Atypical presentation of typical carcinoid

Abstract

Bronchial carcinoid tumours can present with symptoms of distal airway obstruction, local airway irritation or bleeding due to hypervascularity. Presentation with a spontaneous pneumothorax (SP) is rare. We present a case of typical endobronchial carcinoid tumour that presented with a SP. We explored the possible mechanisms of this rare presentation, especially the check-valve mechanism of airway obstruction, which was evident during the fiberoptic bronchoscopic examination.

Figure 1

(A) Chest X-ray (posteroanterior view) showing left apical pneumothorax (arrows). (B) Chest X-ray (lateral view) showing volume loss with elevated left hemidiaphragm and shift of the major fissure anteriorly.

Figure 2

Chest CT showing left apical pneumothorax (A) and endobronchial lesion in the left upper lobe bronchus (arrow) (B).

Figures 3

Positron emission tomography scan showing soft tissue mass extending into the left upper lobe bronchial tree (arrow) with a maximum standard uptake value of 3.6.

Figure 4

Bronchoscopic images showing movements of the endobronchial carcinoid tumour allowing air entry during inspiration (A) and preventing air exit during expiration due to complete obstruction of the lumen (B) (check-valve mechanism).

Figure 5

Diagram illustrating the check-valve mechanism due to flapping endobronchial tumour allowing air entry during inspiration (A) and causing air trapping distal to the obstruction during expiration (B).

Figure 6

(A) Typical carcinoid tumour with the arrow pointing to the endobronchial epithelium (H&E, ×10 magnification). (B) Typical carcinoid tumour demonstrates uniform cells growing in a nesting pattern (H&E, ×10 magnification). (C) Carcinoid tumour cells with round to oval nuclei and coarsely granular stippled salt and pepper chromatin (H&E, ×20 magnification).