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Asian Cardiovasc Thorac Ann 2003;11:189
© 2003 Asia Publishing EXchange Ltd

LETTER TO THE EDITOR

Acromegaly as Manifestation of a Bronchial Carcinoid Tumour

Pier Luigi Filosso, MD, Giovanni Donati, MD, Ottavio Rena, MD, Alberto Oliaro, MD

University of Torino Italy, San Giovanni Battista Hospital, Department of Thoracic Surgery, Via Genova, 3 10126 Torino Italy

We read with interest the paper of Bhansali and Coll.1 Acromegaly as manifestation of a bronchial carcinoid tumour is really rare, and no more than 50 cases are to date described in English literature.

We have some questions for the Authors:

- the pulmonary lesion described is a very large and centrally located within the right lung. Diagnosis of bronchial carcinoid was obtained by a transbronchial lung biopsy. But no data are presented about the endobronchial location of the tumour, and the possible presence of mediastinal lymph node enlargementat the thoracic CT scan;
- the Authors did not perform a preoperative whole boby.111In-DTPA-pentreotide scintigraphy (Octreoscan), which is recognized to be effective in detecting possible mediastinal or distant metastases of neuroendocrine tumours;
- an upper right lobectomy was performed: did the patient underwent a radical mediastinal and hilar lymphadenectomy?
- the tumour was assessed as bronchial carcinoid: was it typical or atypical one?
- a complete immunohistochemical assessment of the neoplasm was performed; in particular somatostatin receptors were detected. Which kind of somatostatin receptors’ subtype did Authors find?

We have observed2 one patient with a pT2N0 typical bronchial carcinoid associated with acromegaly, and two with Cushing’s syndrome; in all cases, both acromegaly and Cushing’s syndrome disappeared with the resection of the tumour.

One patient presented a mediastinal recurrence of ACTH producing carcinoid, promptly detected with Octreoscan.3

In vivo expression of somatostatin receptors is provided by Octreoscan;4 thus tumours expressing a high quantity of these receptors can be easily detected with this technique. Plus, a positive Octreoscan can justify a medical treatment with long-acting somatostatin analogy (octreotide-lanreotide).

In conclusion we emphasize the use of 111In-DTPA-pentreotide scintigraphy in the preoperative evaluation of patients with histologically proven neuroendocrine lung tumours, and in their follow-up.

We suggest to the use of octreotide in the treatment of recurrences or distant metastases of these neoplasm.5

REFERENCES

  1. Bhansali A; Rana DM; Bhattacharya S; Muralidraran R; Dash R; Banerjee AK: Acromegaly: a rare manifestation of bronchial carcinoid. Asian Cardiovasc Thorac Ann . 2002;10:273–6.[Abstract/Free Full Text]

  2. Filosso PL; Rena O; Donati G; Casadio C; Ruffini E; Papalia E; Oliaro A; Maggi G: Bronchial carcinoid tumors: surgical management and long-term outcome. J Thorac Cardiovasc Surg 2002;123:303–9.[Abstract/Free Full Text]

  3. Filosso PL; Rena O; Ruffini E; Oliaro A: Ectopic ACTH-producing tumors of the chest and octreotide scintigraphy. Eur J Cardio-thorac Surg 2002;21:1126.[Free Full Text]

  4. Kwekkeboom DJ; Siang Kho G; Lamberts SWJ: The value of octreotide scintigraphy in patients with lung cancer. Eur J Nucl Med 1994;21:1106.[Medline]

  5. Filosso PL; Ruffini E; Oliaro A; Papalia E; Donati G; Rena O: long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotide. Eur J Cardio-thorac Surg 2002;21:913–7.[Abstract/Free Full Text]





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Giovanni Donati
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