Pulmonary Carcinoid Tumors and Other Primary Lung Tumors Flashcards
Prevalence of pulmonary carcinoid tumors
0.4-3.0% of resected lung cancers
Lungs 2nd most common site of origin for primary carcinoid tumors
WHO classification of carcinoid tumors
Typical (< 2 mitotic figures/hpf, no necrosis)
Atypical (2-10 mitotic figures/hpf, tissue necrosis, or architectural disruption)
Prevelence of typical vs atypical carcinoid tumors
Typical: 75-80% of tumors
Atypical: 15-20% of tumors
According to WHO carcinoid tumors are part of the histologic spectrum of neuroendocrine tumors, including…
- Typical carcinoid (low grade)
- Atypical carcinoid (intermediate grade)
- Large cell neuroendcrine (high grade)
- SCLC (high grade)
Demographic characteristics of carcinoid tumor presentation
Bimodal age distribution (peaks at 35 and 55 years of age)
Patients older than ___ years have a higher incidence of atypical carcinoid tumors?
age = 50 years old
risk 25% vs 10% (50 years vs. <30 years)
Presentation of pulmonary carcinoid
- Asymptomatic (1/3 pts)
- recurrent PNA
- cough
- hemoptysis
Ectopic hormones secreted by carcinoid tumors
- 5-hydroxytryptophan
- ACTH
- vasopressin
- insulin
% pts wtih Cushings syndrome with localized disease
5%
Anatomic characteristics of carcinoid tumors
- Central location
- Typical (70%)
- Atypical (50%)
- Lobar or sublobar bronchus (75%)
CT findings of carcinoid tumors
- Peripheral tumors:
- smooth, round, homogenous appearance
- Central tumors:
- obvious airway component, post-obstructive atelectasis or pneumonitis
Other diagnostic studies used in w/u of carcinoid
- PET scan
- Octreotide scan
- Bronchoscopy (with biopsy)
- central tumors
- CT guided FNA biopsy:
- peripheral tumors
Success of preoperative diagnosis of carcinoid
70-80%
Most peripheral and central tumors without evidence of nodal disease
Typical carcinoid tumors
(no further eval needed prior to resection)
Distribution of atypical carcinoid tumors with central location and cN1 or cN2 disease
Cenral location (50%)
Peripheral location (50-70%)
*need thourough staging prior to resection (including mediastinoscopy)