Bronchial carcinoid tumor
Alerts and Notices
SynopsisBronchial carcinoid tumors are malignant neuroendocrine neoplasms. They derive from the enterochromaffin cells of the bronchial mucosa and can secrete serotonin, adrenocorticotropic hormone (ACTH), and other neurohormones. Generally, carcinoid tumors are most commonly found in the small bowel, but they can also arise in the colon, appendix, rectum, and proximal airways. While bronchial carcinoid tumors make up around a quarter of all neuroendocrine tumors, they account for around 1% of all lung cancers. Sporadic carcinoid tumors that are well-differentiated have been associated with a loss of heterozygosity at the MEN1 gene (see multiple endocrine neoplasia type 1).
These tumors are graded on histological appearance:
- Grade 1 describes well-differentiated tumors with a zellballen or nesting appearance.
- Grade 2 describes cells with atypical appearance or increased mitotic activity in otherwise well-differentiated cells.
- Grade 3 describes poorly differentiated cells.
Bronchial carcinoid tumors occur in adulthood with an approximate average age of diagnosis in the early to mid-50s. Common findings include cough, dyspnea, chest pain, hemoptysis, wheezing (as a result of either airway obstruction or, less often, carcinoid syndrome), and reoccurring pneumonia. ACTH-secreting tumors may result in Cushing syndrome. Excess serotonin secretion may cause carcinoid syndrome; however, carcinoid syndrome is more commonly a manifestation of gastrointestinal carcinoid tumors and may be a sign of metastasis with a primary bronchial carcinoid tumor.
D38.1 – Neoplasm of uncertain behavior of trachea, bronchus and lung
253003009 – Carcinoid Bronchial Adenoma
Differential Diagnosis & Pitfalls
- Asthma – underlying cause of wheeze / cough
- Chronic obstructive pulmonary disease
- Bronchiectasis – history of chronic infections
- Interstitial lung disease – idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis, asbestosis
- Lung cancer – adenocarcinoma, squamous cell carcinoma, small cell carcinoma, non-small cell carcinoma, pleural mesothelioma
- Infectious – upper respiratory tract infections, pneumonia, tuberculosis, aspergillosis, blastomycosis, histoplasmosis, coccidioidomycosis, human immunodeficiency virus (HIV)
- Tropical pulmonary eosinophilia – caused by Wuchereria bancrofti; characterized by cough, asthma attacks, and splenomegaly
- Autoimmune – antiglomerular basement membrane disease (Goodpasture syndrome), granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
- Anaphylaxis – acute presentation of hypotension, wheeze / dyspnea, rash, nausea / vomiting, diarrhea
- Foreign body aspiration – acute cough, wheezing, hemoptysis
- Pulmonary edema
- Pulmonary embolism – tachycardia, dyspnea, hemoptysis; evaluate with Wells' criteria or Geneva score
- Congestive heart failure
- Myocardial infarction
- Dilated cardiomyopathy
- Cushing syndrome – pituitary adenoma, adrenal tumor, or corticosteroid use
- Gastrointestinal carcinoid tumor – primary tumor or metastasis
Bronchial carcinoid tumor