Iridociliary Body Metastasis of Atypical Carcinoid: Case Management with Intravitreal Anti-Vascular Endothelial Growth Factor Injections / 中国医学科学杂志(英文版)

We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.

Compromiso tumoral de vía aérea en pediatría / Pediatric airway compromise by tumors

Los tumores traqueo bronquiales son extremadamente infrecuentes en la edad pediátrica e incluyen lesiones benignas y malignas. Por la baja frecuencia en niños y sintomatología respiratoria inespecífica, la sospecha diagnostica es habitualmente tardía. El tratamiento de elección en la mayoría de ellos es la resección quirúrgica abierta, sin embargo, la remoción endoscopia podría estar indicada es casos muy seleccionados con histología benigna y de localización accesible.

Tracheobronchial tumors are extremely rare in children and include benign and malignant lesions. Due to the low frequency in children and nonspecific respiratory symptoms, diagnostic suspicion is usually late. The treatment of choice in most of them is open surgical resection, however, endoscopy removal could be indicated in highly selected cases with benign histology and accessible location.

ACTH Dependent Cushing’s Syndrome: A 72-Hour Trial of Octreotide will Identify Patients with Pituitary Dependent and Ectopic ACTH Overproduction

Aims:To determine whether the use of an octreotide suppression test will reliably distinguish pituitary from ectopic ACTH overproduction. Somatostatin receptors are expressed in NETs, but are downgraded in the pituitary as the result of hypercortisolaemia. Octreotide should therefore lower ACTH and cortisol levels in patients with NETs but not in patients with Cushing’s disease and pituitary tumors. Methodology:A cross sectional study was performed in 13 patents with ACTH dependent Cushing’s (8 women, 5 men) with ages ranging between 21 to 40 years were studied. Serum cortisol concentrations were measured at 0800 hrs before and during the administration of. Octreotide at a dosage of 100 mcg subcutaneously every 8 hours for 72 hours.Results:The serum cortisol concentrations returned to normal in 4 patients who were later documented to have ectopic disease, two with typical bronchial carcinoids and two with pancreatic NETs and metastatic disease. The other 9 patients had no suppression in serum cortisol concentrations and were documented later to have pituitary tumours.Conclusion:These results indicate that a short trial of octreotide will identify patients with ectopic disease as evidenced by a fall inserum cortisol levels whereas in those with Cushing’s disease and pituitary tumours serum cortisol levels remains unchanged. Recommendation: We recommend all patients with ACTH dependent Cushing’s syndrome have an octreotidesuppression test, even if the MRI shows an adenoma, so as to exclude the possibility of a pituitary incidentaloma in a patient with ectopic disease, or false localization from IPSS to the pituitary gland due to ectopic CRH secretion

Bronchial Carcinoid in a Child: A Case Report.

Bronchial carcinoid (BC) make up 80-90% of a group of lung tumors formerly called “bronchial adenomas,” which also included adenoid cystic carcinoma and mucoepidermoid carcinoma; hence, their actual incidence was not accurately known. It is a rare entity in the pediatric population where metastatic lung tumors greatly outnumber primary lung tumors. BC account for 2-5% of all lung neoplasms in adults but are the most common primary lung neoplasm of childhood, accounting for 80% of malignant bronchopulmonary neoplasms in children. We have presented a case of left BC in an 11-year-old boy, with a short review of literature, and discussed the management. We have discussed the surgical procedure in detail, pointing out the possible pitfalls and their management.

Revisión de veintiún enfermos con hemoptisis estudiados en un año, con énfasis en seis de hemoptisis masiva / Review of twenty one cases of hemoptysis seen in one year, with emphasis on six with massive hemoptysis

Se revisan 27 enfermos consecutivos ingresados a la Unidad de Neumologfa y Cirugía de Tórax "Alejandro Celis" del Hospital General de México, SSA, por hemoptisis durante 2005; 6 de ellos, con sangrado superior a 600 mL en 48 h [hemoptisis masiva (HM)]. La causa del sangrado fue tuberculosis pulmonar avanzada en 9, bronquiectasias, 4; tumores, 3; aspergilomas, 2; y bronquitis, neumonía y trauma 7 de cada 7. Se les practicó fibrobroncoscopía (FBC) a todos, embolización de arterias bronquiales a 5; resección pulmonar a 4 y taponamiento bronquial a 7. En los 6 con HM la FBC localizó el bronquio sangrante. Dos de los 6 enfermos con HM fallecieron por asfixia secundaria a inundación de vías aéreas; los otros 4 viven. El manejo del enfermo con sangrado respiratorio depende del volumen de sangre expectorada, la etiología y las condiciones del enfermo; las opciones terapéuticas varían desde el manejo conservador hasta la resección pulmonar. Los enfermos con HM se deben tratar en unidades especializadas en cuidados intensivos por neumólogos intensivistas certificados.

During 2005 we admitted 27 patients with hemoptysis, six of them with massive hemoptysis (more that 600 mL in 48 h). The cause of bleeding was pulmonary tuberculosis in nine, bronchiectasias in four, tumors in three, aspergillomas in two and one of each due to bronchitis, pneumoniae and thoracic trauma. All had fiberoptic bronchoscopy; five had bronchial artery embolization (BAE), four had pulmonary resection and one bronchial tamponade. Two with massive bleeding died due to asphyxia before BAE or surgery could be performed. The rest are alive and well. The management of hemoptysis depends on the amount of blood, the etiology and the conditions of the patient; therapeutic options available are medical treatment, tracheal intubation, interventional endoscopy, BAE and surgery. Patients with massive hemoptysis should be treated by board certified pulmonologists critical-care specialists.

A Case of Ectopic ACTH Syndrome Associated with Bronchial Carcinoid / 대한내분비학회지

Fifteen percent of patients with Cushing's syndrome could be accompanied with nonpituitary tumors that secrets ACTH-the ectopic ACTH syndrome. Among them, bronchial carcinoid is one of the rare causes of the ectopic ACTH syndrome. We experienced a 60-year-old woman who showed conditions of weight gain, generalized edema, hypokalemia, diabetes mellitus, and right middle lung mass. Histologically, the tumor was diagnosed with bronchial carcinoid and was confirmed as an ectopic ACTH syndrome through immunohistochemical staining of ACTH. After resection of the lung mass, blood sugar, electrolytes, generalized weakness, and blood pressure improved.

A Case of atypical bronchial carcinoid with multiple distant metastasis / 결핵

Branchial carcinoid tumors are uncommon, constituting approximately 3-5% of all primary lung cancers. Classification of these tumors has evolved substantially as our understanding of the cellular, biologic, and clinical aspects of these neoplasms has improved. Initially, bronchial carcinoids were thought to be benign and therefore were classified as branchial adenomas. Currently, however, they are well recognized as having the potential for both local invasion and distant metastatic involvement. Consequently, carcinoid tumors are frankly malignant. Thus bronchial adenoma is a misnomer that should no longer be used for bronchial carcinoids. Most investigators currently favor classifying carcinoid tumors as a type of neuroendocrine neoplasm because of their potential to secrete a variety of chemical substances found in both the central nervous system and the epithelial cells of numerous organs. Bronchial carcinoids are usually characterized by a slow growth pattern and a low incidence of metastasis, and histologically confirmed by the azurophil staining and the presence of the characteristic neurosecretary granule on electron microscopy. Atypical carcinoid tumor was first defined by Arrigoni et al, who proposed the following criteria for separation of atypical carcinoid from typical carcinoid tumor: 1) increased mitotic activity with 1 mitotic figure per 1-2 high power fields (or 5-10 mitoses /10 HPF), 2) nuclear pleomorphism, hyperchromatism, and an abnormal nuclear-cytoplasmic ratio, 3) areas of increased cellularity with disorganization of the architecture, and 4) tumor necrosis. In contrast, typical carcinoid tumor may have focal cytologic pleomorphism, but necrosis is absent and mitotic figures are rare. Recently we experienced a case of atypical bronchial carcinoid with multiple distant metastasis, so we report this case with a review of the literature.