Case report: Radiofrequency ablation combined with biopsy for Cushing’s syndrome due to ectopic ACTH lesions in the lung

Abstract

Lung carcinoid tumor is one of the major tumors causing ectopic ACTH syndrome, and the most common clinical treatment is surgical resection of the lesion. We herein report a suspected pulmonary carcinoid tumor with difficulty in surgical resection and poor response to drug therapy, which was successfully treated with radiofrequency ablation combined with intraoperative biopsy of the lesion. A 48-year-old female patient, with hypercortisolism (reddening of the face, full moon face, hirsutism, acne, and weight gain) detected three months ago. Small and high-dose dexamethasone suppression tests were not suppressed, Cushing’s syndrome was under consideration. PET-CT examination suggested mild FDG uptake in two nodules in the anterior basal segment of the lower lobe of the right lung, the possibility of ectopic ACTH lesions was considered because of the clinical presentation. Due to difficult surgical approach of the lesion, high risk of surgery and the patient’s anxiety, CT-guided thermal ablation combined with puncture biopsy was considered to treat the lesions. Image-guided thermal ablation can effectively inactivate ectopic ACTH lesions in the lung, rapidly improve the symptoms of high cortisol, and can be combined with biopsy for pathologic diagnosis. Therefore, this technique can be considered for treating pulmonary ACTH lesions that are difficult to resect surgically.

Prognostic Immunohistochemistry for Ki-67 and OTP on Small Biopsies of Pulmonary Carcinoid Tumors

“…For such patients, biopsy/cytology specimens provide the only tissue available for prognostication. Tumor ablation techniques are also being explored, 16–19 and may preclude histologic examination of tumor resections. For patients who may never have a resection, the development of other prognostic metrics such as Ki-67 and OTP are particularly attractive options.…”

Uncommon presentation of small cell lung carcinoma with ectopic adrenocorticotropic hormone secretion and resistant hypokalemia: A case report

“…In the article by Richa et al presenting 3 cases (2 cases of small cell lung cancer, one case of neuroendocrine tumor of unknown etiology), in addition to standard treatments, one case included ketokenazole+doxorubicin+paclitaxel, ketoconazole+chemotherapy in one case, and somatostatin and everolimus treatments in addition to carboplatin and etoposide were given in the other, but the patients died within 1 year at the latest [16]. Zhang et al successfully used CT-guided radiofrequency ablation in the diagnosis of lung carcinoid tumor and control of hypercortisolism in a surgically difficult case that was unresponsive to drug therapy [17]. In Suyama et al's case, EAS developed in a patient receiving chemotherapy treatment for small cell lung cancer and a good response was obtained to mitotane treatment in terms of clinical and cortisol level reduction [18].…”