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From the Archives of the AFIP¹

Thoracic Carcinoids: Radiologic-Pathologic Correlation

¹ From the Departments of Radiologic Pathology (M.L.R., J.R.G.) and Pulmonary and Mediastinal Pathology (W.D.T.), Armed Forces Institute of Pathology, 6825 16th St NW, Bldg 54, Room M-121, Washington, DC 20306-6000; the Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.L.R.); the Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, Providence (G.F.A.); the Department of Radiology, New Britain General Hospital, New Britain, Conn (W.M.K.); and the Department of Radiology, University of Maryland Medical System, Baltimore (J.R.G.). Address reprint requests to M.L.R.

View larger version (232K): [in a new window]   Figure 1a.  Typical carcinoid. (a) Low-power photomicrograph (original magnification, x100; hematoxylin-eosin [H-E] stain) of a typical carcinoid demonstrates uniform cells with an organoid nesting pattern. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a typical carcinoid shows uniform cells with granular cytoplasm and stippled nuclear chromatin growing in an organoid nesting pattern.

View larger version (212K): [in a new window]   Figure 1b.  Typical carcinoid. (a) Low-power photomicrograph (original magnification, x100; hematoxylin-eosin [H-E] stain) of a typical carcinoid demonstrates uniform cells with an organoid nesting pattern. (b) High-power photomicrograph (original magnification, x400; H-E stain) of a typical carcinoid shows uniform cells with granular cytoplasm and stippled nuclear chromatin growing in an organoid nesting pattern.

View larger version (229K): [in a new window]   Figure 2a.  Atypical carcinoid. (a) High-power photomicrograph (original magnification, x200; H-E stain) of an atypical carcinoid shows a characteristic punctate focus of necrosis. (b) High-power photomicrograph (original magnification, x400; H-E stain) of an atypical carcinoid demonstrates one mitotic figure (arrow).

View larger version (214K): [in a new window]   Figure 2b.  Atypical carcinoid. (a) High-power photomicrograph (original magnification, x200; H-E stain) of an atypical carcinoid shows a characteristic punctate focus of necrosis. (b) High-power photomicrograph (original magnification, x400; H-E stain) of an atypical carcinoid demonstrates one mitotic figure (arrow).

View larger version (201K): [in a new window]   Figure 3.  Typical carcinoid. High-power photomicrograph (original magnification, x400) of a typical carcinoid stained with immunohistochemistry for chromogranin A shows cytoplasmic staining.

View larger version (127K): [in a new window]   Figure 4. Figures 4, 5. (4) Typical carcinoid in a 38-year-old man with a 2-year history of recurrent pneumonia. Photograph of the resected specimen shows a completely endobronchial ovoid tumor in the left mainstem bronchus. A smooth glistening mucosa covers the lesion. (5) Typical carcinoid in a 28-year-old woman with a 6-month history of dyspnea. Photograph of a cut section of the surgical specimen shows a polypoid carcinoid tumor occluding the main bronchus and focally invading the bronchial wall (arrows).

View larger version (118K): [in a new window]   Figure 5. Figures 4, 5. (4) Typical carcinoid in a 38-year-old man with a 2-year history of recurrent pneumonia. Photograph of the resected specimen shows a completely endobronchial ovoid tumor in the left mainstem bronchus. A smooth glistening mucosa covers the lesion. (5) Typical carcinoid in a 28-year-old woman with a 6-month history of dyspnea. Photograph of a cut section of the surgical specimen shows a polypoid carcinoid tumor occluding the main bronchus and focally invading the bronchial wall (arrows).

View larger version (116K): [in a new window]   Figure 6. Figures 6–8. (6) Typical carcinoid in a 36-year-old woman with a 1-year history of recurrent left lower lobe pneumonia. Photograph of a cut section of the surgical specimen shows that although the bulk of the tumor is parenchymal, an endoluminal component is also present (*). (7) Typical carcinoid in a 38-year-old man with recurrent right lower lobe pneumonia. Photograph of a cut section of the surgical specimen shows a well-circumscribed, fleshy, ovoid mass abutting the bronchovascular bundle. A mucus plug is seen adjacent to the tumor (*). (8) Typical carcinoid in a 50-year-old woman with an 8-month history of cough and recurrent pneumonia. Photograph of a cut section of the surgical specimen shows an endobronchial tumor (*) occluding the bronchus intermedius with consolidation and bronchiectasis of the right middle and lower lobes.

View larger version (123K): [in a new window]   Figure 7. Figures 6–8. (6) Typical carcinoid in a 36-year-old woman with a 1-year history of recurrent left lower lobe pneumonia. Photograph of a cut section of the surgical specimen shows that although the bulk of the tumor is parenchymal, an endoluminal component is also present (*). (7) Typical carcinoid in a 38-year-old man with recurrent right lower lobe pneumonia. Photograph of a cut section of the surgical specimen shows a well-circumscribed, fleshy, ovoid mass abutting the bronchovascular bundle. A mucus plug is seen adjacent to the tumor (*). (8) Typical carcinoid in a 50-year-old woman with an 8-month history of cough and recurrent pneumonia. Photograph of a cut section of the surgical specimen shows an endobronchial tumor (*) occluding the bronchus intermedius with consolidation and bronchiectasis of the right middle and lower lobes.

View larger version (135K): [in a new window]   Figure 8. Figures 6–8. (6) Typical carcinoid in a 36-year-old woman with a 1-year history of recurrent left lower lobe pneumonia. Photograph of a cut section of the surgical specimen shows that although the bulk of the tumor is parenchymal, an endoluminal component is also present (*). (7) Typical carcinoid in a 38-year-old man with recurrent right lower lobe pneumonia. Photograph of a cut section of the surgical specimen shows a well-circumscribed, fleshy, ovoid mass abutting the bronchovascular bundle. A mucus plug is seen adjacent to the tumor (*). (8) Typical carcinoid in a 50-year-old woman with an 8-month history of cough and recurrent pneumonia. Photograph of a cut section of the surgical specimen shows an endobronchial tumor (*) occluding the bronchus intermedius with consolidation and bronchiectasis of the right middle and lower lobes.

View larger version (133K): [in a new window]   Figure 9a.  Typical carcinoid in an asymptomatic 38-year-old woman. (a, b) Posteroanterior (PA) (a) and lateral (b) chest radiographs show a well-circumscribed, spherical left hilar mass. (c) Chest CT scan (lung window) demonstrates the lobular, partially endobronchial mass. Note the convex appearance of the lesion within the bronchial lumen. (d) Photograph of a cut section of the resected left upper lobe demonstrates the relationship of the lesion to the bronchus (arrow). Scale is in centimeters.

View larger version (132K): [in a new window]   Figure 9b.  Typical carcinoid in an asymptomatic 38-year-old woman. (a, b) Posteroanterior (PA) (a) and lateral (b) chest radiographs show a well-circumscribed, spherical left hilar mass. (c) Chest CT scan (lung window) demonstrates the lobular, partially endobronchial mass. Note the convex appearance of the lesion within the bronchial lumen. (d) Photograph of a cut section of the resected left upper lobe demonstrates the relationship of the lesion to the bronchus (arrow). Scale is in centimeters.

View larger version (125K): [in a new window]   Figure 9c.  Typical carcinoid in an asymptomatic 38-year-old woman. (a, b) Posteroanterior (PA) (a) and lateral (b) chest radiographs show a well-circumscribed, spherical left hilar mass. (c) Chest CT scan (lung window) demonstrates the lobular, partially endobronchial mass. Note the convex appearance of the lesion within the bronchial lumen. (d) Photograph of a cut section of the resected left upper lobe demonstrates the relationship of the lesion to the bronchus (arrow). Scale is in centimeters.

View larger version (89K): [in a new window]   Figure 9d.  Typical carcinoid in an asymptomatic 38-year-old woman. (a, b) Posteroanterior (PA) (a) and lateral (b) chest radiographs show a well-circumscribed, spherical left hilar mass. (c) Chest CT scan (lung window) demonstrates the lobular, partially endobronchial mass. Note the convex appearance of the lesion within the bronchial lumen. (d) Photograph of a cut section of the resected left upper lobe demonstrates the relationship of the lesion to the bronchus (arrow). Scale is in centimeters.

View larger version (128K): [in a new window]   Figure 10a. Figures 10, 11. (10) Typical carcinoid in a 21-year-old woman who was being evaluated for pyelonephritis. PA (a) and lateral (b) chest radiographs demonstrate atelectasis of the right middle lobe and an incidental right apical pneumothorax. Bronchography revealed a mass obstructing the bronchus intermedius. (11) Typical carcinoid in an 18-year-old man with a 4-month history of recurrent pneumonia. PA chest radiograph demonstrates right middle and lower lobe consolidation, a parapneumonic pleural effusion, and cut-off of the bronchus intermedius (arrow).

View larger version (123K): [in a new window]   Figure 10b. Figures 10, 11. (10) Typical carcinoid in a 21-year-old woman who was being evaluated for pyelonephritis. PA (a) and lateral (b) chest radiographs demonstrate atelectasis of the right middle lobe and an incidental right apical pneumothorax. Bronchography revealed a mass obstructing the bronchus intermedius. (11) Typical carcinoid in an 18-year-old man with a 4-month history of recurrent pneumonia. PA chest radiograph demonstrates right middle and lower lobe consolidation, a parapneumonic pleural effusion, and cut-off of the bronchus intermedius (arrow).

View larger version (110K): [in a new window]   Figure 11. Figures 10, 11. (10) Typical carcinoid in a 21-year-old woman who was being evaluated for pyelonephritis. PA (a) and lateral (b) chest radiographs demonstrate atelectasis of the right middle lobe and an incidental right apical pneumothorax. Bronchography revealed a mass obstructing the bronchus intermedius. (11) Typical carcinoid in an 18-year-old man with a 4-month history of recurrent pneumonia. PA chest radiograph demonstrates right middle and lower lobe consolidation, a parapneumonic pleural effusion, and cut-off of the bronchus intermedius (arrow).

View larger version (129K): [in a new window]   Figure 12a.  Typical carcinoid in a 22-year-old man with a 2-year history of hemoptysis. (a) PA chest radiograph demonstrates a well-marginated, endoluminal mass within the right mainstem bronchus. (b) Chest CT scan (lung window) demonstrates the well-defined, endoluminal tumor.

View larger version (105K): [in a new window]   Figure 12b.  Typical carcinoid in a 22-year-old man with a 2-year history of hemoptysis. (a) PA chest radiograph demonstrates a well-marginated, endoluminal mass within the right mainstem bronchus. (b) Chest CT scan (lung window) demonstrates the well-defined, endoluminal tumor.

View larger version (169K): [in a new window]   Figure 13a.  Typical carcinoid in a 23-year-old woman with hemoptysis. (a) PA chest radiograph demonstrates left upper lobe atelectasis. (b) Chest CT scan (lung window) helps confirm the left upper lobe collapse and shows a lesion (*) obstructing the left upper lobe bronchus. (c) Photograph of a cut specimen of the resected left upper lobe shows the obstructing endobronchial tumor (*) and the distal bronchiectasis and mucoid impaction.

View larger version (140K): [in a new window]   Figure 13b.  Typical carcinoid in a 23-year-old woman with hemoptysis. (a) PA chest radiograph demonstrates left upper lobe atelectasis. (b) Chest CT scan (lung window) helps confirm the left upper lobe collapse and shows a lesion (*) obstructing the left upper lobe bronchus. (c) Photograph of a cut specimen of the resected left upper lobe shows the obstructing endobronchial tumor (*) and the distal bronchiectasis and mucoid impaction.

View larger version (96K): [in a new window]   Figure 13c.  Typical carcinoid in a 23-year-old woman with hemoptysis. (a) PA chest radiograph demonstrates left upper lobe atelectasis. (b) Chest CT scan (lung window) helps confirm the left upper lobe collapse and shows a lesion (*) obstructing the left upper lobe bronchus. (c) Photograph of a cut specimen of the resected left upper lobe shows the obstructing endobronchial tumor (*) and the distal bronchiectasis and mucoid impaction.

View larger version (106K): [in a new window]   Figure 14a. Figures 14, 15. (14) Typical carcinoid in a 35-year-old woman with recurrent pneumonia. (a) PA chest radiograph demonstrates consolidation and volume loss of the left lung. (b) Chest CT scan (lung window) demonstrates marked cystic bronchiectasis of the left lung. A carcinoid of the left mainstem bronchus was treated with pneumonectomy. (15) Typical carcinoid in a 48-year-old woman with recurrent right lower lobe pneumonia. (a) PA chest radiograph demonstrates consolidation of the right lower lobe. (b) Follow-up PA chest radiograph shows partial resolution of the consolidation and visualization of an ovoid mass (arrow) in the bronchus intermedius.

View larger version (105K): [in a new window]   Figure 14b. Figures 14, 15. (14) Typical carcinoid in a 35-year-old woman with recurrent pneumonia. (a) PA chest radiograph demonstrates consolidation and volume loss of the left lung. (b) Chest CT scan (lung window) demonstrates marked cystic bronchiectasis of the left lung. A carcinoid of the left mainstem bronchus was treated with pneumonectomy. (15) Typical carcinoid in a 48-year-old woman with recurrent right lower lobe pneumonia. (a) PA chest radiograph demonstrates consolidation of the right lower lobe. (b) Follow-up PA chest radiograph shows partial resolution of the consolidation and visualization of an ovoid mass (arrow) in the bronchus intermedius.

View larger version (151K): [in a new window]   Figure 15a. Figures 14, 15. (14) Typical carcinoid in a 35-year-old woman with recurrent pneumonia. (a) PA chest radiograph demonstrates consolidation and volume loss of the left lung. (b) Chest CT scan (lung window) demonstrates marked cystic bronchiectasis of the left lung. A carcinoid of the left mainstem bronchus was treated with pneumonectomy. (15) Typical carcinoid in a 48-year-old woman with recurrent right lower lobe pneumonia. (a) PA chest radiograph demonstrates consolidation of the right lower lobe. (b) Follow-up PA chest radiograph shows partial resolution of the consolidation and visualization of an ovoid mass (arrow) in the bronchus intermedius.

View larger version (150K): [in a new window]   Figure 15b. Figures 14, 15. (14) Typical carcinoid in a 35-year-old woman with recurrent pneumonia. (a) PA chest radiograph demonstrates consolidation and volume loss of the left lung. (b) Chest CT scan (lung window) demonstrates marked cystic bronchiectasis of the left lung. A carcinoid of the left mainstem bronchus was treated with pneumonectomy. (15) Typical carcinoid in a 48-year-old woman with recurrent right lower lobe pneumonia. (a) PA chest radiograph demonstrates consolidation of the right lower lobe. (b) Follow-up PA chest radiograph shows partial resolution of the consolidation and visualization of an ovoid mass (arrow) in the bronchus intermedius.

View larger version (171K): [in a new window]   Figure 16a.  Typical carcinoid in a 20-year-old man with a 3-year history of cough and recurrent pneumonia. (a) PA chest radiograph demonstrates a well-defined, lobular, left hilar mass. Tubular opacities project distal to the lesion. (b, c) Chest CT scans (mediastinal window, with b obtained at a lower level than c) demonstrate the mass, which contains central calcification and produces abrupt bronchial obstruction. Mucoid impaction is seen distal to the lesion in c.

View larger version (111K): [in a new window]   Figure 16b.  Typical carcinoid in a 20-year-old man with a 3-year history of cough and recurrent pneumonia. (a) PA chest radiograph demonstrates a well-defined, lobular, left hilar mass. Tubular opacities project distal to the lesion. (b, c) Chest CT scans (mediastinal window, with b obtained at a lower level than c) demonstrate the mass, which contains central calcification and produces abrupt bronchial obstruction. Mucoid impaction is seen distal to the lesion in c.

View larger version (109K): [in a new window]   Figure 16c.  Typical carcinoid in a 20-year-old man with a 3-year history of cough and recurrent pneumonia. (a) PA chest radiograph demonstrates a well-defined, lobular, left hilar mass. Tubular opacities project distal to the lesion. (b, c) Chest CT scans (mediastinal window, with b obtained at a lower level than c) demonstrate the mass, which contains central calcification and produces abrupt bronchial obstruction. Mucoid impaction is seen distal to the lesion in c.

View larger version (148K): [in a new window]   Figure 17a.  Typical carcinoid in an asymptomatic 68-year-old woman. (a) PA chest radiograph shows an ovoid, solitary, lingular nodule (arrow). (b) Chest CT scan (lung window) demonstrates the sharply marginated, ovoid, lobular pulmonary nodule. (c) Photograph of a cut specimen of the resected lung demonstrates a well-circumscribed, fleshy tumor nodule.

View larger version (134K): [in a new window]   Figure 17b.  Typical carcinoid in an asymptomatic 68-year-old woman. (a) PA chest radiograph shows an ovoid, solitary, lingular nodule (arrow). (b) Chest CT scan (lung window) demonstrates the sharply marginated, ovoid, lobular pulmonary nodule. (c) Photograph of a cut specimen of the resected lung demonstrates a well-circumscribed, fleshy tumor nodule.

View larger version (122K): [in a new window]   Figure 17c.  Typical carcinoid in an asymptomatic 68-year-old woman. (a) PA chest radiograph shows an ovoid, solitary, lingular nodule (arrow). (b) Chest CT scan (lung window) demonstrates the sharply marginated, ovoid, lobular pulmonary nodule. (c) Photograph of a cut specimen of the resected lung demonstrates a well-circumscribed, fleshy tumor nodule.

View larger version (130K): [in a new window]   Figure 18a.  Typical carcinoid in a 35-year-old man with a 3-month history of recurrent pneumonia. (a, b) Contrast-enhanced chest CT scans (lung [a] and mediastinal [b] windows) demonstrate an endobronchial mass in the posterior segmental bronchus of the right lower lobe with a distal tubular mucus plug. The mass enhances and is distinct from the low-attenuation mucus plug. (c) Photograph of a cut specimen of the resected right upper lobe shows the central tumor (*) and distal mucoid impaction.

View larger version (103K): [in a new window]   Figure 18b.  Typical carcinoid in a 35-year-old man with a 3-month history of recurrent pneumonia. (a, b) Contrast-enhanced chest CT scans (lung [a] and mediastinal [b] windows) demonstrate an endobronchial mass in the posterior segmental bronchus of the right lower lobe with a distal tubular mucus plug. The mass enhances and is distinct from the low-attenuation mucus plug. (c) Photograph of a cut specimen of the resected right upper lobe shows the central tumor (*) and distal mucoid impaction.

View larger version (128K): [in a new window]   Figure 18c.  Typical carcinoid in a 35-year-old man with a 3-month history of recurrent pneumonia. (a, b) Contrast-enhanced chest CT scans (lung [a] and mediastinal [b] windows) demonstrate an endobronchial mass in the posterior segmental bronchus of the right lower lobe with a distal tubular mucus plug. The mass enhances and is distinct from the low-attenuation mucus plug. (c) Photograph of a cut specimen of the resected right upper lobe shows the central tumor (*) and distal mucoid impaction.

View larger version (155K): [in a new window]   Figure 19a.  Typical carcinoid in a 35-year-old man with a 1-year history of fever, hemoptysis, and pneumonia. (a) PA chest radiograph demonstrates a lobular, right perihilar mass. (b, c) Chest CT scans (lung window, with b obtained at a slightly higher level than c) demonstrate the partially endobronchial mass. The bulk of the mass is extraluminal with a smaller intraluminal component. (d) Photograph of the bisected specimen demonstrates the ovoid, lobular, endoluminal mass with focal hemorrhage. Note the adjacent bronchial wall (arrow).

View larger version (150K): [in a new window]   Figure 19b.  Typical carcinoid in a 35-year-old man with a 1-year history of fever, hemoptysis, and pneumonia. (a) PA chest radiograph demonstrates a lobular, right perihilar mass. (b, c) Chest CT scans (lung window, with b obtained at a slightly higher level than c) demonstrate the partially endobronchial mass. The bulk of the mass is extraluminal with a smaller intraluminal component. (d) Photograph of the bisected specimen demonstrates the ovoid, lobular, endoluminal mass with focal hemorrhage. Note the adjacent bronchial wall (arrow).

View larger version (122K): [in a new window]   Figure 19c.  Typical carcinoid in a 35-year-old man with a 1-year history of fever, hemoptysis, and pneumonia. (a) PA chest radiograph demonstrates a lobular, right perihilar mass. (b, c) Chest CT scans (lung window, with b obtained at a slightly higher level than c) demonstrate the partially endobronchial mass. The bulk of the mass is extraluminal with a smaller intraluminal component. (d) Photograph of the bisected specimen demonstrates the ovoid, lobular, endoluminal mass with focal hemorrhage. Note the adjacent bronchial wall (arrow).

View larger version (140K): [in a new window]   Figure 19d.  Typical carcinoid in a 35-year-old man with a 1-year history of fever, hemoptysis, and pneumonia. (a) PA chest radiograph demonstrates a lobular, right perihilar mass. (b, c) Chest CT scans (lung window, with b obtained at a slightly higher level than c) demonstrate the partially endobronchial mass. The bulk of the mass is extraluminal with a smaller intraluminal component. (d) Photograph of the bisected specimen demonstrates the ovoid, lobular, endoluminal mass with focal hemorrhage. Note the adjacent bronchial wall (arrow).

View larger version (116K): [in a new window]   Figure 20.  Atypical carcinoid in a 54-year-old man with a 2-month history of cough. Thin-section chest CT scan (lung window) demonstrates a well-marginated, spherical pulmonary nodule that is partially endobronchial.

View larger version (156K): [in a new window]   Figure 21a.  Typical carcinoid in a 46-year-old man with a 2-month history of hemoptysis and shortness of breath. (a) PA chest radiograph shows a masslike consolidation in the superior segment of the right lower lobe. (b) Contrast-enhanced chest CT scan (mediastinal window) demonstrates mass effect on the lateral wall of the bronchus intermedius with dense distal consolidation. The mass (arrows) enhances minimally with contrast material and can thus be distinguished from the adjacent consolidated lung. (c) Photograph of a cut section of the surgical specimen shows the peribronchial neoplasm with endobronchial extension (arrow) surrounded by consolidated lung.

View larger version (115K): [in a new window]   Figure 21b.  Typical carcinoid in a 46-year-old man with a 2-month history of hemoptysis and shortness of breath. (a) PA chest radiograph shows a masslike consolidation in the superior segment of the right lower lobe. (b) Contrast-enhanced chest CT scan (mediastinal window) demonstrates mass effect on the lateral wall of the bronchus intermedius with dense distal consolidation. The mass (arrows) enhances minimally with contrast material and can thus be distinguished from the adjacent consolidated lung. (c) Photograph of a cut section of the surgical specimen shows the peribronchial neoplasm with endobronchial extension (arrow) surrounded by consolidated lung.

View larger version (122K): [in a new window]   Figure 21c.  Typical carcinoid in a 46-year-old man with a 2-month history of hemoptysis and shortness of breath. (a) PA chest radiograph shows a masslike consolidation in the superior segment of the right lower lobe. (b) Contrast-enhanced chest CT scan (mediastinal window) demonstrates mass effect on the lateral wall of the bronchus intermedius with dense distal consolidation. The mass (arrows) enhances minimally with contrast material and can thus be distinguished from the adjacent consolidated lung. (c) Photograph of a cut section of the surgical specimen shows the peribronchial neoplasm with endobronchial extension (arrow) surrounded by consolidated lung.

View larger version (104K): [in a new window]   Figure 22a.  Atypical carcinoid in a 25-year-old woman. (a) Chest CT scan (lung window) demonstrates an endoluminal mass (*) completely occluding the lumen of the left lower lobe bronchus. Note the overinflation of the left lower lobe secondary to obstruction. A pneumomediastinum is also present. (b) Photograph of the resected endobronchial lesion shows the fleshy, spherical, homogeneous, soft-tissue mass that straddled the left main and left lower lobe bronchi at the time of surgery.

View larger version (104K): [in a new window]   Figure 22b.  Atypical carcinoid in a 25-year-old woman. (a) Chest CT scan (lung window) demonstrates an endoluminal mass (*) completely occluding the lumen of the left lower lobe bronchus. Note the overinflation of the left lower lobe secondary to obstruction. A pneumomediastinum is also present. (b) Photograph of the resected endobronchial lesion shows the fleshy, spherical, homogeneous, soft-tissue mass that straddled the left main and left lower lobe bronchi at the time of surgery.

View larger version (124K): [in a new window]   Figure 23a.  Typical carcinoid in a 34-year-old woman with a 2-year history of wheezing, shortness of breath, and recurrent bronchitis. (a) Chest CT scan (lung window) demonstrates a well-marginated, ovoid, completely endoluminal nodule in the left mainstem bronchus. (b) Photograph of a cut specimen from a sleeve resection shows the fleshy tumor within the bronchial lumen.

View larger version (121K): [in a new window]   Figure 23b.  Typical carcinoid in a 34-year-old woman with a 2-year history of wheezing, shortness of breath, and recurrent bronchitis. (a) Chest CT scan (lung window) demonstrates a well-marginated, ovoid, completely endoluminal nodule in the left mainstem bronchus. (b) Photograph of a cut specimen from a sleeve resection shows the fleshy tumor within the bronchial lumen.

View larger version (160K): [in a new window]   Figure 24a.  Typical carcinoid in a 47-year-old woman with a 3-day history of hemoptysis. (a) PA chest radiograph demonstrates a well-marginated, ovoid, peripheral mass in the right lower lobe. (b) Thin-section chest CT scan (lung window) shows the well-defined notched lesion, which abuts a lower lobe bronchus. (c) Photograph of a cut specimen of the resected right lower lobe shows the mass and helps confirm its bronchial relationship (arrow).

View larger version (121K): [in a new window]   Figure 24b.  Typical carcinoid in a 47-year-old woman with a 3-day history of hemoptysis. (a) PA chest radiograph demonstrates a well-marginated, ovoid, peripheral mass in the right lower lobe. (b) Thin-section chest CT scan (lung window) shows the well-defined notched lesion, which abuts a lower lobe bronchus. (c) Photograph of a cut specimen of the resected right lower lobe shows the mass and helps confirm its bronchial relationship (arrow).

View larger version (118K): [in a new window]   Figure 24c.  Typical carcinoid in a 47-year-old woman with a 3-day history of hemoptysis. (a) PA chest radiograph demonstrates a well-marginated, ovoid, peripheral mass in the right lower lobe. (b) Thin-section chest CT scan (lung window) shows the well-defined notched lesion, which abuts a lower lobe bronchus. (c) Photograph of a cut specimen of the resected right lower lobe shows the mass and helps confirm its bronchial relationship (arrow).

View larger version (109K): [in a new window]   Figure 25a.  Atypical carcinoid in a 46-year-old man with a 2-year history of cough and hemoptysis. Contrast-enhanced chest CT scans (mediastinal window, with a obtained at a lower level than b) demonstrate a lobular mass (* in a) that abuts the bronchus intermedius. A large pretracheal lymph node (arrow in b) contained metastatic carcinoid at surgery.

View larger version (113K): [in a new window]   Figure 25b.  Atypical carcinoid in a 46-year-old man with a 2-year history of cough and hemoptysis. Contrast-enhanced chest CT scans (mediastinal window, with a obtained at a lower level than b) demonstrate a lobular mass (* in a) that abuts the bronchus intermedius. A large pretracheal lymph node (arrow in b) contained metastatic carcinoid at surgery.

View larger version (124K): [in a new window]   Figure 26a.  Typical carcinoid in an asymptomatic 46-year-old woman. On both T1-weighted (a) and T2-weighted (b) MR images, an ovoid mass of high signal intensity is seen.

View larger version (120K): [in a new window]   Figure 26b.  Typical carcinoid in an asymptomatic 46-year-old woman. On both T1-weighted (a) and T2-weighted (b) MR images, an ovoid mass of high signal intensity is seen.

View larger version (111K): [in a new window]   Figure 27a.  Typical carcinoid in an 18-year-old woman with a 3-month history of cough and hemoptysis. (a, b) Contrast-enhanced chest CT scans (mediastinal window, with a obtained at a higher level than b) show a mass in the left mainstem bronchus with distal volume loss, bronchiectasis, and consolidation. (c) Octreotide scintigram demonstrates uptake in the central carcinoid tumor. (d) Photograph of a cut section of the resected left lung shows the endobronchial neoplasm and distal consolidated lung.

View larger version (104K): [in a new window]   Figure 27b.  Typical carcinoid in an 18-year-old woman with a 3-month history of cough and hemoptysis. (a, b) Contrast-enhanced chest CT scans (mediastinal window, with a obtained at a higher level than b) show a mass in the left mainstem bronchus with distal volume loss, bronchiectasis, and consolidation. (c) Octreotide scintigram demonstrates uptake in the central carcinoid tumor. (d) Photograph of a cut section of the resected left lung shows the endobronchial neoplasm and distal consolidated lung.

View larger version (139K): [in a new window]   Figure 27c.  Typical carcinoid in an 18-year-old woman with a 3-month history of cough and hemoptysis. (a, b) Contrast-enhanced chest CT scans (mediastinal window, with a obtained at a higher level than b) show a mass in the left mainstem bronchus with distal volume loss, bronchiectasis, and consolidation. (c) Octreotide scintigram demonstrates uptake in the central carcinoid tumor. (d) Photograph of a cut section of the resected left lung shows the endobronchial neoplasm and distal consolidated lung.

View larger version (119K): [in a new window]   Figure 27d.  Typical carcinoid in an 18-year-old woman with a 3-month history of cough and hemoptysis. (a, b) Contrast-enhanced chest CT scans (mediastinal window, with a obtained at a higher level than b) show a mass in the left mainstem bronchus with distal volume loss, bronchiectasis, and consolidation. (c) Octreotide scintigram demonstrates uptake in the central carcinoid tumor. (d) Photograph of a cut section of the resected left lung shows the endobronchial neoplasm and distal consolidated lung.

View larger version (131K): [in a new window]   Figure 28.  Typical carcinoid in a 21-year-old woman with cough and fever. Image from bronchoscopy shows a well-defined, red, polypoid mass obliterating the lumen of the bronchus intermedius.

View larger version (234K): [in a new window]   Figure 29a.  Thymic carcinoid. (a) Low-power photomicrograph (original magnification, x40; H-E stain) shows a punctate focus of necrosis in the center of a nest of tumor cells. (b) High-power photomicrograph (original magnification, x400; H-E stain) shows a tumor that consists of uniform cells growing in ribbons. A mitotic figure is seen in the center, characteristic of the atypical histologic subtype of this lesion.

View larger version (215K): [in a new window]   Figure 29b.  Thymic carcinoid. (a) Low-power photomicrograph (original magnification, x40; H-E stain) shows a punctate focus of necrosis in the center of a nest of tumor cells. (b) High-power photomicrograph (original magnification, x400; H-E stain) shows a tumor that consists of uniform cells growing in ribbons. A mitotic figure is seen in the center, characteristic of the atypical histologic subtype of this lesion.

View larger version (138K): [in a new window]   Figure 30a.  Thymic carcinoid in an asymptomatic 84-year-old man. (a, b) PA (a) and lateral (b) chest radiographs show a large, lobular, right-sided anterior mediastinal mass. (c) Contrast-enhanced chest CT scan (mediastinal window) shows the heterogeneous soft-tissue mass intimately related to the heart. The lesion is indistinguishable from a thymoma. (d) Photograph of a cut section of the resected lesion shows the encapsulated mass with central areas of hemorrhage and necrosis.

View larger version (135K): [in a new window]   Figure 30b.  Thymic carcinoid in an asymptomatic 84-year-old man. (a, b) PA (a) and lateral (b) chest radiographs show a large, lobular, right-sided anterior mediastinal mass. (c) Contrast-enhanced chest CT scan (mediastinal window) shows the heterogeneous soft-tissue mass intimately related to the heart. The lesion is indistinguishable from a thymoma. (d) Photograph of a cut section of the resected lesion shows the encapsulated mass with central areas of hemorrhage and necrosis.

View larger version (102K): [in a new window]   Figure 30c.  Thymic carcinoid in an asymptomatic 84-year-old man. (a, b) PA (a) and lateral (b) chest radiographs show a large, lobular, right-sided anterior mediastinal mass. (c) Contrast-enhanced chest CT scan (mediastinal window) shows the heterogeneous soft-tissue mass intimately related to the heart. The lesion is indistinguishable from a thymoma. (d) Photograph of a cut section of the resected lesion shows the encapsulated mass with central areas of hemorrhage and necrosis.

View larger version (118K): [in a new window]   Figure 30d.  Thymic carcinoid in an asymptomatic 84-year-old man. (a, b) PA (a) and lateral (b) chest radiographs show a large, lobular, right-sided anterior mediastinal mass. (c) Contrast-enhanced chest CT scan (mediastinal window) shows the heterogeneous soft-tissue mass intimately related to the heart. The lesion is indistinguishable from a thymoma. (d) Photograph of a cut section of the resected lesion shows the encapsulated mass with central areas of hemorrhage and necrosis.