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[Bronchial carcinoid in a 7-year-old boy]
1Koła Naukowego przy i Klinice Chorób Dzieci Polsko-Amerykańskiego Instytutu Pediatrii Collegium Medicum Unlwersytetu Jagiellońskiego, Kraków.
Insights
A rare pediatric lung carcinoid tumor caused prolonged pneumonia symptoms in a 7-year-old boy. Surgical resection was successful, highlighting the importance of considering carcinoid tumors in persistent respiratory inflammation.
Area of Science:
- Pediatric Oncology
- Pulmonology
- Thoracic Surgery
Background:
- Childhood primary pulmonary neoplasms are rare, with carcinoid tumors accounting for the majority of bronchial adenomas.
- Early diagnosis of pediatric lung tumors can be challenging due to nonspecific symptoms and delayed presentation.
Observation:
- A 7-year-old boy presented with a month of antibiotic-resistant pneumonia, unresponsive to conservative treatment.
- Imaging revealed a tumor obstructing the left main bronchus, confirmed as a carcinoid tumor via bronchoscopic biopsy.
- The patient underwent successful surgical resection of the tumor and a portion of the left main bronchus.
Findings:
- Post-operative follow-up, including bronchoscopy and chest X-rays, showed normal results at two weeks and six months.
- The child exhibited no symptoms of carcinoid syndrome, and urine acid levels were within normal limits.
- Histopathological examination confirmed a 5 cm carcinoid tumor, with surgical treatment yielding positive outcomes.
Implications:
- Persistent pneumonia, cough, wheezing, or hemoptysis in children warrants consideration of carcinoid tumors in the differential diagnosis.
- Bronchoscopy with biopsy and CT scans are crucial for diagnosing bronchial carcinoid tumors, as radiological findings can be nonspecific.
- Surgical resection offers favorable outcomes for pulmonary carcinoid tumors, even with regional lymph node involvement, due to their relatively low malignancy.
Abstract:
A case of a 7-year-old boy admitted to the clinic with severe symptoms of 1-month lasting pneumonia not responding to antibiotics is presented. The chest X-ray confirmed inflammatory process in left lung parenchyma. Due to unsuccessful further preservative treatment, bronchoscopy and CT of the thorax were performed. They showed the presence of a tumor narrowing the left main bronchus. Histopathologic examination of the tissue taken during bronchoscopy revealed carcinoid. Through the left-sided thoracotomy, the resection of a 5 cm large oval-shaped tumor, as well as the distal part of the left main bronchus was done. During clinical observation the child did not present any symptoms of the carcinoid syndrome. Urine levels of acids: homovanillic, vanillylmandelic and 5-hydroxyindolylacetic were normal. Bronchoscopy and X-ray of the chest directly, two weeks after and six months after resection were normal. Childhood primary pulmonary neoplasms are rare and the most frequent malignant tumors are bronchial adenomas. About 80-90% of them are carcinoids. The period from initial symptoms to clinical diagnosis and the institution of treatment, usually lasts several months. In our case it was a seven-week-long period. When cough, weezing, hemoptysis and inflammation of lung parenchyma are prolonged, carcinoid should always be considered in differential diagnosis. Radiological changes are usually nonspecific in cases of bronchial adenomas. Bronchoscopy with biopsy and CT scan are investigations that are decisive. Because of relatively low malignancy of carcinoid, results of the surgical treatment are good even in presence of metastases in regional lymphatic nodules.