very high mag.jpg | CT - very high mag. (WC)
Image: Lung carcinoid tumourlet - alt - very high mag.jpg | CT - very high mag. (WC)
</gallery>
www:
*[http://pathhsw5m54.ucsf.edu/case7/image75.html Tumourlets - several images (ucsf.edu)].
*[http://pathhsw5m54.ucsf.edu/case7/image75.html Tumourlets - several images (ucsf.edu)].


Latest revision as of 03:30, 22 March 2018

Pulmonary carcinoid tumourlet
Diagnosis in short

Lung carcinoid tumourlet. H&E stain.
Synonyms carcinoid tumourlet
LM cells with salt and pepper chromatin, usually nested architecture, no necrosis, minimal mitotic activity (see below), must be through the bronchial basement membrane
LM DDx pulmonary neuroendocrine cell hyperplasia, typical carcinoid lung tumour, atypical lung carcinoid tumour, pulmonary meningothelial-like nodule
IHC Ki-67 ~2% (0-7%)
Gross <5 mm by definition
Site lung - see lung tumours
Syndromes Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
Clinical history often an incidental finding
Prevalence not common
Prognosis benign

Pulmonary carcinoid tumourlet, also carcinoid tumourlet, is a small benign proliferation of Kulchitsky cells.

The entity is separated from the typical lung carcinoid tumour by size. Carcinoid tumourlets are < 5 mm, typical lung carcinoid tumours are >=5 mm.

General

Microscopic

Features:

  • Neuroendocrine cells - usually in nests (classic pattern).
    • Salt and pepper chromatin - key feature.
  • Nuclei round or ellipsoid.
  • Size criterion: <5 mm.[3][4]
  • Must be through the bronchial basement membrane.[5]

DDx:

Images

  • CT - very low mag. (WC)

  • CT - low mag. (WC)

  • CT - intermed. mag. (WC)

  • CT - high mag. (WC)

  • CT - high mag. (WC)

  • CT - very high mag. (WC)

  • CT - very high mag. (WC)

www:

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A. Lymph Node, Station 4R, Lymphadenectomy:
- Lymph node, NEGATIVE for malignancy.

B. Lymph Node, Station 11R, Lymphadenectomy:
- Lymph node, NEGATIVE for malignancy.

C. Lung, Right Middle Lobe, Lobectomy:
- Typical carcinoid tumour (13 mm maximal dimension).
- Carcinoid tumourlet (3 mm maximal dimension).
- Margins clear of tumour.
- Please see tumour summary.

See also

References

  1. ↑ Bennett, GL.; Chew, FS. (Mar 1994). "Pulmonary carcinoid tumorlets.". AJR Am J Roentgenol 162 (3): 568. PMID 8109497.
  2. ↑ Ramón Capilla, M.; Arnau Obrer, A.; Navarro Ibáñez, R.; Galbis Caravajal, J.; Traves Zapata, V.; Cantó Armengod, A. (Nov 1996). "[Pulmonary tumorlet. Report of 5 cases].". Arch Bronconeumol 32 (9): 489-91. PMID 9064089.
  3. ↑ URL: http://pathhsw5m54.ucsf.edu/case7/image75.html. Accessed on: 23 January 2012.
  4. ↑ He, P.; Gu, X.; Wu, Q.; Lin, Y.; Gu, Y.; He, J. (Dec 2012). "Pulmonary carcinoid tumorlet without underlying lung disease: analysis of its relationship to fibrosis.". J Thorac Dis 4 (6): 655-8. doi:10.3978/j.issn.2072-1439.2012.06.11. PMID 23205296.
  5. ↑ 5.0 5.1 Koo, CW.; Baliff, JP.; Torigian, DA.; Litzky, LA.; Gefter, WB.; Akers, SR. (Sep 2010). "Spectrum of pulmonary neuroendocrine cell proliferation: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, tumorlet, and carcinoids.". AJR Am J Roentgenol 195 (3): 661-8. doi:10.2214/AJR.09.3811. PMID 20729444.
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