Conservative and bronchoplastic resection for bronchial carcinoid tumours

From January 1974 to December 1987, 45 cases of bronchial carcinoid were surgically managed at our Unit, 44 of which were evaluated. All patients but 2 were submitted to fiberoptic bronchoscopy prior to surgery. A standard resection was performed in 19 cases (13 lobectomies, 4 bilobectomies and 2 pneumonectomies). In 11 cases, pulmonary resection was complemented with a bronchoplastic technique (6 lobectomies, 2 bilobectomies, 2 pneumonectomies, 1 segmentectomy). Four cases were managed by minimal resections (2 segmental, 1 wedge, 1 enucleation) and 8 others by bronchotomy and local resection without the sacrifice of lung tissue. There were two major postoperative complications and no operative mortality. Mean follow-up has been 53 months and no local bronchial recurrence has been observed although 2 patients have developed distant metastases, with 1 death. The absence of local recurrence in a series in which more than 50% of patients were treated with some form of conservative surgery seems to indicate that resection of lung tissue should be avoided whenever possible.     

Conservative surgery for bronchial adenomata.

Fifteen patients with bronchial adenomata have undergone surgical treatment and have been followed up for periods of one to 25 years. Management consisted of bronchotomy with local excision in six cases, segmental resection in two, lobectomy in six, and pneumonectomy in one case. One patient who underwent lobectomy subsequently died of an unrelated cause (gastric haemorrhage) in the early postoperative period; of the remaining 14, there have been no cases of recurrence, and all patients have remained sympton-free with normal chest radiographs. These results strongly support a conservative surgical approach where the clinical and histological diagnosis of carcinoid tumour is definite.     

Unilateral increased transradiancy of the lung caused by bronchial carcinoid tumour.

Two patients with an intraluminal carcinoid tumour obstructing the right main bronchus in one, and the left main bronchus in the other, resulting in unilateral increased transradiancy from hypoperfusion of the lung, are described. Resection of the tumours and reconstruction of bronchial continuity was followed by return of perfusion to normal between three and 18 months after the operation. The patient in whom the diagnosis was delayed showed a much slower rate of return of perfusion and a small lung resulted. The finding of increased transradiancy of lung even in an asymptomatic patient should be an indication for bronchoscopy.     

Medullary carcinoma of the thyroid presenting as multifocal bronchial carcinoid tumour.

A 21 year old man presented with diarrhoea and flushing after meals and later developed miliary shadowing on his chest radiograph. Multifocal bronchial carcinoid tumour was diagnosed initially, but at necropsy metastatic medullary carcinoma of the thyroid was found. Multifocal bronchial carcinoid tumour should not be accepted as a primary diagnosis without first excluding medullary carcinoma of the thyroid because of the need to screen relatives of affected patients.     

Giant bronchial carcinoid tumors: a multidisciplinary approach

BACKGROUND: Bronchial carcinoid tumors account for approximately 2% of all lung tumors. Although they were considered benign lesions, they are now categorized malignant, occasionally with poor prognosis. The clinical symptoms can be highly variable and are often present for many years before diagnosis. Whereas some carcinoids are entirely asymptomatic, others are accompanied by carcinoid or paraneoplastic syndromes. METHODS: We describe the multidisciplinary management of a 34-year-old female patient with a massive actively secreting bronchial carcinoid tumor of the right lung. Furthermore, we provide a review of the literature regarding the operative treatment and the perioperative management of pulmonary carcinoid tumors with respect to surgical, anesthetic, radiologic, and pathologic considerations. RESULTS: In the reported case, the first symptoms were chronic watery diarrhea, skin flushing, progressive shortness of breath, and increasing right shoulder pain. When the patient initially presented at our institution, the tumor had already reached an enormous size and it involved the right and left atrium as well as the atrial septum. Using an evidence-based, multidisciplinary approach the patient was treated successfully with extended surgical resection. CONCLUSIONS: Carcinoid tumors are potentially curable even if they reach a significant size and thus an aggressive strategy is warranted. The management of such cases requires careful investigation, planning, and treatment with collaborative expertise provided by a multidisciplinary team. We demonstrated that this approach can lead to a favorable outcome in what first appeared to be a formidable and unresectable tumor.     

Metatarsal giant cell tumour in a 7-year-old child: a case report

Giant cell tumours are uncommon benign osseous neoplasias with an obscure origin. They mostly occur in the epiphyses of long bones after skeletal maturity. Occurrence in a metatarsal bone in a child less than 10 years old is quite exceptional. The authors report a case of a 7-year-old girl with an aggressive giant cell tumour of the first metatarsal bone of her right foot. Intralesional excision by curettage and grafting with morselised iliac cortical and cancellous bone was performed. The girl is now disease free since 7 years. Giant cell tumours in this location and age group are rare; they appear to represent a distinct, more aggressive form of tumour. They should be considered in the differential diagnosis of a destructive bony lesion in skeletally immature patients. Curettage and bone grafting with morcelised iliac cortical and cancellous bone remains a treatment option, despite a high potential for recurrence.     

Giant cell tumour of tendon sheath in a child: a case report.

Giant cell tumour of the tendon sheath is uncommon in children. We describe this tumour arising from the right ring finger in an eight-year-old girl. Plane radiographs showed a soft tissue mass with erosion of the distal phalanx. The tumour was treated by surgical excision with good outcome.     

A case of typical carcinoid accompanied with left atrium myxoma

A 78-year-old female was admitted to Shizuoka red cross hospital because of an abnormal shadow at the right upper lung field on chest X-ray film. A left atrium myxoma was detected at chest CT scan after admission. Though the lung tumor was well defined and hilar and mediastinal lymph nodes were not swollen at CT scan, the tumor was suspected a small cell carcinoma at the result of trans-bronchoscopic biopsy. Firstly we performed removal of the left atrium myxoma, and two months later, we performed thoracotomy and partial resection of the right upper lobe. The lung tumor was finally diagnosed as a typical carcinoid. We have followed the patient for about 32 months after the operation and there is no evidence of tumor recurrence.     

Conservative management of chylous ascites complicating aortic surgery: a case report

Chylous ascites is an uncommon complication of aortic surgery. In the past, operative management was the standard therapy. A 62-year-old man with chylous ascites was treated successfully with paracentesis and total parenteral nutrition alone. A review of the recent literature suggests that a preliminary course of conservative therapy can limit the need for operative intervention to those who fail the primary conservative treatment.     

Elderly presentation of tetralogy of Fallot precipitated by an occult bronchial carcinoid tumour.

A 68-year-old female with tetralogy of Fallot is presented. She had become progressively symptomatic in the 2-3 months prior to referral and at operation was found to have a previously unsuspected neuroendocrine secreting bronchial carcinoid tumour subsequently removed by lobectomy.     

Intrapulmonary solitary fibrous tumor with bronchial involvement: a rare case report in a child

Intrapulmonary solitary fibrous tumor is a very rare neoplasm. Our review of the English literature suggests that it has not previously been reported in children younger than 10 years. Herein, the occurrence of such a rare lesion invading the tracheobronchial tree is reported in a 7-year-old boy.     

Gallbladder carcinoid: a case report

Carcinoids are neuroendocrine tumours that rarely originate in the biliary tract. We report a case of gallbladder carcinoid associated with cholelithiasis extending to hepatic segments IV and V. The mass was detected by ultrasound in a 71-year-old-man investigated for recurrent right upper quadrant pain irradiating to the back and associated with dyspepsia. Cholecystectomy, locoregional lymphadenectomy and 4th and 5th hepatic segment resection were performed. The patient underwent chemotherapy and was also treated with somatostatin analogues. Despite this, he died after 12 months. We stress the rarity and aggressive behaviour of gallbladder carcinoid.