Incidental Presentation of Carcinoid Tumor

Abstract Introduction: Carcinoid tumors are a group of neuroendocrine tumors (NETs) that originate in the gastrointestinal tract, lungs, adrenal glands, thyroid or ovaries and secrete vasoactive substances such as histamine, serotonin, tachykinins, prostaglandins and kallikreins. These tumors are rare and typically occur in the small intestine with approximately 25 percent originating in the lungs. Additionally, pulmonary carcinoid tumors account for 1 to 2 percent of lung cancers making a lung carcinoid tumor an even rarer event. Carcinoid tumors are very slow-growing, presentation ranges from being asymptomatic 25% to 39% of patients to symptoms of bronchial obstruction superinfection, such as recurrent pneumonia, chest pain, wheezing and hemoptysis. Rarely they may present with features of carcinoid syndrome and crisis. Given the rarity of pulmonary carcinoid tumor, we present a case of a 50-year-old female never smoker who was incidentally found to have a right upper lobe (RUL) nodule consistent with carcinoid tumor. Case Report: 50-year-old female never smoker with a history of bilateral breast implants with one rupture and bilateral replacements and no known past medical condition who was incidentally found to have a right upper lobe nodule after chest x-ray performed for pneumonia at Urgent care revealed a lung nodule. Subsequent CT imaging demonstrated a 1.5cm RUL mass. Initial fiberoptic bronchoscopy (FB) with transbronchial biopsy was nondiagnostic. Given the high index of suspicion for carcinoid tumor, the patient was referred to thoracic surgery with subsequent FB and ion biopsy revealing histologic sections with typical carcinoid tumor and absent cytologic atypia and necrosis. Immunostains were also positive for synaptophysin, chromogranin and CD56. The patient successfully underwent robotic assisted right upper lobectomy and mediastinal lymph node dissection (MLND). Her postoperative course was unremarkable and she was discharged after a few days with outpatient follow up recommendations. Discussion: Carcinoid tumors are rare and typically low-grade NETs that are often discovered during imaging studies performed for unrelated reasons as illustrated in this case report. While many carcinoid tumors are indolent, some may exhibit aggressive features, making it essential for healthcare providers to maintain a high index of suspicion even with initial investigations are non diagnostic. A multidisciplinary approach with prudent monitoring is crucial for optimizing patient outcomes as complete resection remains the most effective treatment.