C79-17 Bronchoscopic and Surgical Treatment of Endobronchial Carcinoid Incidentally Diagnosed in a Woman With Abdominal Pain

Abstract Introduction Endobronchial carcinoid is a rare and slow-growing neoplasm of neuroendocrine origin that arises within the bronchus. This case demonstrates the effective use of both bronchoscopic and surgical approaches in the management of endobronchial carcinoid tumors. Case Report A 58-year-old female with no significant past medical history presented with abdominal pain to the emergency department. Computed tomography (CT) of the abdomen and pelvis incidentally revealed an occlusive endobronchial mass in the basilar trunk of the right lower lobe, which was confirmed on CT chest. Upon further questioning, she endorsed a chronic, persistent post-pneumonic cough with occasional production of white sputum. The patient was scheduled for outpatient bronchoscopy. Interventional bronchoscopic recanalization demonstrated an occlusive polypoid mass. Pathology was positive for typical carcinoid cells. A staging positron emission tomography demonstrated a small persistent endobronchial nodule with no functional or anatomical evidence of metastatic disease. A right lower lobectomy is now planned with cardiothoracic surgery. Discussion Endobronchial carcinoid tumors typically originate from bronchial mucosa, particularly from the right bronchial tree. Less commonly arising from tracheobronchial cartilage. Cell types are divided into typical and atypical carcinoids - defined by mutations in genes such as p53, BCL2, or BAX. Atypical carcinoids being associated with poorer outcomes. This slow-growing neoplasm accounts for approximately 1-2% of all lung cancers and, due to its indolent nature, is commonly discovered incidentally. Approximately 25% of patients are asymptomatic at diagnosis. Symptoms include productive cough, chest pain, wheezing, hemoptysis, and recurrent post-obstructive pneumonia. As a consequence of its neuroendocrine origin, some patients may present with new-onset Cushing’s syndrome due to ectopic ACTH secretion. Surgical resection is often first-line treatment. A recent clinical trial by Neuberger et al. (2021) compared outcomes in patients treated with bronchoscopic intervention, surgery, or a combination of both. It was found that the latter resulted in a statistically significant increase in long-term survival. Therefore, as seen in our case, early diagnosis and timely intervention are critical for optimizing positive outcomes in endobronchial carcinoid. This abstract is funded by: none