Haemorrhage post biopsy of a bronchial carcinoid
DOI:
https://doi.org/10.32896/tij.v2n1.16-22Keywords:
bronchial carcinoid, tumour markers, bleeding, endobrochial biopsyAbstract
Background: Bronchial carcinoid tumours are rare, indolent, malignant neuroendocrine tumours derived from Kulchitsky cells and are not related to smoking. As these tumours can be asymptomatic or present with nonspecific symptoms, a high index of suspicion is essential to make an early diagnosis which determines the prognosis. Surgery is curative and remains the mainstay of treatment.
Case presentation: A 41-year-old female with no background medical illness first presented with a spontaneous left sided pneumothorax requiring a chest tube insertion. High-resolution CT (HRCT) thorax detected an incidental solitary pulmonary nodule. Bronchoscopy revealed a smooth round tumour sitting at the ostium of the basal right lower lobe bronchus. Endobronchial biopsy was complicated with massive bleeding requiring emergency exploration via rigid bronchoscopy. Multiple attempts to secure haemostasis using Watanabe spigot and argon plasma coagulation failed. She was intubated with a double lumen tube to isolate the healthy left lung. An urgent CT pulmonary angiogram (CTA) was performed to look for collaterals and feasibility of embolization, but no collaterals were seen. She was then referred to the cardiothoracic surgeon for an emergency right lobectomy. Histopathological examination revealed typical carcinoid tumour. She was discharged from the hospital in a stable condition.
Discussion: Bronchial carcinoids embryologically originate from the foregut and patients rarely present with features suggestive of carcinoid syndrome and crisis. Mostly are asymptomatic resulting in late presentation and diagnosis. Majority of the typical carcinoids are centrally located and may present with obstructive symptoms and recurrent pneumonia. Bronchoscopists may face massive bleeding following endobronchial biopsy in bronchial carcinoids.
Conclusion: Massive bleeding after endobronchial biopsy can occur and therefore the bronchoscopist should have anaesthesia, interventional radiology, and cardiothoracic support to handle this complication. Using tumour markers may obviate the need for biopsy in typical bronchial carcinoids to prevent massive bleeding after endobronchial biopsy.
References
Lips CJ, Lentjes EG, Höppener JW. The spectrum of carcinoid tumours and carcinoid syndromes. Annals of clinical biochemistry. 2003;40(6):612-27.
Davila DG, Dunn WF, Tazelaar HD, Pairolero PC. Bronchial Carcinoid Tumors. Mayo Clinic Proceedings. 1993;68(8):795-803.
Sachithanandan N, Harle RA, Burgess JR. Bronchopulmonary carcinoid in multiple endocrine neoplasia type 1. Cancer. 2005;103(3):509-15.
Fink G, Krelbaum T, Yellin A, Bendayan D, Saute M, Glazer M, et al. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest. 2001;119(6):1647-51.
Papaporfyriou A, Domayer J, Meilinger M, Firlinger I, Funk G-C, Setinek U, et al. Bronchoscopic diagnosis and treatment of endobronchial carcinoid: case report and review of the literature. European Respiratory Review. 2021;30(159):200115.
Ayache M, Donatelli C, Roncin K, AnsariGilani K, Yang M, Faress J, et al. Massive hemorrhage after inspection bronchoscopy for carcinoid tumor. Respir Med Case Rep. 2018;24:125-8.
André S, Correia J, Raposo M, Matos C, Nogueira F, Abreu M. Pulmonary carcinoid tumours. Breathe. 2006;2(4):322-31.
Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. Introduction to The 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart. J Thorac Oncol. 2015;10(9):1240-2.
Mindaye ET, Tesfaye GK. Bronchial carcinoid tumor: A case report. International Journal of Surgery Case Reports. 2020;77:349-52.
Hage R, de la Rivière AB, Seldenrijk CA, van den Bosch JMM. Update in Pulmonary Carcinoid Tumors: A Review Article. Annals of Surgical Oncology. 2003;10(6):697-704.
Rea F, Binda R, Spreafico G, Calabrò F, Bonavina L, Cipriani A, et al. Bronchial carcinoids: a review of 60 patients. The Annals of thoracic surgery. 1989;47(3):412-4.
McCaughan BC, Martini N, Bains MS. Bronchial carcinoids: review of 124 cases. The Journal of thoracic and cardiovascular surgery. 1985;89(1):8-17.
Seregni E, Ferrari L, Bajetta E, Martinetti A, Bombardieri E. Clinical significance of blood chromogranin A measurement in neuroendocrine tumours. Annals of oncology : official journal of the European Society for Medical Oncology. 2001;12 Suppl 2:S69-72.
Bajetta E, Ferrari L, Martinetti A, Celio L, Procopio G, Artale S, et al. Chromogranin A, neuron specific enolase, carcinoembryonic antigen, and hydroxyindole acetic acid evaluation in patients with neuroendocrine tumors. Cancer. 1999;86(5):858-65.
Lamberts SW, Hofland LJ, Nobels FR. Neuroendocrine tumor markers. Frontiers in neuroendocrinology. 2001;22(4):309-39.
Walts AE, Said JW, Peter Shintaku I, Lloyd RV. Chromogranin as a Marker of Neuroendocrine Cells in Cytologic Material—An Immunocytochemical Study. American Journal of Clinical Pathology. 1985;84(3):273-7.
Chughtai TS, Morin JE, Sheiner NM, Wilson JA, Mulder DS. Bronchial carcinoid—Twenty years' experience defines a selective surgical approach. Surgery. 1997;122(4):801-8.
Pasala UJS, Hui M, Uppin SG, Kumar NN, Bhaskar K, Paramjyothi GK. Clinicopathological and immunohistochemical study of pulmonary neuroendocrine tumors - A single-institute experience. Lung India : official organ of Indian Chest Society. 2021;38(2):134-8.
Martini N, Zaman M, Bains M, Burt M, McCormack P, Rusch V, et al. Treatment and prognosis in bronchial carcinoids involving regional lymph nodes. The Journal of thoracic and cardiovascular surgery. 1994;107 1:1-6; discussion -7.
Eriksson B, Öberg K, Stridsberg M. Tumor markers in neuroendocrine tumors. Digestion. 2000;62(Suppl. 1):33-8.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
