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神经内分泌类癌肺肿瘤:惰性肿瘤病例系列

Neuroendocrine Carcinoid Lung Tumor: A Case Series of an Indolent Tumor.

作者信息

Dogra Ratika, Schroeder Kyle, Chaudhary Krishna, Khatri Krishna, Khatri Vinod

机构信息

Internal Medicine, Bon Secours Mercy Health, Toledo, USA.

Pulmonary and Critical Care, University of Toledo, Ohio, USA.

出版信息

Cureus. 2024 Oct 24;16(10):e72315. doi: 10.7759/cureus.72315. eCollection 2024 Oct.

Abstract

Neuroendocrine tumors (NETs) of the lung are infrequently encountered tumors, constituting a small subset of pulmonary neoplasms. The lung is the second most common site of carcinoid tumors. Most patients experience vague symptoms for many years, making them fairly difficult to diagnose. This case series presents three unique and challenging cases of pulmonary neuroendocrine tumors. Case 1 is a 55-year-old female with a 6-month history of progressive dyspnea and noted to have a lung mass blocking the left main bronchus. The patient underwent bronchoscopy with tissue diagnosis and ultimately needed thoracotomy and left-sided pneumonectomy. Case 2 is a 61-year-old female with a chronic cough for several years who was seen to have a right lung mass, underwent a bronchoscopy showing a Carcinoid tumor, and was taken for a right lower lobe lobectomy. Case 3 is a 75-year-old female who was seen to have a right hilar mass as an incidental finding on CT imaging. The patient underwent bronchoscopy with the biopsy proving carcinoid tumor. The patient had multiple co-morbidities, was not deemed to be a surgical candidate, and was referred for radiation therapy. The patients in the case series presented with nonspecific respiratory symptoms, leading to diagnostic investigations including imaging studies and bronchoscopy evaluation. Histopathological examination revealed a well-differentiated neuroendocrine tumor with positive immunohistochemical staining for neuroendocrine markers. Subsequent staging investigations confirmed localized disease without distant metastasis. Multidisciplinary collaboration involving pulmonologists, oncologists, radiation oncologists, and surgeons played a pivotal role in determining the optimal therapeutic approach. These patients underwent surgical resection, and postoperative pathology confirmed clear margins. Adjuvant therapy was considered based on the tumor characteristics and the overall risk of recurrence.

摘要

肺神经内分泌肿瘤(NETs)是罕见肿瘤,仅占肺肿瘤的一小部分。肺是类癌肿瘤的第二大常见发病部位。大多数患者多年来症状不明确,因此很难诊断。本病例系列展示了三例独特且具有挑战性的肺神经内分泌肿瘤病例。病例1是一名55岁女性,有6个月进行性呼吸困难病史,检查发现肺部肿块阻塞左主支气管。患者接受了支气管镜检查及组织诊断,最终需要开胸手术并进行左侧肺切除术。病例2是一名61岁女性,有慢性咳嗽数年,检查发现右肺有肿块,接受支气管镜检查显示为类癌肿瘤,随后进行了右下叶肺叶切除术。病例3是一名75岁女性,在CT成像检查中偶然发现右肺门肿块。患者接受了支气管镜检查及活检,证实为类癌肿瘤。该患者有多种合并症,被认为不适合手术,因此转诊接受放射治疗。本病例系列中的患者均表现出非特异性呼吸道症状,因此进行了包括影像学检查和支气管镜评估在内的诊断性检查。组织病理学检查显示为高分化神经内分泌肿瘤,神经内分泌标志物免疫组化染色呈阳性。随后的分期检查证实为局限性疾病,无远处转移。由肺科医生、肿瘤内科医生、放疗科医生和外科医生组成的多学科协作团队在确定最佳治疗方案中发挥了关键作用。这些患者均接受了手术切除,术后病理证实切缘清晰。根据肿瘤特征和复发总体风险考虑进行辅助治疗。

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