Pulmonary Carcinoid Tumorlets: A Rare Cause of Chronic Intractable Cough

Tariq Sharman^1, and Jeffrey Song¹

¹Department of Internal Medicine, Southern Ohio Medical Center, Portsmouth, U.S.A.

Cite this paper

Tariq Sharman and Jeffrey Song. Pulmonary Carcinoid Tumorlets: A Rare Cause of Chronic Intractable Cough. American Journal of Medical Case Reports. 2019; 7(8):173-175. doi: 10.12691/AJMCR-7-8-6

Abstract

Chronic cough is a common presenting complaint in pulmonary clinics. We present a patient who had undergone extensive work up for chronic intractable cough that was finally diagnosed as diffuse pulmonary carcinoid tumorlets. Pulmonary tumorlet is an incidental finding at histopathologic examination of lung parenchyma that is often located adjacent to bronchogenic tumors or carcinoid tumors or particularly in lung scarred by bronchiectasis or other chronic inflammatory processes. Tumorlets are usually smaller than 5 mm in diameter and are multiple. Tumorlets are composed of small uniform cells that appear cytologically benign; they tend to form compact aggregates or nests and may grow into the mucosa of the airways. Also, tumorlets, like carcinoids, contain neurosecretory granules and have distinctive electron microscopic and immunohistochemical findings. Our case is a 61 year old Caucasian female, non-smoker, was followed in pulmonary clinic because of chronic dry cough which was associated with dyspnea and wheezing. Normal physical examination except for occasional wheezes. Pulmonary function test showed restrictive pattern, FEV1 75%, FEV1/FVC 88% and TLC 67% of predicted. High resolution chest CT had shown multiple non-calcified well circumscribed pulmonary nodules scattered throughout the lungs, the largest 5 mm. She had been treated as a case of asthma. Inhaled bronchodilators and corticosteroids partially improved her symptoms. Later her cough had become intractable with worsening exertional dyspnea. Otolaryngology evaluation and EGD had been inconclusive. Bronchoscopy with bronchoalveolar lavage and multiple transbronchial biopsies came with normal results. VATS biopsy showed multiple small nodules less than 1 cm in the right upper, middle, and lower lobes, predominantly peripheral lesions. The lesions were found to represent carcinoid tumorlets. Usually the lesions are asymptomatic and discovered incidentally on CT scan and can be confused with metastases, however they can present with chronic cough or dyspnea.

Keywords

carcinoid tumorlets, Chronic Cough, pulmonary tumorlets, neuroendocrine tumors

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Ranchod M. The histogenesis and development of pulmonary tumorlets. Cancer 1977; 39:1135-1145.
[2]	Davies SJ, Gosney JR, Hansell DM, et al. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: an under-recognised spectrum of disease. Thorax 2007; 62: 248-52.
[3]	Nassar AA, Jaroszewski DE, Helmers RA, et al. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview. Am J Respir Crit Care Med 2011; 184: 8-16.
[4]	Koo CW, Baliff JP, Torigian DA, Litzky LA, Gefter WB, Akers SR. Spectrum of pulmonary neuroendocrine cell proliferation: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, tumorlet, and carcinoids. AJR Am J Roentgenol. 2010; 195: 661-66.
[5]	Hocking JA, Mitchell J, Harp M, Ejiofor J, DiMaio JM. Risk of developing pulmonary carcinoid tumors following breast cancer. J Clin Oncol. 2010; 28: e12025.
[6]	Travis WD. Advances in neuroendocrine lung tumors. Ann Oncol. 2010;21(Suppl 7):vii, 65-71.
[7]	Ranchod M. The histogenesis and development of pulmonary tumorlets. Cancer. 1977; 39: 1135-1145
[8]	Dewan M, Malatani TS, Osinowo O, al-Nour M, Zahrani ME. Carcinoid tumourlets associated with diffuse bronchiectasis and intralobar sequestration. J R Soc Promot Health. 2000; 120: 192-195.
[9]	Ginsberg, M.S., Akin, O., Berger, D.M. et al. Pulmonary tumorlets: CT findings. AJR Am J Roentgenol. 2004; 183: 293-296.
[10]	Ye Y, Mu Z, Wu D, et al. Carcinoid tumorlet in pulmonary sequestration with bronchiectasis after breast cancer: a case report. Oncol Lett 2013; 5: 1546-8.
[11]	Walker CM, Vummidi D, Benditt JO, et al. What is DIPNECH? Clin Imaging 2012; 36: 647-9.
[12]	Korn D, Bensch K, Liebow AA, et al. Multiple minute pulmonary tumors resembling chemodectomas. Am J Pathol 1960; 37: 641-72.
[13]	Churg A, Warnock M. Pulmonary tumorlet: a form of peripheral carcinoid. Cancer 1976; 37: 1469-1477.
[14]	Bennett GL, Chew FS. Pulmonary carcinoid tumorlets. AJR 1994; 162: 568.
[15]	Thomas CF Jr, Tazelaar HD, Jett JR. Typical and atypical pulmonary carcinoids: outcome in patients presenting with regional lymph node involvement. Chest 2001; 119: 1143.