Neuroendocrine cancer adrenal gland.
MATERIALS AND METHODS: Imaging studies of 22 patients 12 men, mean age 60 years with histopathologically confirmed diagnosis, evaluated in the authors's institution during the last five years were retrospectively reviewed neuroendocrine cancer adrenal gland two radiologists, with findings being consensually described focusing on changes observed at computed tomography.
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Only one typical carcinoid presented the characteristic appearance of central endobronchial nodule with distal pulmonary atelectasis, while the others were pulmonary nodules or masses.
The atypical carcinoids corresponded to peripheral heterogeneous masses.
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One out of the three LCNCs was a peripheral homogeneous mass, while the others were ill-defined and heterogeneous. The 11 SCLCs corresponded to central, infiltrating and heterogeneous masses with secondary pleuropulmonary changes.
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Keywords: Computed tomography; Lung neoplasms; Neuroendocrine tumors. Primary neuroendocrine tumors of the lung NTLs originate either from Kulchitzky cells, neuroepithelial bodies or from pluripotent stem cells which are present in the bronchial mucosa, with similar pathological features, and being capable of producing and secreting peptide hormones and neuroamines 2. Since the neuroendocrine cancer adrenal gland 's, because of its clinical and histological characteristics, SCLC is classified as a neuroendocrine neoplasia of the lung.
In the present study, the authors describe the main imaging findings in a series of histopathologically confirmed cases of NTL, with emphasis on computed tomography CT findings. Also, the authors make a brief description of the main clinical data, including information on the evolution of the cases, correlating them with radiological and anatomopathological data. Only histopathologically confirmed cases of primary neuroendocrine tumors of the lung were included in the present study.
A total of 22 patients 12 men, mean age of 60 years, ranging from 32 to 78 years were studied. Considering the retrospective nature of the study, with exams that are part of the clinical routine in the assessment of such patients, it exempted a term of free and informed consent in addition to the one obtained previously to the performance of the exams.
Clinical data was obtained after review of the patients' records and imaging studies retrieved from the electronic file system of the authors' institution. Images were reviewed by two radiologists, and the findings were described in consensus.
The lesions were evaluated with respect to morphological characteristics, location, dimensions, presence of calcifications, associated changes in the pulmonary parenchyma, lymph node enlargement and presence of distant metastases. All the imaging studies stored in the electronic file system were reviewed, including plain radiographs and magnetic resonance imaging MRI studies, but the reviewers have particularly focused on the description of CT findings, which is currently the most accurate radiological method and most commonly utilized in the evaluation of lung tumors.
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In spite of not being related to the main objective of the present study, the post-treatment follow-up exams, whenever available, were also reviewed for correlation of imaging findings with the clinical progression according to the type of neoplasia identified at the anatomopathological study. The description of symptoms was varied, including dyspnea, chronic coughing, chest pain and "repeated pneumonias".
Along the medical records review process, data confirming the presence of paraneoplastic syndrome due to ectopic production of hormones were not found for any of the patients.
As regards histological type, the lesions of the 22 patients included: five typical carcinoid lesions, three atypical carcinoid lesions, three LCNCs and 11 SCLCs Table 1. Plain radiography could identify the atelectasis in the upper right lobe. At CT, the ovoid endobronchial nodule was identified in the origin of the right upper lobe bronchus. The other cases of typical carcinoid lesion presented as lung neuroendocrine cancer adrenal gland or masses, either centrally or peripherally located, with smooth or lobulated margins, homogeneous soft tissue density, and dimensions ranging from 2.
No patient presented lymph node enlargement or metastatic lesions at neuroendocrine cancer adrenal gland initial presentation of the disease.
Diagnostic Pathology: Cytopathology
Distal, secondary changes were described in all cases, mainly represented by areas of inflammatory consolidation or atelectasis. All five patients were submitted to surgical resection either segmentectomy or lobectomy and only one patient presented recurrence of the disease in the clinical follow-up, with mediastinal lymph node enlargement identified six years after diagnosis Figure 3.
One patient with neuroendocrine cancer adrenal gland typical carcinoid lesion biodescodificacion cancer de prostata underwent MRI, which demonstrated the presence of a well defined nodule in the left lower lobe with intermediate signal intensity on T1-weighted and hyperintense signal on T2-weighed sequences, also with restriction in diffusion weighted imaging and prominent contrast-enhancement more noticeable in delayed phases and with homogeneous appearance Figure 2.
The three cases of atypical carcinoid tumors were identified both at plain radiography neuroendocrine cancer adrenal gland CT, described as peripheral lung masses with lobulated or irregular contours, with heterogeneous density and contrast-enhancement, dimensions ranging between 3.
One lesion presented nodular calcifications identified at plain radiography, but best characterized at CT. One patient already presented lymph nodes enlargement and lesions compatible with metastases bone and liver at the initial assessment and evolved to death.
Another patient presented suspicious metastic liver neuroendocrine cancer adrenal gland at the moment of the diagnosis, progressing with enlargement of the lesions neuroendocrine cancer adrenal gland disease and at the time of the present study such patient was undergoing systemic therapy.
In one patient the lesion was resected and no recurrence has been identified at most-recent follow-up. Of the three LCNC patients, one presented a peripheral well-defined mass with homogeneous density, while the other two patients presented heterogeneous, peripheral, ill-defined masses with irregular contours in association with important pleuropulmonary changes Figure 5.
The lesions dimensions ranged from 4. The two patients presenting with heterogeneous lesions already presented lymph nodes enlargement and distant metastatic lesions at their initial assessment, and underwent non-surgical therapy, but evolved with progressive disease at follow-up and, later, death. The other patient presented progressive, metastatic disease and currently is cancer peritoneal speranta de viata undergoing local and systemic treatment and has not been submitted to surgical resection of the lung lesion.
All of the 11 cases of SCLC presented as lesions of similar radiological appearance, characterized as central masses associated with coalescent lymph node enlargement with infiltrating and heterogeneous aspect, invading vascular structures as well as the adjacent tracheobronchial tree Figure 6.
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Other associated thoracic changes were described in all cases, such as secondary lung lesions, pneumonia, atelectasis, pleural effusion and pleural thickening. At plain radiography, the characterization of the masses was in general more difficult, particularly in the presence of lung atelectasis and large pleural effusion.
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In general, the lesions that could be measured were larger than 5.
