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Venkata S. Erella, Barbara E. Larson, Heron E. Rodriguez, Matthew J. Blecha, Mark M. Connolly, Francis J. Podbielski
CaseRepClinPractRev 2002; 3(4):209-211
Background: Primary neuroendocrine tumors of the lung are uncommon neoplasms. Of those found, the vast majority occur in the distal trachea and proximal larger airways. The risk of metastasis depends on the histologic
subtype of the tumor.
Case Report: Our patient is a 46-year-old woman who developed a cough and presented with hemoptysis. Further evaluation revealed a two-centimeter lung mass in her left lower lobe. The mediastinum was radiographically
negative. A lung resection was performed that revealed a well-differentiated typical carcinoid tumor. Given its size and nodal status the tumor was assigned a T1N0MX class or Stage 1 malignancy.
Conclusions: The atypical location of this uncommon pulmonary neoplasm raises salient issues regarding the appropriate evaluation of indeterminant pulmonary nodules. The routine use percutaneous lung biopsy with its
small sample size could lead to an error in diagnosis, as differentiation between small cell lung cancer and neuroendocrine tumors can often be difficult. We believe the optimal approach to treatment of a solitary pulmonary
nodule in a patient with a radiographically negative mediastinum should be flexible bronchoscopy, and if not contraindicated, open or VATS resection of the nodule for definitive diagnosis and treatment.