IMAGES IN THORAX

Broncholithiasis mimicking a bronchial carcinoid tumour

P Stassano¹, S Griffo², L Di Tommaso¹, A Luciano²

¹ University Federico II, School of Medicine, Naples, Italy
² Istituto Clinico Pineta Grande, Castelvolturno (CE), Italy

Correspondence to:
Dr P Stassano, University Federico II, School of Medicine, Naples, Italy; pstassano{at}libero.it

Received 3 July 2008

Accepted 3 September 2008

A 29-year-old woman was transferred to our unit with a diagnosis of bronchial carcinoid tumour. She complained of chest pain, dyspnoea, cough and haemoptysis. She smoked 20 cigarettes per day and denied any history of tuberculosis, histoplamosis or occupational exposure and her family history was strongly positive for cancer. She had undergone a contrast-enhanced CT scan of the chest in the endocrinology unit which showed a partially calcified mass in the left hilum (fig 1A, arrow). Further pulmonary scintigraphy with ¹¹¹In-octreotide showed a concentration of the isotope in the left hilar region (fig 1B, arrow) and a positron emission tomographic scan with ¹⁸F-FDG (FDG-PET) showed that the mass had an uptake suggestive of bronchial carcinoid tumour (fig 1C, arrow). Carcinoembryonal antigen (CEA) and tissue-specific polypeptide (TSP) levels were 7.9 ng/ml (normal 0–4) and 122.0 U/l (normal 0–80), respectively. Fibreoptic bronchoscopy revealed a pedunculated mass which bled easily occluding the left upper bronchus (fig 1D), and a CT-guided fine needle aspiration of the mass yielded inconclusive results. The patient underwent a left superior lobectomy with mediastinal lymphadenectomy. At gross examination, the mass measured 2.5 cm and appeared solid and pale. The histological diagnosis was broncholithiasis of the left upper bronchus (fig 2). One year later the patient is in good health with no sign of recurrence.

View larger version (117K): in this window | in a new window | PowerPoint for Teaching   Figure 1 (A) CT scan showing the mass in the left hilar region (arrow). (B) Concentration of 111In-octreotide in the same region (arrow). (C) FDG-PET scan showing lesion in the left hilar region (arrow). (D) The bleeding mass at bronchoscopy.

 

View larger version (140K): in this window | in a new window | PowerPoint for Teaching   Figure 2 Histiocytes with foreign body reaction, rare giant cells and calcific lesions. Lymphocytes with reactive fibrous tissue can be seen at the periphery of the lesion.

 

It is noteworthy that the mass showed significant FDG activity on the PET scan¹ and concentration of ¹¹¹In-octreotide on scintigraphy. Furthermore, the values of CEA and TSP were abnormally high, and bronchoscopy revealed an easily bleeding mass suggestive of bronchial carcinoid tumour.

Broncholithiasis is a rare disease with varying clinical presentations.² Despite its rarity, it should also form part of the differential diagnosis of pulmonary opacities with high FDG uptake on PET and concentration of In-octreotide on pulmonary scintigraphy.

FOOTNOTES

Patient consent: Obtained.

REFERENCES

TOP REFERENCES

1. Chang ET, Wang AH, Lin CB, et al.. Pulmonary cryptococcosis mimicking solitary lung cancer in an immunocompetent patient. Thorax 2008;63:478.[Free Full Text]
2. Olson EJ, Utz JP, Prakash UBS. Therapeutic bronchoscopy in broncholithiasis. Am J Respir Crit Care Med 1999;160:766–70.[Abstract/Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?