Unusual Pulmonary Lesions: Endobronchial Carcinoid of the Lung
Authors: Frank Detterbeck, Pieter E. Postmus, Tom Sutedja
Journal: Journal of Clinical Oncology (2002)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2002.99.141 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12377973 Unusual Pulmonary Lesions: Endobronchial Carcinoid of the Lung Frank DetterbeckxFrank DetterbeckSearch for articles by this author Pieter E. PostmusxPieter E. PostmusSearch for articles by this author , Tom SutedjaxTom SutedjaSearch for articles by this author Show More University of North Carolina Multidisciplinary Thoracic Oncology Program, Chapel Hill, NCVrije Universiteit Medical Center, Amsterdam, the Netherlands https://doi.org/10.1200/JCO.2002.99.141 First Page Full Text PDF Figures and Tables © 2002 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15102002In Reply:By asking if endobronchial resection should be the treatment of choice for an atypical carcinoid, Dr Detterbeck in fact questions whether the currently used classification1 is appropriate for carcinoids presenting as endobronchial tumors. The reason for classifying the tumor in our patient2 as atypical carcinoid is strictly based on the number of mitoses in 10 high-power fields (2-10/mm2 instead of < 2/mm2). In the previously used classification,3 the cutoff point was at five mitoses. The new classification is based on a tumor tissue bank of 200 neuroendocrine pulmonary tumors. From the publication by Travis et al,1 it is unclear how many, if any, tumors are included in this series that presented in the same way as our patient’s did. Furthermore, in the univariate and multivariate analysis, the clinical presentation was not mentioned as a prognostic factor tested in this population; therefore, there remains uncertainty about whether the very strict cutoff point at two mitosis per 2 mm3 is the only important criterion and as such more important than the clinical presentation in a patient like the one we described.Based on our series, the clinical behavior of patients presenting with an endobronchially growing neuroendocrine tumor is much more like the behavior of a typical carcinoid, with no tendency to metastasize to regional lymph nodes or distant sites and no invasion of the surrounding tissue. In a series of 37 patients presenting with an endobronchial tumor, 19 patients were successfully treated with endobronchial resection; the mean follow-up of these patients was 5 years (range, 1 to 10 years). Of the remaining 18 resected patients, in 13 patients the invasion into the bronchial wall, measured using high-resolution computed tomography,4 was to deep to make cure possible by this endobronchial technique. In four patients, resection was performed because of technical limitations of endobronchial treatment. In only one patient was there doubt about the diagnosis before treatment. Of these 18 patients, only one had a lymph node metastasis.On the basis of these results, we still think that besides the histologic classification, the clinical presentation should also be taken into account before deciding what the appropriate treatment is for a patient with a neuroendocrine tumor presenting as an endobronchial tumor. Since the ability to evaluate local extension of a tumor is becoming more and more accurate, a local treatment, such as intraluminal therapy, should be taken into consideration for this tumor, with its rather benign behavior, as a possible alternative for the more dogmatic choice of immediate surgical bronchoplasty and bronchotomies.1. Travis WD, Rush W, Fkieder DB, et al: Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol 22:: 934,1998-944, Crossref, Medline, Google Scholar2. Codrington H, Sutedja T, Golding R, et al: Unusual pulmonary lesions: Case 2—Endobronchial carcinoid of the lung. J Clin Oncol 20:: 2747,2002-2748, Link, Google Scholar3. Arrigoni MG, Woolner LB, Bernatz PE: Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg 64:: 313,1972-421, Google Scholar4. Van Boxem TJ, Golding RP, Venmans BJ, et al: High resolution computed tomography in patients with intraluminal typical bronchial carcinoid treated with bronchoscopic therapy. Chest 117:: 125,2000-128, Crossref, Medline, Google Scholar