CASE N°30 – Pulmonary Carcinoid Tumor

Clinical History:

Age: 78

Sex: Female

Chest TAC-SCAN: In the left lower lobe of the lung presence of  nodular formation about 2 cm in diameter .
No further similar nodules at the level of the remaining lung fields. No pleural effusion and no mediastinal lymphadenopathy.

Cytological Images:

Cytological speciemen: Bronchial brushing

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Cytological Report:

Presence of many tumor cells, small-medium sized, with finely granular chromatin pattern. Absence of necrosis and mitotic figures.
Neuroendocrine neoplasia.

Histological Images:

Histological speciemen:  Pulmonary Fine-Needle-Biopsy

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cromo Cromogranin

Ki67 MIB1

Synapto Synaptofisin

Histological Report:

Pulmonary parenchyma proliferation of  neuroendocrine cells with low proliferative index (MIB1 <1%), no significant nuclear atypia, absence of mitosis and background necrosis.
Immunophenotype: + Chromogranin, Synaptophysin +.

Low-grade neuroendocrine tumors (carcinoid typical).

Discussion:

The low-grade neuroendocrine tumor of the lung (also called carcinoid), is characterized by cells of medium-small size, often with elongated nucleus and sometimes with prominent nucleoli. The cytoplasm is scant but more abundant than the cytoplasm  from small cell carcinoma. Occasionally there may be very large size nuclei, but never we will observe mitotic figures and background necrosis in this type of tumors. Lung biopsy of  this carcinoid tumor show low proliferation index and positivity to neuroendocrine markers.

Tips:

Compare the carcinoid tumor cyto-morphology pattern with this one from pulmonary small cell carcinoma

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