Correct!
3. Bronchoscopy
Choosing surgical resection at this point is somewhat premature- the exact nature and precise location of the lesion have not yet been characterized, and non-surgical causes for the left upper lobe lesion- such as focal allergic bronchopulmonary aspergillosis- while unlikely, have not been excluded. The lesion is too centrally located to attempt percutaneous fine needle aspiration biopsy- the likelihood of complication increases when such central lesions undergo percutaneous approaches for biopsy. Although imaging with 18FDG-PET could be attempted, while tracer utilization would prompt a tissue diagnosis, lack of tracer utilization would not provide information useful for further management- an endobronchial lesion in a patient with hemoptysis would still remain and require evaluation. Follow up thoracic CT is also not appropriate. Follow up thoracic CT is typically reserved for lesions that are indeterminate as regards malignant potential- the intention is to show growth to indicate aggressive potential, versus stability to indicate a non-aggressive lesion, avoiding intervention in the latter case. This situation most commonly occurs in patients with asymptomatically detected lung nodules, or for whom the nodule detection is likely incidental to the indication for the thoracic CT. In this circumstance, the left upper lobe lesion is certainly the cause of the patient’s hemoptysis, and therefore intervention is required. Bronchoscopy is the best method for further investigation of this lesion.
Bronchoscopy was performed and showed a mass protruding into the left upper lobe airway, thought to be arising from the lingular bronchus (Figure 4).
Figure 4. Virtual bronchoscopy showing the internal perspective of the trachea and left upper airways- the mass protruding from the bronchus is visible (arrow). (click here for a movie of the virtual bronchoscopy)
The lesion was highly vascular, and therefore biopsy was not attempted. The right-side airways, left lower lobe bronchus, and trachea appeared normal. The patient subsequently underwent surgical resection of the lesion, which established the diagnosis of a well-differentiated neuroendocrine neoplasm consistent with “typical” carcinoid tumor).
Diagnosis: Left upper lobe well-differentiated neuroendocrine neoplasm (“typical” carcinoid tumor).
Which of the following regarding carcinoid tumor is false?
