대한흉부영상의학회 Weekly Chest Cases

Case No : 787 Date 2012-11-28

Courtesy of Yoon Kyung Kim, Yon Mi Sung, Eun Young Kim. / Gachon University Gil Medical Center
Age/Sex 69 / M
Chief ComplaintCough (1 month)

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Figure 1.

Diagnosis With Brief Discussion

Diagnosis: Endobronchial typical carcinoid tumor
Radiologic Findings: Posteroanterior chest radiograph shows consolidation in left middle lung zone. On the pre and post contrast chest CT scan, a small enhancing nodular lesion is seen within the left upper lobar bronchus. Consolidation with air-bronchogram is noted in left upper lobe, suggestive of obstructive pneumonitis. He underwent left upper lobectomy. There was a well-defined endobronchial tumor within the left upper lobar bronchus near the orifice of lingular divisional bronchus. The tumor size was 1.0 x 0.7 cm, and it was positive for neuroendocrine markers (chromogranin and synaptophysin) on immunohistochemical study.
Brief Review: Carcinoid tumors account for 1-2% of pulmonary neoplasms. There are two types of tumors; typical carcinoid (80-90%) and atypical carcinoid (10-20%). Typical and atypical bronchial carcinoids have similar imaging features. Because most bronchial carcinoids (80-85% of cases) are located in central airways, radiologic findings are usually related to bronchial obstruction. Central bronchial carcinoids manifest as an endobronchial nodule or hilar or perihilar mass with a close anatomic relationship to the bronchus. The mass is usually a well-defined, round or ovoid lesion and may be slightly lobulated at radiography and computed tomography (CT). Associated atelectasis, air trapping, obstructing pneumonitis, and mucoid impaction may also be seen. Peripheral bronchial carcinoids appear as solitary nodules. Calcification is visible on CT in 30% of cases. Carcinoids have a rich vascular stroma and often show marked, homogeneous enhancement on CT after intravenous administration of contrast material. Prognosis of bronchial carcinoids is highly dependent on histologic findings: Typical bronchial carcinoids generally have an excellent prognosis, whereas atypical bronchial carcinoids have a worse prognosis.
References: 1. Jeung MY et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics 2002 Mar-Apr;22(2):351-65
2. Muller NL et al. Imaging of the chest. Chpter 26 Carcinoid tumors, pulmonary tumorlets, and neuroendocrine hyperplasia. Volume I. p542-548
Keywords: airway, benign tumor,

No. of Applicants : 88

▶ Correct Answer : 43/88, 48.9%

- Radnet Teleradiology , Turkey Murat Ulusoy
- radiologist, aditya imaging centre , India vivek patel
- Az Osp Santa Maria Terni , Italy angelo carloni
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- University of British Columbia , Canada Amr Ajlan
- health science centre , Canada jeffrey marantz
- Korea university , Korea (South) Kun Woo Kang
- GHICL , France manuel toledano
- UWO , Canada S Lee
- Kohka Public Hospital , Japan Akitoshi Inoue
- All India Institute of Medical Sciences , India Ashish Gupta
- SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
- , Korea (South) Chan Park
- SNUH , Korea (South) Euijin Hwang
- H�pital du Sacr , Canada Andrea Ojanguren
- Suncheon Plus Medicine , Korea (South) Park Sang Hyun
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- , Korea (South) Ja Kim
- HIA Legouest - METZ , France Alban Gervaise
- CHU Poitiers , France CHAN paul
- Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- Asan Medical Center , Korea (South) Hye Jeon Hwang
- Fukuyama city hospital , Japan Ryotaro Kishi
- Government Medical College, Nagpur, India , India Krishna Prasad Bellam
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- Hanyang University Hospital , Korea (South) Yo Won Choi
- Chungbuk University Hospital , Korea (South) Yunhee Jang
- Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
- Bupyong Serim Hospital , Korea (South) Hee Seok Choi
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- IRSA La Rochelle France , France Denis Chabassiere
- All India Institute of medical sciences , India Justin Moses
- IRSA , France, Metropolitan BIGOT
- Homs National Hospital , Syria Rami Abou Zalaf
- Goa Medical College , India Paresh Desai
- chp st martin , France Mariotte benoit
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- , Korea (South) Sanghyuk Ahn
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- CAC Rennes , France nicolas gautier
- Yangsan Pusan National Hospital , Korea (South) JOOYEON JANG
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- NASA SCANS , India RAKESH BHATIA

▶ Correct Answer as Differential Diagnosis : 20/88, 22.7%

- Regional Medical Center , Kazakhstan Svetlana Kuzmenko
- SCGH , Australia Yuranga Weerakkody
- Onomichi municipal hospital , Japan Hirofumi Mifune
- , Korea (South) Choong-Ki Park
- Department of Radiology, Tseung Kwan O Hospital, Hospital Authority, Hong Kong Special Administrative Region, China , China Wai Pong CHU
- Chonnam university hospital , Korea (South) Jang mi Baek
- HUEC , Brazil Diogo Pinheiro
- GM InHospital , Korea (South) Ju Won Lee
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Asan Medical Center , Korea (South) Eunyoung Kim
- Asan Medical Center , Korea (South) Ji Eun Kim
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- Alswaida- zaid alsherity hospital , Syria jehad alakabani
- Fortis hospital , Mohali , India Shaleen Rana
- Myongji hospital , Korea (South) Ji Ye Lee
- Medicheck health care , Korea (South) Chae Lim
- Okayama university , Japan Mayu Uka

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 787 Date 2012-11-28

Discussion

No. of Applicants : 88