Diagnosis and Management of Pulmonary Carcinoids.

Abstract

Neuro-Endocrine: Tumours (NETs) are rare slowly growing malignancies that arise from neuroendocrine cells, which can be found anywhere in the human body. Broncho-pulmonary neuroendocrine tumours (bpNETs) represents approximately about 20-30 % of NETs and about 25% of all lung cancers (1, 2) . Recently the prevalence of bpNETs has increased, this may be attributed to early disease detection and/or improved survival (3) . Broncho-pulmonary neuroendocrine tumours are classified according to their degree of differentiation into well and poorly differentiated forms, depends on the mitotic index and presence of necrosis. The well-differentiated pulmonary carcinoid, include the low grade which is the typical carcinoid (TC). While, the intermediate-grade which is the atypical carcinoid (AC). The poorly differentiated group include large cell neuroendocrine carcinomas (LCNEC) and small cell lung cancer (SCLC) (4, 5) . Although there is some similarities between the two groups, the behaviour of pulmonary carcinoids are completely different from that of SCLC and LCNEC (6) . Pulmonary carcinoid tumours are uncommon malignancies, which appeared to be increasing overtime. Diagnosis and management depends on accurate histological classification that also can predict the prognosis. Contrast enhanced CT is the first recommended investigation, 68Ga-dotatate–PET/CT should be done for well differentiated tumours, while FDG PET/CT is useful with tumours of high proliferation index.