Typical and atypical lung carcinoids: clinical and morphological diagnosis

Forty cases of carcinoid tumors of the lung were studied retrospectively from 1989-1993 in the Pathology Department of Hospital Pulido Valente in Lisbon. The mean age of patients was 44 years old, and the presenting symptoms included hemoptysis, cough, thoracic pain, fever, and dyspnea. An endobronchial mass was seen in 75% of the cases. The histopathological study was based on the following morphological criteria: disorganized architecture with increased cellularity (8 cases; 20%), nuclear pleomorphism (14 cases; 22%), the presence of coarse chromatin (19 cases; 30%), increased mitotic activity (13 cases; 21%), enlarged nucleoli (17 cases; 27%), necrosis (12 cases; 25%), vascular permeation (8 cases; 15%), distant metastasis (6 cases; 14%). Chromogranin was the most strongly reliable immunostaining for the diagnosis. In our series the initial routine diagnosis and the diagnosis after morphological criteria evaluation matched, and in 14 cases the final diagnosis was of atypical carcinoids.