A rare ectopic ACTH secreting atypical pulmonary carcinoid- case report

  • Dr Niharika Jain Final Year Pathology Resident, Department of Pathology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
  • Dr. Nikita Gidwani Final Year Pathology Resident, Department of Pathology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
Keywords: Pulmonary, Ectopic Cushing’s, Carcinoid tumor

Abstract

Pulmonary carcinoids are rare pulmonary neoplasms which account for 1-2% of all lung neoplasms. Pulmonary carcinoid tumors are a rare cause of ectopic ACTH secretion. The incidence of Cushing's syndrome in pulmonary carcinoid tumor is approximately 1%. A case of 25-year-old young male with typical cushingoid appearance presented with headache on and off and episodes of hypertension since 1year.Thoracic CT revealed a nodular region in left lower lobe. The patient underwent left lower lobectomy and histopathology revealed an atypical carcinoid tumor. On immunohistochemistry, tumor cells were positive for CK PAN9, CD117, S100, TTF-1, synaptophysin, chromogranin and negative for P40, CK7, Her-2 and CD99.This case is presented for its rarity.

Downloads

Download data is not yet available.

References

Boddaert G, Grand B, Le Pimpec-Barthes F, Cazes A, Bertagna X, Riquet M. Bronchial carcinoid tumors causing Cushing’s syndrome: more aggressive behavior and the need for early diagnosis. Ann. Thorac. Surg. 2012;94(6):1823-1829. doi: https://doi.org/10.1016/j.athoracsur.2012.07.022.

Deb SJ, Nichols FC, Allen MS, Deschamps C, Cassivi SD, Pairolero PC. Pulmonary carcinoid tumors with Cushing’s syndrome: an aggressive variant or not? Ann. Thorac. Surg. 2005;79(4):1132-1136. doi: https://doi.org/10.1016/j.athoracsur.2004.07.021.

Riggs BL, Sprague RG. Association of Cushing's syndrome and neoplastic disease: Observations in 232 cases of Cushing's syndrome and review of literature. Arch Int Med. 1961;108(6):841-849. doi: https://doi.org/10.1001/archinte.1961.03620120025005.

D. G. Gardner and D. Shoback, Greenspan’s Basic & Clinical Endocrinology, Lange, 9th edition, 2007.

S. Melmed, K. S. Polonsky, R. Larsen, and H. M. Kronenberg, Williams Textbook of Endocrinology, Saunders Elsevier, 12th edition, 2011.

Pedicelli I, Patriciello G, Scala G, Sorrentino A, Gravino G, Patriciello P, et al. Cushing's like syndrome in typical bronchial carcinoid a case report and review of the literature. Int J Surg Case Rep. 2016;20S:1–4. doi: https://doi.org/10.1016/j.ijscr.2016.02.006

Nenekidis I, Stathopoulos GT, Anagnostakou V, Kokkori A, Dedeilias P, Kokotsakis J, et al. Atypical pulmonary carcinoid tumour in a 28-year-old nonsmoker with Prader–Willi syndrome. Europe Resp J. 2011;38(5):1230-1233. doi: https://doi.org/10.1183/09031936.00034711.

Ilias I, Torpy DJ, Pacak K, Mullen N, Wesley RA, Nieman LK. Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the National Institutes of Health. J Clinic Endocrinol Metabol. 2005;90(8):4955-4962. doi: https://doi.org/10.1210/jc.2004-2527.

Kaltsas GA, Giannulis MG, Newell-Price JD, Dacie JE, Thakkar C, Afshar F, et al. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occult ectopic adrenocorticotropin syndrome. J Clinic Endocrinol Metabol. 1999;84(2):487-492. doi: https://doi.org/10.1210/jcem.84.2.5437.

Ye L, Li X, Kong X, Wang W, Bi Y, Hu L, et al. Hypomethylation in the promoter region of POMC gene correlates with ectopic overexpression in thymic carcinoids. J Endocrinol. 2005;185(2):337-343. doi: https://doi.org/10.1677/joe.1.05963.

Doppman JL, Nieman L, Miller DL, Pass HI, Chang R, Cutler Jr GB, et al. Ectopic adrenocorticotropic hormone syndrome: localization studies in 28 patients. Radiol. 1989;172(1):115-124. doi: https://doi.org/10.1677/joe.1.05963.

Beuschlein F, Hammer GD. Ectopic pro-opiomelanocortin syndrome. Endocrinol Metabol Clinic North Am. 2002;31(1):191-234. doi: https://doi.org/10.1016/s0889-8529(01)00025-1.

Nunes JM, Pinho E, Camões I, Maciel J, Bastos PC, de Moura CS, Bettencourt P. A challenging case of an ectopic Cushing syndrome. Case reports in medicine. 2014;2014. doi: https://doi.org/10.1155/2014/413136.

Venugopal H, Griffin K, Amer S. A case of severe ectopic ACTH syndrome from an occult primary–diagnostic and management dilemmas. Endocrinol, Diab Metabol Case Rep. 2015;2015(1). doi: https://doi.org/10.1530/EDM-15-0099.

Isidori AM, Kaltsas GA, Pozza C, Frajese V, Newell-Price J, Reznek RH, et al. The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J Clinic Endocrinol Metabol. 2006;91(2):371-377. doi: https://doi.org/10.1210/jc.2005-1542.

Salameh JR, Borman KR, Varkarakis GM. Laparoscopic bilateral adrenalectomy for occult ectopic ACTH syndrome. J Laparoendoscop Advanc Surg Tech. 2008;18(1):52-55. doi: https://doi.org/10.1089/lap.2007.0016

Salgado LR, Fragoso MC, Knoepfelmacher M, Machado MC, Domenice S, Pereira MA, de Mendonça BB. Ectopic ACTH syndrome: our experience with 25 cases. European Journal of Endocrinology. 2006 Nov 1;155(5):725-733. doi: https://doi.org/10.1530/eje.1.02278.

Kenchaiah M, Hyer S. Cushing’s syndrome due to ectopic acth from bronchial carcinoid: A case report and review. Case reports in endocrinology. 2012;2012; 215038. doi: https://dx.doi.org/10.1155%2F2012%2F215038.

CITATION
DOI: 10.17511/jopm.2020.i01.17
Published: 2020-02-07
How to Cite
Jain, D. N., & Gidwani, N. (2020). A rare ectopic ACTH secreting atypical pulmonary carcinoid- case report. Tropical Journal of Pathology and Microbiology, 6(1), 103- 107. https://doi.org/10.17511/jopm.2020.i01.17
Section
Case Report