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J Thorac Cardiovasc Surg 2004;127:1840-1843
© 2004 The American Association for Thoracic Surgery

Brief communication

Thyroid metastasis after resection of atypical bronchial carcinoid

^a Department of Thoracic Surgery, University of Torino, Torino, Italy
^b Division of General Surgery, University of Torino, Torino, Italy,
^c Department of Human Oncology and Biomedical Sciences, University of Torino, Torino, Italy

Received for publication February 11, 2003; accepted for publication March 12, 2003.

^* Address for reprints: Pier Luigi Filosso, MD, University of Torino, San Giovanni Battista Hospital, Via Genova, 3, Torino 10126, Italy
pierluigifilosso@tiscalinet.it

The first 20% of the full text of this article appears below.

Bronchial carcinoids (BCs) are rare and constitute less than 2% of pulmonary tumors.¹ They are characterized by slow, mainly endobronchial growth, with infrequent regional lymph node involvement or distant metastases.²

Atypical carcinoids are part of the spectrum of neuroendocrine bronchopulmonary tumors, according to the 1999 World Health Organization–International Association for the Study of Lung Cancer (WHO-IASLC) Lung Tumor classification.³ They present 2 low-grade (typical and atypical carcinoids) and 2 high-grade malignant varieties (large cell neuroendocrine carcinoma and small cell lung carcinoma), the latter characterized by a high tendency toward mediastinal and distant metastatic spread.

Among low-grade malignant tumors, atypical carcinoids show a more aggressive biologic behavior than typical carcinoids⁴: mediastinal lymph node metastases occur at presentation in about 15% of cases. Distant metastases are generally in the liver and in the bone.

We present a case of a woman in whom thyroid metastasis occurred 30 months after the resection of an atypical BC.

Clinical summary

A 53-year-old white woman was referred to us in June 1999 because of the presence of a large pulmonary mass (7 x 3 cm in size) in the right lower lobe. The lesion had been detected with chest radiography performed in July 1998, and it was 5 x 2 cm in size, but at that time, the patient refused the intervention. She eventually agreed to be operated on because of the progression of the lesion and the associated cough and dyspnea. A preoperative transthoracic fine-needle aspiration biopsy was performed, and neoplastic cells with neuroendocrine features were observed. ¹¹¹In-DTPA-Pentetreotide scintigraphy (Octreoscan) was performed for a correct preoperative assessment, resulting in an elective uptake in correspondence of the pulmonary lesion with no other abnormal uptakes. Chromogranin A and neuron-specific enolase serum levels were performed and increased: 197 ng/mL (normal . . . [Full Text of this Article]