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Weekly Chest CasesArchive of Old Cases

Case No : 701 Date 2011-04-01

  • Courtesy of Sun-Young Park, M.D., Hye Jeon Hwang, M.D., Hyun Joo Lee, M.D., Mi Young Kim, M.D. / University of Ulsan College of Medicine, Asan Medical Center.
  • Age/Sex 31 / F
  • Chief ComplaintA 31 year-old women was found to have an incidental findings of solitary pulmonary mass.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Fig a

Diagnosis With Brief Discussion

Diagnosis
Typical carcinoid tumor
Radiologic Findings
Chest radiograph shows mass-like opacity in left upper lobe (Fig.a). Pre-enhanced chest CT scan shows a 4cm well-defined soft tissue mass with internal eccentric calcification in the left upper lobe (Fig.b). Post-enhanced CT scan reveals heterogenous well-enhancing mass within the left upper lobe bronchus, with distal obstructive atelectasis (Fig.c). PET scan reveals irregular mild hypermetabolic activity in the left lower lobar bronchus (maxSUV:3.6) with obstructive pneumonitis (maxSUV:7.5) around primary tumor (Fig.d)
Brief Review
Introduction
- A low-grade malignant tumor, only about 1%~2% of all pulmonary neoplasm.
- About 10% - 20% of pulmonary carcinoids are atypical carcinoids.
- Most of these tumors occur centrally and involve the main, lobar, or segmental airways.
- Mean presenting age : 46(40~60).
- 5-year-survival : typical(>76%), atypical(37~71%).
Radiologic findings
- The imaging features of typical carcinoids and atypical carcinoids are too similar to be separated.
- Chest radiographs : a well-defined hilar or perihilar mass.
: consolidation (atelectasis, obstructive pneumonitis, or recurrent pneumonia)
: mucus plugging as "glove finger pattern"
- CT : spherical, or ovoid nodule or mass with a well defined and slightly lobulated border.
: typically, close to central bronchi, near bifurcation area.
:calcification (30%), intense enhancement(>30HU), hilar or mediastinal LAP(reactive vs. metastasis).
: paraneoplastic syndrome (carcinoid syndrome : flushing of the skin, diarrhea, abdominal clamp..)
-PET : Usually lower FDG uptake.
References
Chong S, Lee KS, Chung MJ, et al. Neuroendocrine Tumors of the Lung: Clinical, Pathologic, and Imaging Findings, Radiographics 2006;26:41-57
Keywords
Lung, Malignant tumor,

No. of Applicants : 109

▶ Correct Answer : 41/109,  37.6%
  • - SMC , Korea (South) Yi Kyung Kim
  • - bjmc, pune , India rahul arkar
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - McGill University Health Center , Canada Alexandre Semionov
  • - CNUH , Korea (South) Seoin Jeong
  • - NEPEAN HOSPITAL , Australia YOGESH THAKKAR
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Okayama University , Japan Akihiro Tada
  • - Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
  • - Severance hospital , Korea (South) Saerom Hong
  • - Radiologie Brabois adultes , France ROPION helene
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Saga University , Japan Ryoko Egashira
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Az Osp Santa Maria , Italy angelo carloni
  • - IMS, BHU,VARANASI , India Sriram Patwari
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - chonnam national university , Korea (South) Byung Hyun Baek
  • - Assam Medical college , India samudra borah
  • - National Taiwan University Hospital , Taiwan Yen-Fu Chen
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Chonnam national university hospital , Korea (South) seo yeon Park
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - CHRU lille , France manuel toledano
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - Hanyang University Hospital , Korea (South) Jina Park
  • - Montreal , Canada D J
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - McGill University , Canada Sean Carr
  • - HSC , Brazil Diogo Pinheiro
  • - National Jewish Health , United States Jonathan Chung
  • - Padmashree diagnostics, Bangalore , India r gopinath
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Seoul St Mary Hospital , Korea (South) Chaehun Lim
  • - Assam medical college , India Sarbesh Tiwari
  • - HIMEJI RED CROSS HOSPITAL , Japan RYOTA INAI
▶ Correct Answer as Differential Diagnosis : 34/109,  31.2%
  • - radiologist, aditya imaging centre , India vivek patel
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Paramount Diagnostic & Research Centre , India Mahavir Swami
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Istanbul , Turkey Armagan Sarac
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - University of British Columbia , Canada Amr Ajlan
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Goa Medical College , India Paresh Desai
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - SMC , Korea (South) JIHYE MIN
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - kobe city general hospital , Japan rintaro hashimoto
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - IRSA , France jean-luc BIGOT
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Saint Malo , France jean-baptiste Noel
  • - Zaid Alsheriti hospital- Alsweida , Syria jehad alakabani
  • - NASA SCANS , India RAKESH BHATIA
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - khoo teck puat hospital , Singapore SIVASUBRAMANIAN SRINIVASAN
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - Okayama university , Japan Mayu Uka
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