756

Radiologic-Pathologic

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Bronchial Felix S. Chew

Conferences

of the Massachusetts

General

Hospital

Carcinoid and James

H. Brown1

A 20-year-old man had four episodes of hemoptysis over the past year. Chest radiographs and conventional tomograms showed a mass in the left mainstem bronchus (Fig. 1). CT scan confirmed the presence of a single endobronchial lesion and revealed no extrabronchial abnormalities. The differential diagnosis included bronchial carcinoid, mucoepidermoid adenoma, adenoid cystic carcinoma, hamartoma, and mesenchymal tumor. A sleeve resection of the left mainstem bronchus was performed, and an ovoid mass arising from the mucosal surface was found. There was no invasion of the underlying cartilaginous rings. Six regional lymph nodes were sampled and found to be free of tumor. The final pathologic diagnosis was bronchial carcinoid. The classic bronchial carcinoid, formerly called bronchial adenoma, is a low-grade malignant neoplasm that shares histologic features with Kulchitsky’s cells, a neuroendocrine argentaffin cell of the bronchial and bronchiolar mucosa [13]. The carcinoid tumor is further characterized by an organoid growth pattern with a rich vascular stroma, minimal nuclear pleomorphism, minimal mitotic activity, and an absence of necrosis. It is the lowest grade subtype of the pulmonary neuroendocrine tumors (the others being atypical carcinoid

tumor and neuroendocrine

carcinoma),

cell carcinomas (type I of three subtypes). The lesion occurs in adults and is rare in adolescents. The prognosis is favorable following surgical resection with clear margins [2, 3]. Bronchial

proximal

carcinoids

bronchi.

usually

Because

involve

subsegmental

the lesions

grow

bronchial lumen, the typical presentation atelectasis, leading to indolent symptoms

or more

slowly

into the

is segmental of coughing,

or lobar wheez-

ing, recurrent infections, or hemoptysis. When directly visualized, the lesions are polypoid intraluminal masses smaller than 3 cm. A more peripheral lesion will present as an asymptomatic pulmonary nodule because the region of distal atelectasis is radiologically and clinically insignificant. Even in patients with metastatic disease (1 0% of cases), carcinoid syndrome (intermittent diarrhea, flushing, and cyanosis) is uncommon [3]. REFERENCES

1 . Forster BB, MUller NL, Miller AR, Nelems B, Evans KG. Neuroendocnne carcinomas of the lung: clinical, radiologic, and pathologic correlation. Radiology 1989;170:441-445 2. Warren WH, Faber LP, Gould yE. Neuroendocnne neoplasms of the lung. A clinicopathologic update. J Thorac c&diovasc Surg 1989;98:321-332 3. McCaughan BC, Martini N, Bains MS. Bronchial carcinoids. Review of 124

also called Kulchitsky-

cases. J Thorac cardiasc

Surg 1985;89:8-17 tie

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Fig. 1.-Bronchial carcinoid. A and B, Anteroposterior linear tomogram

(A) and CT scan (B) show intrabronchial polypold mass (arrows) without extrabronchial extension. C, Removed segment of bronchus shows ovoid mass (M) arising from mucosal surface of left main bronchus (arrow). 0, Phetomlcregraph shows cords and Islands of tumor cells that have centrally placed nucl& and modarate amounts of eosinophlllc cytoplasm. Numerous vessels (arrows) travrse the stroma From the weekly radidogic-pathologic correlation conferences conducted by Jack Wtttenberg. Pathology editor: Andrew E. Rosenberg. Radiology editors: Felix 5. Chew. William E. Palmer, Daniel P. Barboriak, Daniel I. Rosenthal. I Both authors: Department of RadiOlogy, Massachusetts General Hospital and Harvard Medical School, 32 Fruit St., Boston, MA 021 14. Address reprint requests to F. 5. Chew. AJA

159.756, October

1992 0361-803X/92/1594-0756

C American Roentgen

Ray Society