Endobronchial Pulmonary Typical Carcinoid Tumors in Young Adults: A Three-Case Series Highlighting Obstructive Complications and Surgical Outcomes.

Abstract

Background: Typical pulmonary carcinoid tumors are uncommon, well-differentiated neuroendocrine neoplasms that often arise in the central airways and may present with nonspecific obstruction-related respiratory symptoms, resulting in delayed diagnosis. We report a three-case series of endobronchial typical pulmonary carcinoid tumors in young adults, highlighting their variable obstructive complications and surgical outcomes.

Methods: This retrospective case series included three consecutive patients managed at a tertiary university hospital in Syria. Clinical presentation, imaging, bronchoscopic findings, operative details, histopathology, and follow-up data were obtained from medical records. All patients had histopathologically confirmed typical pulmonary carcinoid tumors with central/endobronchial involvement and underwent definitive surgical resection. Patient identifiers were removed, and written informed consent for publication and use of accompanying images was obtained.

Results: The patients were 23-35 years old and presented with different manifestations of central airway obstruction: chronic productive cough (Case 1), post-obstructive suppuration with lung abscesses (Case 2), and recurrent hemoptysis with atelectatic/post-obstructive changes (Case 3). Bronchoscopy demonstrated obstructing endobronchial lesions in all three cases, and histopathology confirmed typical carcinoid tumors with low mitotic activity and no necrosis. Case 1 underwent right middle and lower bilobectomy with systematic mediastinal lymph node dissection for a large tumor staged T4N1M0. Cases 2 and 3 underwent left lower lobectomy; in Case 3, this included bronchial segment resection with primary closure and mediastinal lymph node dissection. Resection margins were negative in all cases, and mediastinal nodes were negative in Cases 2 and 3. No adjuvant therapy was administered. Follow-up showed no recurrence approximately 4.5 years after surgery in Case 1, clinical stability at one month in Case 2, and stable chest imaging at six months in Case 3.

Conclusion: Endobronchial typical pulmonary carcinoid tumors in young adults can produce diverse obstruction-related complications, including chronic cough, post-obstructive suppuration, and hemoptysis with atelectatic changes. Timely airway evaluation and complete surgical resection with appropriate nodal assessment can achieve favorable outcomes, including in locally advanced disease when complete resection is feasible.