대한흉부영상의학회 Weekly Chest Cases

Case No : 839 Date 2013-11-25

Courtesy of Tae Jung Kim / Seoul National University Bundang Hospital
Age/Sex 60 / F
Chief Complaintweight gain (10kg / 1 year)

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Diagnosis With Brief Discussion

Diagnosis: Carcinoid tumor with ectopic Cushing syndrome
Radiologic Findings: Abdomen CT shows diffuse thickening of adrenal glands suggesting adrenal hyperplasia. A well-defined nodule with strong enhancement (HU=160) was noted in the left lower lobe. An endocrine evaluation showed a corticotropin-dependent hypercortisolism, which was not suppressed with the administration of high-dose dexamethasone and could not be stimulated with the administration of corticotropin-releasing hormone, a finding that suggested a diagnosis of Cushing's syndrome resulting from the ectopic secretion of corticotropin. There was no evidence of pituitary adenoma on brain MR and inferior petrosal sinus sampling was negative. The nodule in the left lower lobe assumed to be an ACTH producing carcinoid tumor and was resected. Final pathology was an atypical carcinoid tumor.
Brief Review: Many bronchopulmonary (BP)-carcinoids are detected incidentally on chest radiographs. Plain radiographs are nonspecific, although BP-carcinoids often appear as an isolated, well-defined hilar or perihilar mass. Once a suspicious lesion is detected on chest radiograph, CT of the chest and upper abdomen should be undertaken to determine the size, characteristics, extent of the primary tumor, involvement of mediastinal lymph nodes, and presence of distant metastases. Typical carcinoid tumor shows a well-defined, spherical or ovoid mass that narrow, deform, and/or obstruct airways. They tend to be vascular and are located close to central bronchi, often near the bifurcation area, whereas atypical carcinoid tumors usually are located peripherally in the lung. Calcification is evident in up to 30% of tumors and manifests in a punctuate or diffuse pattern. Typical as well as atypical carcinoid tumors may be associated with hilar or malignant lymphadenopathy. Cushing syndrome (ectopic production and secretion of ACTH) may occur in ~2% of BP-carcinoids, whereas <1% of individuals with Cushing syndrome have a BP carcinoid. Other, rare endocrine conditions associated with carcinoids include acromegaly, hypercalcemia, and hypoglycemia.
References: 1. Limper AH,Carpenter PC,Scheithauer B, et al. The Cushing syndrome induced by bronchial carcinoid tumors. Ann Intern Med. 1992; 117: 209-214
2.Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics. 2006; 26:41-57
Keywords: Lung, Benign tumor,

No. of Applicants : 82

▶ Correct Answer : 43/82, 52.4%

- prince salman bin abdulaziz university , Saudi Arabia NABIL GHALEB
- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- University of British Columbia , Canada Amr Ajlan
- kanto Rosai Hp , Japan Takana Yamakawa
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Niigata City General Hospital , Japan Takao Kiguchi
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Samsung Medical Center , Korea (South) Jihyun LEE
- Myongji hospital , Korea (South) Ji Ye Lee
- CHRU Lille , France Paul Lebert
- Montreal , Canada Drago Le King
- Columbia Asia , India John Joseph
- Government Medical College, Nagpur, India , India Krishna Prasad Bellam
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Korea University Ansan hosipital , Korea (South) Doran Hong
- Chonnam National Univ. Hospital , Korea (South) Jaemyeong Jo
- CHU Saint Pierre , Belgium Abd Alla Fares
- Asan medical center , Korea (South) Sang Young Oh
- university of montreal , Canada Andrei Gorgos I
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
- Kyungpook National Univ. Hospital , Korea (South) Park jongmin
- Dept. Radiology, Kyungpook medical school hosipital , Korea (South) Hyejin Cheon
- SNUH , Korea (South) Eui Jin Hwang
- Chungbuk University Hospital , Korea (South) Yunhee Jang
- 異⑸ , China ZHANG YING
- Chungbuk univertisy hospital , Korea (South) Soohyun Lee
- Ondokuz Mayis University , Turkey Cetin Celenk
- IRSA La Rochelle , France Denis Chabassiere
- GHOL, Hopital de Nyon , Switzerland Benoit Rizk
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- , Korea (South) Kim sungmo
- Bupyong Serim Hospital , Korea (South) Hee Seok Choi
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- NASA SCANS , India RAKESH BHATIA
- Saint Malo , France jean-baptiste Noel
- C.B.H. DPT of Imaging "Clinica Mater Dei" - BARI - , Italy Carlo Florio
- All India Institute of medical sciences , India Justin Moses
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- CAC Rennes , France nicolas gautier
- Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 9/82, 11.0%

- Oita University, Faculty of Medicine , Japan Fumito Okada
- Kyoto University , Japan Akihiko Sakata
- Avrasya Hospital , Turkey Murat Ulusoy
- Niigata University , Japan Atsushi Uehara
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Samsung medical center , Korea (South) Soyi Kwon
- CHU Poitiers , France CHAN paul

▶ Semi-Correct Answer : 3/82, 3.7%

- CH de la C�te Basque , France Paul ARDILOUZE
- okayama university , Japan takumi sakamoto
- Goa Medical College , India Paresh Desai

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 839 Date 2013-11-25

Discussion

No. of Applicants : 82