An 18-year delay in the clinical presentation of bronchial carcinoid

Leuzzi, Giovanni; Forcella, Daniele; Melis, Enrico; Visca, Paolo; Facciolo, Francesco

doi:10.1016/j.remnie.2015.07.011

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(b, c) Planar lateral view and SPECT images of the skull revealed central photopenic area surrounded by rim of increased uptake. (d) Axial FLAIR-sequence MRI, images suggestive of an intradiploic epidermoid cyst of the temporal bone. (e) SPECT/MRI hybrid images." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. Lojo-Ramírez, F.J. García-Gómez, A. Kaen, F. Roldán, D. Marcilla-Plaza, I. Acevedo-Báñez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Lojo-Ramírez" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "García-Gómez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Kaen" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Roldán" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Marcilla-Plaza" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Acevedo-Báñez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000865?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000865/v1_201508130058/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253808915000841" "issn" => "22538089" "doi" => "10.1016/j.remnie.2015.07.010" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "667" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:325-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 100 "formatos" => array:2 [ "HTML" => 20 "PDF" => 80 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Interesting image" "titulo" => "Pulmonary tumor embolus with high 18FDG uptake mimicking lung metastasis from renal-cell cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "325" "paginaFinal" => "326" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolia pulmonar tumoral con alta captación de 18FDG imitando metástasis pulmonar de cáncer de células renales" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1246 "Ancho" => 1660 "Tamanyo" => 490579 ] ] "descripcion" => array:1 [ "en" => "Intraoperative findings: after arteriotomy of the lower pulmonary artery, an attempt to remove the thrombus was performed. Due to macroscopic infiltration of the arterial posterior wall, a left lower lobectomy was carried out in order to obtain a radical resection. Final pathology was consistent with tumor embolus from RCC." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Giovanni Leuzzi, Enrico Melis, Daniele Forcella, Francesco Facciolo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Giovanni" "apellidos" => "Leuzzi" ] 1 => array:2 [ "nombre" => "Enrico" "apellidos" => "Melis" ] 2 => array:2 [ "nombre" => "Daniele" "apellidos" => "Forcella" ] 3 => array:2 [ "nombre" => "Francesco" "apellidos" => "Facciolo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000841?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000841/v1_201508130058/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Interesting images" "titulo" => "An 18-year delay in the clinical presentation of bronchial carcinoid" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "327" "paginaFinal" => "328" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Giovanni Leuzzi, Daniele Forcella, Enrico Melis, Paolo Visca, Francesco Facciolo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Giovanni" "apellidos" => "Leuzzi" "email" => array:1 [ 0 => "gio.leuzzi@yahoo.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Daniele" "apellidos" => "Forcella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Enrico" "apellidos" => "Melis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Paolo" "apellidos" => "Visca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Francesco" "apellidos" => "Facciolo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute IFO, Rome, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Pathology, Regina Elena National Cancer Institute – IFO, Rome, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Retraso de 18 años en la presentación clínica de carcinoide bronquial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2334 "Ancho" => 1668 "Tamanyo" => 614710 ] ] "descripcion" => array:1 [ "en" => "(A) CT scan performed in 1996: the image evidences a round-shaped solid nodule (measuring 21mm in the major axis) localized near to the apical bronchus of the right lower lobe. The clinical diagnosis was consistent with intrapulmonary lymph-node associated to tuberculosis. (B) CT scan performed 18 years after: CT slice demonstrates the enlargement of the lung nodule (26mm in the major axis). (C) Whole body PET/CT performed 1h after the administration of 296MBq of 18FDG (axial, coronal and sagittal slices): the images evidenced an increased uptake of a round-shaped solid nodule of the right lower lobe (SUV max 4.7). No sign of mediastinal or extra-thoracic disease was disclosed." ] ] ] "textoCompleto" => "A 74-year-old Caucasian woman referred to our department for acute onset of dry cough and mild chest pain. Her medical history was unremarkable with the exception of right pulmonary tuberculosis diagnosed and treated in 1996. A computed tomography (CT) scan disclosed the enlargement (26mm vs 21mm in the major axis) of a round-shaped solid nodule localized near to the apical bronchus of the right lower lobe (RLL): in particular- the lesion was already diagnosed 18 years before as intrapulmonary lymph-node (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), thus a radiological follow-up was not performed due to its benign features. A whole body 18FDG positron emission tomography (PET-CT) scan was then executed: PET-CT images evidenced a hyper-metabolism (SUV max 4.7) of the lung nodule; no sign of extra-thoracic uptakes was reported (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). After a multidisciplinary meeting, the patient underwent surgery. An apical RLL segmentectomy was performed and intra-operative pathology was suggestive for lung cancer (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), so an uneventful right lower lobectomy plus systematic lymphadenectomy was executed. Final pathology was consistent with typical carcinoid classified as pT1bN0M0 (stage IA, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Six months after surgery the patient was free from recurrence.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>So far, delayed presentation/diagnosis of lung cancers has been seldom analyzed in literature. Some authors suggested that lung tumours growth generally takes 10–15 years from the appearance of the first cancer-cell to the detection of lung cancer by conventional imaging<a class="elsevierStyleCrossRef" href="#bib0020">1</a>: considering that tumour growth is biologically slow, this could indicate that the prognosis is unlikely changed by delayed diagnosis. In this setting, Salomaa et al.<a class="elsevierStyleCrossRef" href="#bib0020">1</a> reported that long specialist treatment delays are not correlated with worse prognosis in patients with advanced disease, while the delay time may be more critical in those cases with limited disease.In our case, the “lucky” and exceptional (18 years) diagnosis of bronchial typical carcinoid was delayed because: (1) the lung nodule was diagnosed as intrapulmonary lymph-node by conventional imaging only; (2) the symptoms were not disease-specific: in fact, bronchial carcinoids have been sometimes associated to delayed diagnosis due to masquerading symptoms related to other thoracic diseases (cough, chest pain, asthma, etc.).We assume that the tumour has already arisen in 1996 due to the usual indolent clinical course of such neoplasms. In addition, while oncocytic features were not observed, our case further demonstrates that typical carcinoids have been sometimes associated to higher uptake at PET-CT scan, thus confirming the role of nuclear imaging in detecting also slow-growth tumours.<a class="elsevierStyleCrossRefs" href="#bib0025">2,3</a>In conclusion, although bronchial carcinoids have an indolent clinical course, extremely delayed diagnosis or presentation is very uncommon. In those patients with lung nodule and uncertain nature for long time, the PET-CT may be useful to determine whether the patient would need a radiological surveillance or surgical therapy." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-21" "fechaAceptado" => "2014-12-22" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2334 "Ancho" => 1668 "Tamanyo" => 614710 ] ] "descripcion" => array:1 [ "en" => "(A) CT scan performed in 1996: the image evidences a round-shaped solid nodule (measuring 21mm in the major axis) localized near to the apical bronchus of the right lower lobe. The clinical diagnosis was consistent with intrapulmonary lymph-node associated to tuberculosis. (B) CT scan performed 18 years after: CT slice demonstrates the enlargement of the lung nodule (26mm in the major axis). (C) Whole body PET/CT performed 1h after the administration of 296MBq of 18FDG (axial, coronal and sagittal slices): the images evidenced an increased uptake of a round-shaped solid nodule of the right lower lobe (SUV max 4.7). No sign of mediastinal or extra-thoracic disease was disclosed." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 999 "Ancho" => 2500 "Tamanyo" => 630212 ] ] "descripcion" => array:1 [ "en" => "(A) Intraoperative findings: apical segmentectomy with a brownish encapsulated solid nodule (2.6cm) in its context. (B) Microscopic findings (Haematoxylin and Eosin, original magnification 10×): tumour cells organized in organoid pattern, exhibiting a polygonal to fusiform shape with pale cytoplasm. No oncocytic features are evidenced. The diagnosis was consistent with typical carcinoid (pT1bN0M0)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delays in the diagnosis and treatment of lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.R. Salomaa" 1 => "S. Sällinen" 2 => "H. Hiekkanen" 3 => "K. Liippo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.128.4.2282" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "128" "paginaInicial" => "2282" "paginaFinal" => "2288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236885" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchial carcinoids with oncocytic features and expressing GLUT1 receptor: does the intense (18)F-FDG uptake correlate with long-term survival?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Leuzzi" 1 => "F. Facciolo" 2 => "G. Treglia" 3 => "F. Lococo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hell J Nucl Med" "fecha" => "2014" "volumen" => "17" "paginaInicial" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25097901" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028207010229" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of pulmonary typical carcinoid with an extensive oncocytic component showing intense uptake of FDG" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Kadowaki" 1 => "S. Yano" 2 => "K. Araki" 3 => "T. Tokushima" 4 => "N. Morioka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2010.135525" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "361" "paginaFinal" => "362" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075777" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000853/v1_201508130058/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003400000005/v1_201508130058/S2253808915000853/v1_201508130058/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000853?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Vol. 34. Issue 5.

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