Fourteen-year-old girl with endobronchial carcinoid tumour presenting with asthma and lobar emphysema.
BACKGROUND
Bronchial carcinoid tumours seldom occur in children, and represent a rare cause of pulmonary obstruction. Because of low clinical suspicion and the variable ways of presentation, diagnosis may be delayed.


OBJECTIVE
We report on a patient with this tumour. It is hoped that increased awareness of the tumour can lead to earlier diagnosis.


METHODS
Report of a case.


RESULTS
This case describes a 14-year-old previously healthy girl, presenting with asthma-like symptoms throughout 2 years, decreased lung function and emphysema in left lower lobe on chest x-ray. Computerized tomography (CT) showed an intraluminal process in the left main bronchus and emphysema in both the upper and lower left lobe and showed no signs of metastasis or spread to lung tissue. Bronchoscopy showed an inflammatory polyp. Surgical resection demonstrated a typical carcinoid tumour. Later control biopsy revealed no persisting malignant tissue. The asthma symptoms returned and a new bronchoscopy showed scarring and narrowing of the left bronchus. Treatment comprised of dilatation by bronchoscopy plus daily combination corticosteroids and beta-2-agonist inhalation and the symptoms improved. No signs of relapse 16 months postdiagnosis.


CONCLUSIONS
The case clearly shows the delay, which is common in the diagnosis of children with bronchial carcinoid tumours. Symptoms of the obstructive nature of the tumour are variable and might present as emphysema seen on x-ray and CT. Carcinoid tumour should be considered in children with longstanding pulmonary symptoms with no response to conventional treatment. Prognosis is good but long-term follow up is needed.
Andersen
Julie Bjerglund
JB
Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark.
Mortensen
Jann
J
Damgaard
Karen
K
Skov
Marianne
M
Sparup
Jørgen
J
Petersen
Bodil Laub
BL
Rechnitzer
Catherine
C
Borgwardt
Lise
L
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy; D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging* / Q000473:pathology*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D001993:Bronchodilator Agents