H Klee1, T Vestring, I Bittmann. 1. Lungenklinik Unterstedt, Diakoniekrankenhaus Rotenburg (Wümme). drholgerklee@yahoo.de
Abstract
BACKGROUND: Bronchial carcinoids are a rare differential diagnosis of solitary pulmonary nodes. Because of their typical manifestation in the major bronchi, carcinoid tumours are visible regularly via bronchoscopy where they show a typical picture. In lymph node-negative disease a favourable outcome can be expected. Typically metastases develop in the lung, liver, brain, bone and adrenal glands. CASE REPORT: Seven years after lobectomy of a bronchial carcinoid, a slow-growing thickening of the pleura parietalis was noted in a 54-year-old male patient. No clinical signs of neuroendocrine activity were seen. The histological diagnosis of pleural metastases was established via trans-thoracic punctation. Pleural metastases of bronchial carcinoids are extremely rare. Only two other cases have been reported so far. Palliative cytotoxic chemotherapy was started. CONCLUSIONS: The postoperative prognosis of bronchial carcinoids in lymph node-negative disease is excellent. Metastatic disease--as in the rare case of pleural metastases shown here--remains a therapeutic dilemma. Extensively evaluated concepts for adjuvant or palliative settings do not exist. Further research is needed.
BACKGROUND: Bronchial carcinoids are a rare differential diagnosis of solitary pulmonary nodes. Because of their typical manifestation in the major bronchi, carcinoid tumours are visible regularly via bronchoscopy where they show a typical picture. In lymph node-negative disease a favourable outcome can be expected. Typically metastases develop in the lung, liver, brain, bone and adrenal glands. CASE REPORT: Seven years after lobectomy of a bronchial carcinoid, a slow-growing thickening of the pleura parietalis was noted in a 54-year-old male patient. No clinical signs of neuroendocrine activity were seen. The histological diagnosis of pleural metastases was established via trans-thoracic punctation. Pleural metastases of bronchial carcinoids are extremely rare. Only two other cases have been reported so far. Palliative cytotoxic chemotherapy was started. CONCLUSIONS: The postoperative prognosis of bronchial carcinoids in lymph node-negative disease is excellent. Metastatic disease--as in the rare case of pleural metastases shown here--remains a therapeutic dilemma. Extensively evaluated concepts for adjuvant or palliative settings do not exist. Further research is needed.