Letter to the Editor
Local Recurrence of a Bronchial Carcinoid Tumor
Recidiva local de tumor carcinoide bronquial
Emilio Antonio Santalla Valle
, Silvia García, María Beatriz Cartón
Corresponding author
Sección de Neumología, Complejo Asistencial Universitario de León, León, Spain
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"en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Local Recurrence of a Bronchial Carcinoid Tumor" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "81" "paginaFinal" => "82" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Emilio Antonio Santalla Valle, Silvia García, María Beatriz Cartón" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Emilio Antonio" "apellidos" => "Santalla Valle" "email" => array:1 [ 0 => "emansanva@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Silvia" "apellidos" => "García" ] 2 => array:2 [ "nombre" => "María Beatriz" "apellidos" => "Cartón" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Neumología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recidiva local de tumor carcinoide bronquial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1276 "Ancho" => 994 "Tamanyo" => 110334 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Endoscopic image showing a polylobulated mass with areas of necrosis in the region of the right upper lobectomy stump.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 74-year-old man presented in the emergency room in November 2012 with bloody expectoration, having expelled a solid “foreign body” of a fleshy appearance. He reported that in the days leading up to the event, he had experienced a sensation of self-limiting wheezing without dyspnea. The patient had no history of smoking or substance or alcohol abuse. In 2003, he required hospital admission for pneumonia and, in April 2008, underwent right upper lobectomy for a typical bronchial carcinoid tumor. At the time of presentation, he was attending regular check-ups and remained free of recurrence.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed wheezing in the right hemithorax, with no other findings. Clinical laboratory tests showed hemoglobin 11.1<span class="elsevierStyleHsp" style=""></span>g/dl; all other parameters were normal. The chest X-ray revealed a loss of right hemithorax volume due to the right upper lobectomy, but was unchanged compared to previous images. Computed tomography (CT) of the chest and abdomen showed polypoid lesions in the right main bronchus and in the stump of the right upper lobar bronchus. On bronchoscopy, bloody remnants and several rounded, hypervascular, millimeter-sized lesions were observed in lower third of the trachea and right anterolateral and anterior wall of the right main bronchus, above the entrance to the middle lobe. The carina and left bronchial tree were normal. A lobulated mass was observed in the area of the right upper lobectomy stump, suggestive of carcinoid tumor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The bronchial biopsy results reported a well-differentiated carcinoid type lesion with an organoid growth pattern and no necrotic foci that was determined to be a high grade carcinoma due to the 70% proliferation index. Immunohistochemistry showed positive Ki-67 expression in 70% of the intensely synaptophysin-positive tumor cells. The extension studies were completed with an octreotide scintigraphy that did not show any pathological radiotracer uptake.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the Chest Surgery Department, the tumor tissue was locally excised with argon gas cryoablation of the lesions, with the exception of the most distal infiltration of the right and intermediate bronchus. The patient then received systemic chemotherapy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Carcinoid tumor is a malignant neuroendocrine carcinoma originating in the glandular basal enterochromaffin cells (“Kulchitsky cells”). The most common locations are gastrointestinal (55%) and pulmonary (30%). In the lung, it occurs most frequently in endobronchial regions of the main or lobar bronchi (70%). Histological subtyping categorizes these tumors as typical carcinoid (very slow growth and 4 times more common) and atypical carcinoid, depending on the number of mitosis per field and the presence of necrosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical presentation is often asymptomatic or it can present with bleeding and obstruction, causing cough, wheezing, chest pain or recurrent pneumonia. In only 5% of cases is there secretion of the vasoactive substances responsible for the carcinoid syndrome. It is diagnosed by chest X-ray, CT and bronchoscopy. Magnetic resonance imaging and somatostatin receptor scintigraphy are used for staging.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment modalities include elective radical surgical, endobronchial excision by laser, somatostatin analogs, interferon alfa, chemotherapy and radiotherapy. Five-year survival rates for the typical subtype is 82%–87% and that for the atypical subtype is 56%–75%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This case is of interest because, despite the advanced age of onset (69 years) and a diagnosis of typical carcinoid tumor, there was local recurrence after the patient was disease-free for more than 4 years. The tumor showed no necrotic element but the mitotic index was high, so the final diagnosis was atypical carcinoid carcinoma. The central location of the recurrence prevented radical treatment. The patient is currently asymptomatic, leading a normal life and attending regular check-ups.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santalla Valle EA, García S, Cartón MB. Recidiva local de tumor carcinoide bronquial. Arch Bronconeumol. 2014;50:81–82.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1276 "Ancho" => 994 "Tamanyo" => 110334 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Endoscopic image showing a polylobulated mass with areas of necrosis in the region of the right upper lobectomy stump.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Fink" 1 => "T. Krelbaum" 2 => "A. Yellin" 3 => "D. Bendayan" 4 => "M. Saute" 5 => "M. Glazer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2001" "volumen" => "119" "paginaInicial" => "1647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11399686" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary carcinoid tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.M. McMullan" 1 => "D.E. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Thorac Cardiovasc Surg" "fecha" => "2003" "volumen" => "15" "paginaInicial" => "289" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12973707" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor carcinoide bronquial. Análisis retrospectivo de 62 casos tratados quirúrgicamente" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Iglesias" 1 => "J. Belda" 2 => "X. Baldó" 3 => "J.M. Gimferrer" 4 => "M. Catalán" 5 => "M. Rubio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "218" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15117621" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.F. Thomas Jr." 1 => "J.R. Jett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Bronchial carcinoid tumors: epidemiology, risk factors, classification, histology, diagnosis, and staging [monografía en Internet]" "serieFecha" => "2013" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.F. Thomas Jr." 1 => "J.R. Jett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Bronchial carcinoid tumors: treatment and prognosis [monografía en Internet]" "serieFecha" => "2013" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000002/v1_201403040040/S1579212914000184/v1_201403040040/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000002/v1_201403040040/S1579212914000184/v1_201403040040/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914000184?idApp=UINPBA00003Z" ]
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| 2015 June | 26 | 10 | 36 |
| 2015 May | 49 | 9 | 58 |
| 2015 April | 29 | 22 | 51 |
| 2015 March | 32 | 15 | 47 |
| 2015 February | 22 | 15 | 37 |
| 2015 January | 32 | 17 | 49 |
| 2014 December | 31 | 15 | 46 |
| 2014 November | 27 | 10 | 37 |
| 2014 October | 39 | 17 | 56 |
| 2014 September | 44 | 23 | 67 |
| 2014 August | 37 | 13 | 50 |
| 2014 July | 33 | 16 | 49 |
| 2014 June | 47 | 32 | 79 |
| 2014 May | 41 | 12 | 53 |
| 2014 March | 0 | 2 | 2 |
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