Atypical bronchial carcinoid with postobstructive mycobacterial infection: case report and review of literature

Abstract

Background Pulmonary carcinoids are included in the group of neuroendocrine tumors (NET) and derive from pulmonary neuroendocrine cells. The incidence of these tumors is increasing, but disease awareness remains low among clinicians. The synchronous presentation of lung cancer and mycobacterial infection is well known but the combination of pulmonary carcinoid and mycobacterial infection is rare. Case presentation We treated a 45-year-old female who presented with recurrent pneumonia. Chest X-ray showed a consolidation in the left upper lobe. The patient was treated with various courses of antibiotics without full recovery after six months. Computed tomography (CT) scan demonstrated a central mass in the left upper lobe. Bronchoscopy revealed an endobronchial, well-defined lesion that totally obstructed the left upper lobe bronchus. Bronchial biopsy showed typical carcinoid tumor. Rigid bronchoscopy with electrocautery was attempted, but we were unable to radically remove the tumor. Therefore lobectomy was performed. The surgical pathology specimen showed atypical bronchial carcinoid and consolidations in the lung parenchyma with granulomatous inflammation distally of the bronchial obstruction. Ziehl-Neelsen staining demonstrated acid fast bacilli indicative of mycobacterial infection. Conclusions This case history illustrates the importance of careful surgical pathologic examination, not only of the resected tumor, but also of the postobstructive lung parenchyma. Specific postobstructive infections such as tuberculosis or nontuberculous mycobacteria (NTM) can have clinical implications.

An Overlooked Manifestation of Hypercortisolism: Cerebral Cortical Atrophy and Challenges in Identifying the Etiology of Hypercortisolism – A Report of 2 Pediatric Cases

“…The clinical picture of the second case, who was diagnosed with tuberculosis based on the histopathological findings and positive Ehrlich-Ziehl-Neelsen staining, was considered a latent tuberculosis infection. However, similar to our case, there are cases reported in the literature where bronchial carcinoid and pulmonary tuberculosis were mistaken [20,21]. Diagnosis and follow-up of these patients, who are already challenging to diagnose and treat, may be more difficult in low resource-limited compliance settings.…”

Right middle lobe obstruction associated with synchronous endobronchial carcinoid and aspergillosis

“…Bronchial carcinoids are unusual, slow growing, low-grade malignant tumors comprising 0.5%-5% of all primary lung cancers. 9,13,15 While typical carcinoid tumors are generally found in the central main bronchi, atypical carcinoid tumors occur in the lung periphery. 16 The relationship between bronchial carcinoid tumor and smoking was not confirmed and its exact cause is unknown.…”

“…Some case reports have been published on endobronchial carcinoids, which can be confused with other lung diseases, such as tuberculosis and nontuberculous mycobacterial (NTM) infections. 6,13,14 Here, we present a rare case of synchronous aspergillosis and a carcinoid, which caused bronchial obstruction.…”