AB 35. Dyspnoea and wheezing don’t always indicate asthma: a case of bronchial typical carcinoid

Background: Bronchial carcinoids are classified among the pulmonary neuroendocrine tumors. They account for 1-2% of pulmonary tumors and 25% of carcinoid tumors. Due to their clinical presentation they can be falsely diagnosed as asthma.
Patients and methods: We present the case of a 42 year old woman who suffered from a typical carcinoid tumor which was successfully treated with lobectomy with bronchoplasty. The patient visited the emergency department because of fever and left chest pain, as well as paroxysmal cough. She reported a previous history of “pneumonia” 8 months ago. She was diagnosed with asthma since then, and followed systematic treatment with bronchodilators and ICS without any relief from her symptoms. At physical examination, breath sounds were decreased at the base of the left lung and the chest X-ray showed left lower lobe atelectasis. The CT chest scan that followed confirmed the presence of endobronchial tissue in the left main bronchus, without pathologically enlarged mediastinal or axillary lymph nodes. A bronchoscopy revealed a tumor, arising from the left lower lobe bronchus that caused its complete obstruction and almost complete blockage of the left main bronchus. A biopsy of the lesion was compatible with bronchial typical carcinoid.
Results: The patient experienced sudden deterioration of respiratory function and intense chest pain. She was urgently taken to the operating room where she underwent left lower lobectomy with bronchoplasty. The surgical specimen confirmed the histological diagnosis (limited number of mitosis <1/10 and immunophenotype: synaptophysin + chromognanin +, CD56+, CK8/18+, TTF-). Lymph node metastases were not detected. The postoperative course was smooth and the endoscopic control of the bronchial stump excellent.
Conclusions: In patients with persistent asthma symptoms that do not respond to medication, diagnosis should be revised. Lobectomy with bronchoplasty is a successful method of surgical removal of typical carcinoids and the long-term effects are comparable to those of pneumonectomy.