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CARCINOD TUMOR
Authored By: Farrokh Dehdashti and Dhanashree Rajderkar.
Patient: 26 year old
History: 26 year old patient:  with repeated chest infections, status post multiple regimens of antibiotics.
Image Size:[small][as-submitted]

Multimedia: 295278_1_submitted.avi

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Findings:

PET-CT:There is a lobulated soft tissue mass in the right hilum, measuring 4 x 3.7 cm, causing effacement of the bronchus intermedius and right lower lobe bronchus. There are specks of calcification within the lesion. The mass shows mild to moderately increased FDG uptake with maximum SUV of 4. No other focal area of FDG uptake is identified. No distal atelectasis or consolidation is seen.

Radiograph of Chest: Right hilar and suprahilar mass is seen with some mild right upper lobe volume loss. There is no pneumothorax or pneumomediastinum. Left lung is clear.

DDx:

1. Hamartoma.

2. Granulomatous disease.

3. Mucoepidermoid carcinoma.

4. Foreign body, in a correct clinical setting.

Diagnosis: Endobronchial carcinoid tumor in the bronchus intermedius.
General Discussion: Bronchial carcinoid tumors are rare, accounting for up to 2.5% of all pulmonary neoplasms and for 12-15% of carcinoid tumors overall. Like other neuroendocrine tumors, carcinoids have somatostatin receptors; therefore, they can be imaged with somatostatin analogues (octreotide, pentetreotide) tagged with an appropriate radioisotope. Single photon emission CT (SPECT) scanning and subtraction techniques improve detection. Bronchial carcinoids may take up iodine-123 N -isopropyl-p –iodoamphetamine. (FDG) PET uptake is associated with malignancy. Higher SUVs on pre-operative FDG-PET scanning portend greater tumor aggressiveness, a greater chance of metastatic disease at the time of surgery, and diminished post-operative survival in patients who undergo surgery for lung carcinoid tumors. Carcinoid tumors show increased uptake and irreversible trapping of another PET tracer, carbon-11–labeled 5-hydroxytryptophan (5-HTP), a serotonin precursor. With11 C-labeled 5-HTP, small ACTH-producing bronchial carcinoids that were not detectable with other imaging techniques were detected. Iodine-131 meta-iodo-benzylguanidine (MIBG) scintigraphy is a valuable tool in the detection of neuroendocrine tumors. This has been used to detect bronchial carcinoids. Thallium-201 scintigraphy has been used in the diagnosis of a single case of a small (<1 cm), ectopic, ACTH-producing carcinoid tumor. 111 In-DOTA-lanreotide) scintigraphy yields high tumor binding in various lung tumors, including carcinoids. Both111 In-DOTA-lanreotide and111 In-DOTA-Tyr3-octreotide can be used for the evaluation of somatostatin receptor–mediated radionuclide therapy. The intraoperative identification and localization of a bronchial carcinoid tumor with a radiolabeled somatostatin analogue (111 In pentetreotide) have been described.
References:

1. Pre-operative PET scanning for lung carcinoid tumors predicts tumor behavior and patient survival.Daniel DeArmond1, Ali Mahtabifard1, Jessica Lee1, Alan Waxman1, Alberto Marchevsky1, Clark Fuller1 and Robert McKenna1 1 Imaging, Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, California . J Nucl Med. 2007; 48 (Supplement 2):82P

2. http://emedicine.medscape.com/article/357921-imaging. Lung, Carcinoid Imaging

3.http://www.medscape.com/viewarticle/452492_3.Typical bronchial carcinoid tumor:Discussion.

4.Irfan Kayani1, Brendon G. Conry1, Ashley M. Groves1, Thida Win2, John Dickson1, Martyn Caplin3 and Jamshed B. Bomanji1, Clinical Investigation,A Comparison of 68Ga-DOTATATE and 18F-FDG PET/CT in Pulmonary Neuroendocrine Tumors. Journal of Nuclear Medicine Vol. 50 No. 12 1927-1932.

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Additional Details:

Case Number: 295278Owner(s): Farrokh Dehdashti and Dhanashree RajderkarLast Updated: 12-08-2011
Anatomy: Cardiopulmonary   Pathology: Neoplasm
Modality: Conventional Radiograph, PETAccess Level: Readable and writable by Nuclear Medicine only
Keywords: endobronchial carcinoid

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Certified by Farrokh Dehdashti on 12-08-2011

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