PANCE Blueprint Pulmonary (10%)

Carcinoid tumors

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Patient will present with → haemoptysis, cough, focal wheezing or recurrent pneumonia. Carcinoid syndrome = Cutaneous flushing, diarrhea, wheezing and low blood pressure (hallmark sign)

Carcinoid tumors are a GI tract cancer that has metastasized to the lungs

  • Cancer of the appendix is the most common cause.  The appendiceal cancer travels from the appendix then to the liver where it metastasizes to the lungs
  • Most common type: Adenoma - Slow growing, rare metastasis

Presents with haemoptysis, cough, focal wheezing or recurrent pneumonia, carcinoid syndrome (the hallmark sign) is actually quite rare

Chest X Ray shows low grade CA seen as pedunculated sessile growth in the central bronchi

  • Bronchoscopy- pink/purple central lesion, well vascularized
  • Elevated 5-Hydroxyindoleacetic acid (5-HIAA) -  is the main metabolite of serotonin and is used to determine serotonin levels in the body
Endobronchial carcinoid tumor in a Crohn disease patient

Endobronchial carcinoid tumor in a Crohn disease patient (centrally located sessile growth is common)

Treatment is by surgical excision and carries a good prognosis.

  • The lesions are resistant to radiation therapy and chemotherapy
  • Octreotide - a somatostatin analogue which decreases the secretion of serotonin by the tumor
IM_MED_BronchialCarcinoidTumor_v1.1_ Lung carcinoma is typically divided into two categories, small cell carcinoma and non-small cell carcinoma. Non-small cell carcinoma subtypes include adenocarcinoma, squamous cell carcinoma, large cell carcinoma and carcinoid tumor. Bronchial carcinoid tumor is a neuroendocrine tumor that carries an excellent prognosis. It may be asymptomatic or may present with symptoms of bronchial obstruction such as coughing or hemoptysis. Occasionally, bronchial carcinoid tumors may cause carcinoid syndrome which is characterized by flushing, diarrhea and wheezing. These tumors are chromogranin A positive and histology shows nests of neuroendocrine cells. Additionally, patients will have elevated urine 5-HIAA when carcinoid syndrome is present. Treatment includes surgical resection and octreotide for symptomatic relief.

Bronchial Carcinoid Tumor Picmonic

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