Endocrine Abstracts

The prevalence of bronchial carcinoid, both typical (TC) and atypical (AC), has increased significantly over the past 30 years, most likely as a consequence of better awareness and diagnostic tools e.g. carcinoid specific immunohistochemistry stains. The peak incidence of TC and AC are in the fourth and fifth decades of life respectively. Diagnosis at younger ages is much rarer although carcinoid represents one of the commonest pulmonary tumours in children, teenagers and young adults. We present 3 cases of bronchial carcinoid tumours arising in patients in their teens or 20’s, particularly highlighting management issues either related to their young age or unusual pattern of metastases. Case 1: An 18 year old woman presenting with chest pain. Central lung mass detected on CT and biopsy reveals typical carcinoid. Surgical resection - middle and lower lobectomy. 12 months later - enlarging sub-carinal lymph nodes. Case 2: A 20 year old woman presents with cough and reduced exercise tolerance. Left bronchial tumour detected. Left upper lobectomy and sleeve resection for typical carcinoid. 2 years later development of axillary and sub-cutaneous nodules - recurrent disease. Case 3: A 28 year old woman presents with Cushing’s syndrome. Ectopic ACTH secretion diagnosed. Two sub-cm lung nodules, with no uptake on octreotide or Ga68 PET scan, detected. Wedge resection reveals typical bronchial carcinoid. Further symptoms of Cushing’s after 10 months - relapsed disease in lung and mediastinum. A concise review of each case, including relevant images, and their on-going care will be used to draw attention to management dilemmas.