A case of a resected typical pulmonary carcinoid with mediastinal lymph node metastasis exhibiting an elevated serum progastrin-releasing peptide (pro-GRP) level

Abstract

Background: Typical pulmonary carcinoids rarely metastasize to the lymph nodes. We herein report a case of a resected typical pulmonary carcinoid with metastases to the mediastinal lymph nodes that released serum progastrin-releasing peptide (pro-GRP). Case: A 41-year-old female complaining of dizziness was diagnosed with Cushing syndrome based on the findings of endocrinologic examinations. A pulmonary nodular shadow was found on a chest X-ray. The maximum diameter of the shadow was 11 mm in the middle lobe. The patient was referred to our department under suspicion of an ectopic adrenocorticotropic hormone (ACTH)-producing tumor. The intraoperative pathological diagnosis of the resected tumor was a carcinoid. Right middle lobectomy with dissection of the lymph nodes was performed. The final diagnosis was a typical carcinoid with positive mediastinal lymph node (# 4R) metastasis of pTlaN2M0, p-stage IIIA. The elevated ACTH and pro-GRP levels decreased to the normal range postoperatively. Adjuvant chemotherapy was administered, and the patient is currently disease-free at 20 months after undergoing surgery. Conclusions: Clinicians should therefore be aware of the possibility of lymph node metastases, even in cases of typical pulmonary carcinoids. © 2013 The Japan Lung Cancer Society.