Journal of Advanced Lung Health

POSTGRADUATE FORUM
Year
: 2022  |  Volume : 2  |  Issue : 2  |  Page : 73--74

Self-assessment quiz


Vishnu Sharma Moleyar 
 Department of Respiratory Medicine, A.J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

Correspondence Address:
Dr. Vishnu Sharma Moleyar
Department of Respiratory Medicine, A.J. Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka
India

Abstract

Intra thoracic tumors can lead to a variety of para-neoplastic manifestations which is often overlooked. Awareness about the para-neoplastic manifestations and the possible intra thoracic causes for the same will lead to early diagnosis and appropriate management. In this self assessment quiz we have discussed regarding the para-neoplastic manifestations in Carcinoid tumor.



How to cite this article:
Moleyar VS. Self-assessment quiz.J Adv Lung Health 2022;2:73-74


How to cite this URL:
Moleyar VS. Self-assessment quiz. J Adv Lung Health [serial online] 2022 [cited 2022 Aug 17 ];2:73-74
Available from: http://www.jalh.com/text.asp?2022/2/2/73/345373


Full Text



1. A 46-year-old female is admitted for evaluation of mediastinal mass. On physical examination, she is found to have typical moon face, buffalo hump, centripetal obesity, skin pigmentation, proximal muscle weakness, and hirsutism. Her blood pressure is found to be 180/100 mmHg and her blood sugar is 340 mg/dl. She was not a known hypertensive or diabetic. She had no premorbid illness. She was not on any medications. No history of any addictions or illicit drug abuse. What is the MOST LIKELY diagnosis of mediastinal mass?

TeratomaThymic carcinoidNeurogenic tumorHodgkin's lymphomaGerm cell tumor.

Answer – B. Physical findings are typical of Cushing's syndrome. Cushing's syndrome is known to cause hirsutism, hypertension, and diabetes mellitus. Endogenous Cushing's syndrome is mainly due to adrenocorticotropic hormone (ACTH) secreting pituitary adenomas – (75% to 80%), adrenal neoplasms (10%–15%), and ectopic ACTH secretion (10%). Ectopic sources of ACTH include small cell carcinoma of the lung and neuroendocrine tumors such as bronchial and thymic carcinoid and rarely gastrointestinal tract carcinoids.[1]

2. A 28-year-old male patient is admitted for evaluation of intermittent episodes of flushing of the face, breathlessness, diarrhea, and palpitation. Physical examination showed reduced breath sounds on right hemithorax. Chest x-ray revealed partial collapse of the right lung. Bronchoscopy revealed endobronchial lesion partially occluding the right main bronchus. What is the MOST LIKELY diagnosis?

Carcinosarcoma of lungSquamous cell carcinoma of the lungLarge cell carcinoma of the lungCarcinoid tumorAdenocarcinoma of the lung.

Answer – D. Flushing of face, breathlessness, diarrhea, and palpitation are typical symptoms of carcinoid syndrome.[2] Flushing is the most common symptom in carcinoid syndrome.

3. Which is a WRONG statement about carcinoid tumours?

Most common site is the ileumCarcinoid syndrome is rareBronchial carcinoid commonly associated with MEN type 2Carcinoid syndrome is more common in malignant carcinoidLung carcinoid can produce carcinoid syndrome without liver metastasis.

Answer – C. 5% to 10% of cases bronchial carcinoid may be associated[3] with MEN type 1. MEN type 1 is characterized by the combination of parathyroid tumors, pancreatic islet cell tumors, and anterior pituitary tumors.[3] It was initially known as Wermer syndrome, described in 1954 by Wermer.

4. Which of the following is NOT seen in carcinoid syndrome?

Mesenteric fibrosisPellagraBronchospasmAbdominal painLeft ventricular failure.

Answer – E. Carcinoid syndrome can lead to deposition of fibrous tissue on the tricuspid valve leading to stenosis and right heart failure. Left heart involvement is rare as 5 Hydroxytryptophan is inactivated in the lungs before it reaches the left heart.[2] More than 40 hormones and vasoactive substances have been found to be secreted by carcinoid tumors. Serotonin (5-HT), histamine, kallikrein, prostaglandins, and tachykinins are the main substances responsible for the clinical manifestations of carcinoid syndrome. Up to 80% of well-differentiated carcinoid tumors express somatostatin receptors on their cell surface. Somatostatin analogs namely octreotide and lanreotide are the mainstay of treatment for carcinoid syndrome. Somatostatin analogs bind to the somatostatin receptors and inhibit the secretion of several hormones and vasoactive substances, thus improving flushing and diarrhea symptoms.[2] Octreotide in depot form can be administered intramuscularly at a dose of 20 to 30 mg once in every 4 weeks. Lanreotide is administered subcutaneously at a dose of 120 mg every 4 weeks.

5. Which of the following is a WRONG statement regarding atypical carcinoid tumor of the lung?

Less common compared to typical carcinoidMore aggressive compared to typical carcinoidMajority are central in locationMore common after age 60 yearsUsually larger in size on diagnosis compared to typical carcinoid.

Answer – C. Majority of atypical carcinoids are peripheral in location.[4] Because of the peripheral location, they remain asymptomatic for a long time. Symptoms appear only when they attain large size leading to the involvement of surrounding structures.

6. Which is a WRONG statement regarding mediastinal lesion?

The most common paraneoplastic syndrome associated with Thymoma is myasthenia gravisPain after alcohol ingestion is seen in Hodgkin's lymphomaHypercalcemia may occur in lymphomaRecurrent infections can be the manifestation of Neurogenic tumorFevers, night sweats, and weight loss are classically seen with lymphoma.

Answer – D. Thymoma can cause hypogammaglobulinemia which can lead to recurrent skin and respiratory infections due to reduced immunity.[5] Neuroblastoma can lead to diarrhea due to vasoactive intestinal peptides secreted from the tumor.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Bhansali A, Walia R, Rana SS, Dutta P, Radotra BD, Khandelwal N, et al. Ectopic Cushing's syndrome: Experience from a tertiary care centre. Indian J Med Res 2009;129:33-41.
2Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP. Carcinoid syndrome: Update on the pathophysiology and treatment. Clinics (Sao Paulo) 2018;73 Suppl 1:E490.
3Phan AT, Oberg K, Choi J, Harrison LH Jr., Hassan MM, Strosberg JR, et al. NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: Well-differentiated neuroendocrine tumors of the thorax (includes lung and thymus). Pancreas 2010;39:784-98.
4Baxi AJ, Chintapalli K, Katkar A, Restrepo CS, Betancourt SL, Sunnapwar A. multimodality imaging findings in carcinoid tumors: A head-to-toe spectrum. Radiographics 2017;37:516-36.
5Almeida PT, Heller D. Anterior Mediastinal Mass. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.