Introduction: Pulmonary neurodocrine (NE) tumors include a spectrum of tumors from the low-grade typical carcinoid (TC) and intermediate-grade atypical carcinoid (AC) to the high-grade large-cell NE carcinoma (LCNEC) and small-cell carcinoma (SCLC). These tumors are also clinically problematic because the optimal therapy for AC and LCNEC is not established.
Case Study: An 87 year old obese male was admitted for work up for pulmonary nodule. He was a 66 pack/year smoker and a non-alcoholic beverage drinker He had previous history of a car accident for he sustained compression fracture of the vertebra. Chest x-ray was done which revealed fibrocalcific densities on the upper love. A vertebroplasty was done. On examination, he had (+) rhonchi at the right mid lung no wheezes. A computerized tomography (CT) of the chest enhancing soft tissue on the apicoposterior segment of the left upper lobe measuring 2.4.x2.2x2.7 cm, it has microlobulations with sorrounding minimal ground glass densities. Adjacent reticulonodular densities are also seen including a tiny calcific nodule. A subpleural enhancing nodule with spiculated border is also seen in the superior segment of the right lower lobe. Measures about 1x1.1x1.3 cm. CT scan guided biopsy cytomorphologic features of Primary Neuroendocrine Carcinoma. Immunohistochemistry done with strong reactivity against TTF and neuron specific endolase, non reactive to CEA and calretinin. Test for TSH, FT4 FT3 and serum calcium were done which revealed normal findings.
Conclusion: A thorough work-up is needed in investigating a pulmonary nodule. In this case, biopsy of the pulmonary nodule is rendered helpful in arriving to the correct diagnoses leading to the appropriate treatment of the disease.