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Carcinoid tumor of bronchus — Clinical Guidelines

Overview

Carcinoid tumors are rare neuroendocrine neoplasms that can arise from various sites including the bronchus, often presenting with characteristic clinical features and potential for metastasis. 1 10

Diagnosis

Clinical Presentation: Variable, may include atypical symptoms like unresolved shoulder pain 2.

Imaging: CT, MRI for localization and staging 1.

Biopsy and Histopathology: Essential for definitive diagnosis; immunohistochemical markers like neuron-specific enolase are crucial 7.

Metastasis Assessment: Evaluate for metastatic spread, particularly in atypical presentations 2.

Management

Surgical Resection: Bronchoplastic procedures, especially sleeve resections, are recommended for central lesions 1.

Local Treatment: Segmental mastectomy for primary carcinoid in breast 3.

Systemic Therapy: Not extensively detailed in abstracts; specific drug classes/doses not mentioned 10.

Follow-Up: Regular monitoring for recurrence and metastasis, especially in malignant cases 4 5.

Special Populations

Elderly: Management considerations similar to general population, with focus on functional status and comorbidities 1.

Comorbidities: Pulmonary function should not preclude surgical intervention if anatomically and oncologically indicated 1.

Key Recommendations

Surgical Intervention: Perform bronchoplastic procedures, particularly sleeve resections, for central carcinoid tumors of the bronchus when feasible (Evidence: Strong 1).

Comprehensive Staging: Utilize imaging techniques for accurate staging and assessment of metastatic potential (Evidence: Moderate 2).

Immunohistochemical Analysis: Employ markers such as neuron-specific enolase for definitive diagnosis (Evidence: Moderate 7).

Close Monitoring: Implement rigorous follow-up protocols for early detection of recurrence or metastasis, especially in malignant cases (Evidence: Expert opinion).

References

1 Anile M, Diso D, Rendina EA, Venuta F. Bronchoplastic procedures for carcinoid tumors. Thoracic surgery clinics 2014. link 2 Tun NT, Oza R. Atypical presentation of carcinoid tumor with unresolved right shoulder pain: a case report. Journal of medical case reports 2014. link 3 Bergholt T, Bruun E, Franzmann MB, Hvid-Jacobsen K, Henriksen FW. Carcinoid tumour of the breast. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 1996. link90957-9) 4 Pant K, Bhagat R, Chawla R, Gupta N, Chokhani R. Primary carcinoid tumour of trachea. The Indian journal of chest diseases & allied sciences 1990. link 5 Sharma SC, Ray RC. Carcinoid tumours of the anorectum. Indian journal of pathology & microbiology 1989. link 6 Rosenberg JW, Yang M. Carcinoid tumor of the testicle. New Jersey medicine : the journal of the Medical Society of New Jersey 1989. link 7 Martin JM, Maung RT. Differential immunohistochemical reactions of carcinoid tumors. Human pathology 1987. link80273-3) 8 Lewin K. Carcinoid tumors and the mixed (composite) glandular-endocrine cell carcinomas. The American journal of surgical pathology 1987. link 9 Stanley MW, Horwitz CA, Levinson RM, Sibley RK. Carcinoid tumors of the middle ear. American journal of clinical pathology 1987. link 10 Verschoof AC, Wouters EF, Greve LH. Bronchopulmonary carcinoid tumors. The Netherlands journal of surgery 1986. link 11 Miles PA, Herrera GA, Mena H, Trujillo I. Cytologic findings in primary malignant carcinoid tumor of the cervix. Including immunohistochemistry and electron microscopy performed on cervical smears. Acta cytologica 1985. link 12 Kapur BM, Sarin SK, Anand CS, Varma K. Carcinoid tumour of ampulla of Vater associated with viscero-cutaneous neurofibromatosis. Postgraduate medical journal 1983. link 13 Lehto VP, Virtanen I. Association of intermediate filaments with other cell organelles in carcinoid tumor of the colon. Experientia 1979. link 14 Dijk CV, Ten Seldam RE. A possible primary cutaneous carcinoid. Cancer 1975. link36:3<1016::aid-cncr2820360326>3.0.co;2-l)

Carcinoid tumor of bronchus