Sequential Laser Photoresection and Cryotherapy for Very Late Recurrent Subglottic Atypical Carcinoid: A Case Report.

Abstract

Atypical pulmonary carcinoids may recur many years after initial treatment, but very late central-airway recurrence is uncommon and its optimal endoscopic management is uncertain. We report a 67-year-old man with metastatic atypical pulmonary carcinoid who developed recurrent subglottic disease almost 20 years after pulmonary resection. Following mild haemoptysis and inspiratory dyspnoea, bronchoscopy showed progression of a known subglottic lesion causing approximately 80% tracheal obstruction. Laser photoresection achieved rapid debulking, haemostasis and marked airway recanalization. Residual endoluminal disease was treated 5 months later with cryotherapy, resulting in complete endoscopic recanalization. No major complications occurred, symptoms resolved, and follow-up bronchoscopy at 3 months showed sustained airway patency without significant residual obstruction. This case illustrates the feasibility of a sequential multimodal bronchoscopic approach combining immediate thermal debulking with non-thermal treatment of residual disease.