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Typical carcinoid lung tumour (view source)
Revision as of 23:40, 17 March 2019
, 23:40, 17 March 2019→General
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| LMDDx = [[atypical carcinoid lung tumour]], [[pulmonary carcinoid tumourlet]], [[lung adenocarcinoma]] | | LMDDx = [[atypical carcinoid lung tumour]], [[pulmonary carcinoid tumourlet]], [[lung adenocarcinoma]] | ||
| Stains = | | Stains = | ||
| IHC = Ki-67 ~2% (0-7%) | | IHC = Ki-67 ~2% (0-7%), TTF-1 +ve/-ve, CK7 +ve/-ve, CK20 -ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = well-circumscribed, solid | | Gross = well-circumscribed, solid, >=5 mm (definition) | ||
| Grossing = | | Grossing = | ||
| Site = [[lung]] - see ''[[lung tumours]]'' | | Site = [[lung]] - see ''[[lung tumours]]'' | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = [[diffuse idiopathic pulmonary neuroendocrine cell hyperplasia]] | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Line 27: | Line 27: | ||
| Prognosis = benign | | Prognosis = benign | ||
| Other = | | Other = | ||
| ClinDDx = other [[lung tumours]] | | ClinDDx = other [[lung tumours]], [[lung metastases]] (esp. when multiple) | ||
| Tx = excision to exclude other types of lung tumours & treat symptoms | | Tx = excision to exclude other types of lung tumours & treat symptoms | ||
}} | }} | ||
| Line 34: | Line 34: | ||
==General== | ==General== | ||
*Approximately 80% of lung carcinoids.<ref name=pmid20888248>{{Cite journal | last1 = Naalsund | first1 = A. | last2 = Rostad | first2 = H. | last3 = Strøm | first3 = EH. | last4 = Lund | first4 = MB. | last5 = Strand | first5 = TE. | title = Carcinoid lung tumors--incidence, treatment and outcomes: a population-based study. | journal = Eur J Cardiothorac Surg | volume = 39 | issue = 4 | pages = 565-9 | month = Apr | year = 2011 | doi = 10.1016/j.ejcts.2010.08.036 | PMID = 20888248 }}</ref> | *Approximately 80% of lung carcinoids.<ref name=pmid20888248>{{Cite journal | last1 = Naalsund | first1 = A. | last2 = Rostad | first2 = H. | last3 = Strøm | first3 = EH. | last4 = Lund | first4 = MB. | last5 = Strand | first5 = TE. | title = Carcinoid lung tumors--incidence, treatment and outcomes: a population-based study. | journal = Eur J Cardiothorac Surg | volume = 39 | issue = 4 | pages = 565-9 | month = Apr | year = 2011 | doi = 10.1016/j.ejcts.2010.08.036 | PMID = 20888248 }}</ref> | ||
*May be multiple.<ref name=pmid356600>{{Cite journal | last1 = Miller | first1 = MA. | last2 = Mark | first2 = GJ. | last3 = Kanarek | first3 = D. | title = Multiple peripheral pulmonary carcinoids and tumorlets of carcinoid type, with restrictive and obstructive lung disease. | journal = Am J Med | volume = 65 | issue = 2 | pages = 373-8 | month = Aug | year = 1978 | doi = | PMID = 356600 }}</ref> | |||
**Can mimicking metastatic disease.<ref name=pmid17400673>{{Cite journal | last1 = Aubry | first1 = MC. | last2 = Thomas | first2 = CF. | last3 = Jett | first3 = JR. | last4 = Swensen | first4 = SJ. | last5 = Myers | first5 = JL. | title = Significance of multiple carcinoid tumors and tumorlets in surgical lung specimens: analysis of 28 patients. | journal = Chest | volume = 131 | issue = 6 | pages = 1635-43 | month = Jun | year = 2007 | doi = 10.1378/chest.06-2788 | PMID = 17400673 }}</ref> | |||
**Often re-occur - but long term survival good. | |||
*Can be seen in the context of [[diffuse idiopathic pulmonary neuroendocrine cell hyperplasia]] (DIPNECH).<ref name=pmid26104490>{{Cite journal | last1 = Wirtschafter | first1 = E. | last2 = Walts | first2 = AE. | last3 = Liu | first3 = ST. | last4 = Marchevsky | first4 = AM. | title = Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia of the Lung (DIPNECH): Current Best Evidence. | journal = Lung | volume = | issue = | pages = | month = Jun | year = 2015 | doi = 10.1007/s00408-015-9755-1 | PMID = 26104490 }}</ref><ref name=pmid26112453>{{Cite journal | last1 = Chauhan | first1 = A. | last2 = Ramirez | first2 = RA. | title = Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) and the Role of Somatostatin analogs: A Case Series. | journal = Lung | volume = | issue = | pages = | month = Jun | year = 2015 | doi = 10.1007/s00408-015-9754-2 | PMID = 26112453 }}</ref> | |||
*A common primary lung tumour in children.<ref name=pmid26971789>{{Cite journal | last1 = Giuseppucci | first1 = C. | last2 = Reusmann | first2 = A. | last3 = Giubergia | first3 = V. | last4 = Barrias | first4 = C. | last5 = Krüger | first5 = A. | last6 = Siminovich | first6 = M. | last7 = Botto | first7 = H. | last8 = Cadario | first8 = M. | last9 = Boglione | first9 = M. | title = Primary lung tumors in children: 24 years of experience at a referral center. | journal = Pediatr Surg Int | volume = 32 | issue = 5 | pages = 451-7 | month = May | year = 2016 | doi = 10.1007/s00383-016-3884-3 | PMID = 26971789 }} | |||
</ref> | |||
**Most common lung tumour in children: metastasis (80-85% of lung tumours in children<ref name=pmid>{{Cite journal | last1 = Dishop | first1 = MK. | last2 = Kuruvilla | first2 = S. | title = Primary and metastatic lung tumors in the pediatric population: a review and 25-year experience at a large children's hospital. | journal = Arch Pathol Lab Med | volume = 132 | issue = 7 | pages = 1079-103 | month = Jul | year = 2008 | doi = 10.1043/1543-2165(2008)132[1079:PAMLTI]2.0.CO;2 | PMID = 18605764 }}</ref>). | |||
Presentation:<ref name=pmid16810137>{{Cite journal | last1 = Gungor | first1 = S. | last2 = Damadoglu | first2 = E. | last3 = Aybatli | first3 = A. | last4 = Yilmaz | first4 = A. | last5 = Kir | first5 = A. | last6 = Akkaya | first6 = E. | title = Typical pulmonary carcinoid tumors: presentation and outcome of 24 cases. | journal = Med Sci Monit | volume = 12 | issue = 7 | pages = CR315-8 | month = Jul | year = 2006 | doi = | PMID = 16810137 }}</ref> | Presentation:<ref name=pmid16810137>{{Cite journal | last1 = Gungor | first1 = S. | last2 = Damadoglu | first2 = E. | last3 = Aybatli | first3 = A. | last4 = Yilmaz | first4 = A. | last5 = Kir | first5 = A. | last6 = Akkaya | first6 = E. | title = Typical pulmonary carcinoid tumors: presentation and outcome of 24 cases. | journal = Med Sci Monit | volume = 12 | issue = 7 | pages = CR315-8 | month = Jul | year = 2006 | doi = | PMID = 16810137 }}</ref> | ||
*Cough. | *Cough. | ||
*Hemoptysis. | *Hemoptysis. | ||
Treatment: | |||
*Surgical resection.<ref name=pmid25646366>{{Cite journal | last1 = Caplin | first1 = ME. | last2 = Baudin | first2 = E. | last3 = Ferolla | first3 = P. | last4 = Filosso | first4 = P. | last5 = Garcia-Yuste | first5 = M. | last6 = Lim | first6 = E. | last7 = Oberg | first7 = K. | last8 = Pelosi | first8 = G. | last9 = Perren | first9 = A. | title = Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. | journal = Ann Oncol | volume = 26 | issue = 8 | pages = 1604-20 | month = Aug | year = 2015 | doi = 10.1093/annonc/mdv041 | PMID = 25646366 }}</ref> | |||
==Gross== | ==Gross== | ||
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*Nests of cells. | *Nests of cells. | ||
**Stippled chromatin. | **Stippled chromatin. | ||
** | **Scant-to-moderate cytoplasm. | ||
*No necrosis. | *Nuclei round or ellipsoid. | ||
*No necrosis - '''important'''. | |||
*Low mitotic rate. | *Low mitotic rate. | ||
*[[diagnostic size cutoff|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> | *[[diagnostic size cutoff|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> | ||
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*[[Atypical carcinoid lung tumour]]. | *[[Atypical carcinoid lung tumour]]. | ||
*[[Lung adenocarcinoma]].<ref name=pmid22269186>{{Cite journal | last1 = Demirci | first1 = I. | last2 = Herold | first2 = S. | last3 = Kopp | first3 = A. | last4 = Flaßhove | first4 = M. | last5 = Klosterhalfen | first5 = B. | last6 = Janßen | first6 = H. | title = Overdiagnosis of a typical carcinoid tumor as an adenocarcinoma of the lung: a case report and review of the literature. | journal = World J Surg Oncol | volume = 10 | issue = | pages = 19 | month = | year = 2012 | doi = 10.1186/1477-7819-10-19 | PMID = 22269186 }}</ref> | *[[Lung adenocarcinoma]].<ref name=pmid22269186>{{Cite journal | last1 = Demirci | first1 = I. | last2 = Herold | first2 = S. | last3 = Kopp | first3 = A. | last4 = Flaßhove | first4 = M. | last5 = Klosterhalfen | first5 = B. | last6 = Janßen | first6 = H. | title = Overdiagnosis of a typical carcinoid tumor as an adenocarcinoma of the lung: a case report and review of the literature. | journal = World J Surg Oncol | volume = 10 | issue = | pages = 19 | month = | year = 2012 | doi = 10.1186/1477-7819-10-19 | PMID = 22269186 }}</ref> | ||
*[[Pulmonary meningothelial-like nodule]] - usually 1-3 mm, not associated with airway. | |||
===Images=== | ===Images=== | ||
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==IHC== | ==IHC== | ||
Proliferation: | |||
*Ki-67 ~2% (range 0-7%).<ref name=pmid25318848>{{Cite journal | last1 = Liu | first1 = SZ. | last2 = Staats | first2 = PN. | last3 = Goicochea | first3 = L. | last4 = Alexiev | first4 = BA. | last5 = Shah | first5 = N. | last6 = Dixon | first6 = R. | last7 = Burke | first7 = AP. | title = Automated quantification of Ki-67 proliferative index of excised neuroendocrine tumors of the lung. | journal = Diagn Pathol | volume = 9 | issue = | pages = 174 | month = | year = 2014 | doi = 10.1186/s13000-014-0174-z | PMID = 25318848 }}</ref> | *Ki-67 ~2% (range 0-7%).<ref name=pmid25318848>{{Cite journal | last1 = Liu | first1 = SZ. | last2 = Staats | first2 = PN. | last3 = Goicochea | first3 = L. | last4 = Alexiev | first4 = BA. | last5 = Shah | first5 = N. | last6 = Dixon | first6 = R. | last7 = Burke | first7 = AP. | title = Automated quantification of Ki-67 proliferative index of excised neuroendocrine tumors of the lung. | journal = Diagn Pathol | volume = 9 | issue = | pages = 174 | month = | year = 2014 | doi = 10.1186/s13000-014-0174-z | PMID = 25318848 }}</ref> | ||
**[[Atypical lung carcinoid tumour|Atypical carcinoid]] is on average 17% (range 10-26%).<ref name=pmid25318848/> | |||
[[Neuroendocrine markers]]:<ref name=pmid25006841>{{Cite journal | last1 = Sayeg | first1 = Y. | last2 = Sayeg | first2 = M. | last3 = Baum | first3 = RP. | last4 = Kulkarni | first4 = HR. | last5 = Presselt | first5 = N. | last6 = Mäder | first6 = I. | last7 = Kunze | first7 = A. | last8 = Sänger | first8 = J. | last9 = Hörsch | first9 = D. | title = [Pulmonary neuroendocrine neoplasms]. | journal = Pneumologie | volume = 68 | issue = 7 | pages = 456-77 | month = Jul | year = 2014 | doi = 10.1055/s-0034-1365642 | PMID = 25006841 }}</ref><ref name=pmid23676981>{{Cite journal | last1 = Zhu | first1 = L. | last2 = Shen-Tu | first2 = Y. | last3 = Zhang | first3 = J. | last4 = Fan | first4 = X. | title = [Pathological characteristic and clinical management of pulmonary carcinoid]. | journal = Zhongguo Fei Ai Za Zhi | volume = 16 | issue = 5 | pages = 246-51 | month = May | year = 2013 | doi = 10.3779/j.issn.1009-3419.2013.05.06 | PMID = 23676981 }}</ref> | |||
*[[ | *Chromogranin A +ve. | ||
*Synaptophysin +ve. | |||
*[[CD56]] +ve. | |||
**Also +ve in [[pulmonary meningothelial-like nodule]]. | |||
Others: | |||
*[[TTF-1]] +ve/-ve (11 +ve of 16 cases<ref name=pmid11679943/>). | |||
*[[CK7]] +ve/-ve (10 +ve of 16 cases<ref name=pmid11679943>{{Cite journal | last1 = Cai | first1 = YC. | last2 = Banner | first2 = B. | last3 = Glickman | first3 = J. | last4 = Odze | first4 = RD. | title = Cytokeratin 7 and 20 and thyroid transcription factor 1 can help distinguish pulmonary from gastrointestinal carcinoid and pancreatic endocrine tumors. | journal = Hum Pathol | volume = 32 | issue = 10 | pages = 1087-93 | month = Oct | year = 2001 | doi = 10.1053/hupa.2001.28245 | PMID = 11679943 }}</ref>). | |||
*[[CK20]] -ve (0 +ve of 16 cases<ref name=pmid11679943/>). | |||
==Sign out== | ==Sign out== | ||
===Biopsy=== | |||
<pre> | |||
Lung, Left Upper Lobe, Core Biopsy: | |||
- Consistent with typical lung carcinoid. | |||
Comment: | |||
The tumour stains as follow: | |||
POSITIVE: CK7, TTF-1 (very weak, focal), CD56, chromogranin A, synaptophysin. | |||
NEGATIVE: p63. | |||
PROLIFERATION (Ki-67): ~3% of tumour cells. | |||
</pre> | |||
===Excision=== | |||
<pre> | <pre> | ||
A. Lymph Node, Station 2L, Lymphadenectomy: | A. Lymph Node, Station 2L, Lymphadenectomy: | ||
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==See also== | ==See also== | ||
*[[Lung tumours]]. | *[[Lung tumours]]. | ||
*[[Pancreatic neuroendocrine tumour]]. | |||
*[[Gastric neuroendocrine tumour]]. | |||
*[[Neuroendocrine tumours]]. | |||
==References== | ==References== | ||