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Presented by Pedram Argani, M.D. and prepared by Anil Parwani, M.D.,Ph.D.
Case 1: A middle-aged male with a 2-cm. nodule picked up on chest CT scan.
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Question 1 of 1
1. Question
Week 136: Case 1
A middle-aged male with a 2-cm. nodule picked up on chest CT scan./images/51203case1fig1.jpg
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/images/51203case1fig4.jpgCorrect
Answer: Carcinoid tumor
Histology: The tumor has a nested architecture, with a prominent vascularized stroma. The tumor cells are polygonal or spindled, and have even, fine, “salt and pepper” chromatin. Necrosis is absent, and mitoses are scarce (less than 2 per 10 high power fields). The tumor is strongly immunoreactive for chromogranin, and demonstrates dot-like positivity for cytokeratin.
Discussion: Paragangliomas primary to the lung are rare. Paraganglioma is distinguished from carcinoid tumor by its absence of cytokeratin immunoreactivity, as well as the usual presence of a population of S-100 positive sustentacular cells. An atypical carcinoid is distinguished from a carcinoid tumor by the presence of focal, spotty necrosis as well as greater mitotic activity (usually >2 per 10 high power fields). Large cell neuroendocrine carcinoma is a high-grade carcinoma, characterized by extensive, sheet-like necrosis and high mitotic activity (>10 per 10 high power fields).
Carcinoid tumors are low-grade malignancies. Many now advocate using the alternative terminology of low-grade neuroendocrine carcinoma, or Grade 1 (of 3) neuroendocrine carcinoma, to convey the fact that this tumor has a small but significant rate of metastasis.
Incorrect
Answer: Carcinoid tumor
Histology: The tumor has a nested architecture, with a prominent vascularized stroma. The tumor cells are polygonal or spindled, and have even, fine, “salt and pepper” chromatin. Necrosis is absent, and mitoses are scarce (less than 2 per 10 high power fields). The tumor is strongly immunoreactive for chromogranin, and demonstrates dot-like positivity for cytokeratin.
Discussion: Paragangliomas primary to the lung are rare. Paraganglioma is distinguished from carcinoid tumor by its absence of cytokeratin immunoreactivity, as well as the usual presence of a population of S-100 positive sustentacular cells. An atypical carcinoid is distinguished from a carcinoid tumor by the presence of focal, spotty necrosis as well as greater mitotic activity (usually >2 per 10 high power fields). Large cell neuroendocrine carcinoma is a high-grade carcinoma, characterized by extensive, sheet-like necrosis and high mitotic activity (>10 per 10 high power fields).
Carcinoid tumors are low-grade malignancies. Many now advocate using the alternative terminology of low-grade neuroendocrine carcinoma, or Grade 1 (of 3) neuroendocrine carcinoma, to convey the fact that this tumor has a small but significant rate of metastasis.
