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70 year old female with dry cough and history of Stage 1 Carcinoid

  • 7 years ago
    • Mass  in left upper lobe
    • multiple other nodules
    • 1 year later showed minimal growth of the nodule
      History of Chronic Cough left thyroidectomy 5 pack year smoker shows a minimal growth of the spiculated nodule in the left upper lobe
      PET CT was positive and CT gioded biopsy showed a neuroendocrine tumour consistent with carcinoid tumor
      Ashley Davidoff
      TheCommonVein.net

      Growth in 1 Year

      History of Chronic Cough left thyroidectomy 5 pack year smoker shows a spiculated nodule in the left upper lobe
      PET CT was positive and CT gioded biopsy showed a neuroendocrine tumour consistent with carcinoid tumor
      Ashley Davidoff
      TheCommonVein.net

  • PET
    • Focal moderate uptake in a left apical subpleural pulmonary
      nodule.
    • No suspicious lymph node tracer uptake.
  • CT guided biopsy
    • positive for neurendocrine tumor
      • POS for STAINING OF THE LESIONAL CELLS FOR
        • SYNAPTOPHYSIN AND
        • C HROMOGRANIN.
        • TTF-1 IS FOCALLY POSITIVE.
        • KI-67 SHOWS A LOW PROLIFERATIVE NUCLEAR STAINING PATTERN.
        • THIS IMMUNOPROFILE SUPPORTS
          THE DIAGNOSIS.
  • 4 years ago re thyroid
    • prior benign FNA of right mid thyroid nodule, (5years ago)
    • prior left lobectomy
  • dry cough for > 6 years that feels
  • minimal smoking exposure (5 py),
  • 4 YEARS AGO
    • PFTs in
      • no obstruction
      • reduced spiro (potentially due to cough)
      • normal lung volumes
      • moderately reduced DL.
    • CT imaging
      • subtle mosaicism and
      • lung nodules.
    • 1 YEAR AGO
      • cough is unchanged
      • CT Imaging 1 year ago
        • diffuse mosaicism – actual air trapping
          – PFTs with 6MWT ordered today, can be scheduled with follow up
          – follow up CT chest ordered for 6/2023 by cardiothoracic surgery ; will request that this include insp/exp images
CT from 1 year ago was performed in expiration
Ashley Davidoff TheCommonVein.net
Carcinoid tumorlets in the airways accounting for small airways disease and air trapping
Ashley Davidoff TheCommonVein.net
CT from 1 year ago was performed in expiration and shows air trapping
Ashley Davidoff TheCommonVein.net
CT from 1 year ago was performed in expiration and shows air trapping
Ashley Davidoff TheCommonVein.net

Slowly Growing Nodules

6 yrs Ago

CT from 6 years ago shows a small nodule in the middle lobe at the time of primary carcinoid resection
Ashley Davidoff TheCommonVein.net

Current

CT from 1 year ago was performed in expiration shows the largest of many growing nodules over a 6 year period
Ashley Davidoff TheCommonVein.net

 

 

    • Important considerations
      • Mosaicism is actually air trapping becasue the study is performed in expiration
      • Nodules have enlarged since 6 years prior particularly the largest in the middle lobe