DOI: 10.1148/rg.261055057
Neuroendocrine Tumors of the Lung: Clinical, Pathologic, and Imaging Findings1
Semin Chong, MD,
Kyung Soo Lee, MD,
Myung Jin Chung, MD,
Joungho Han, MD,
O Jung Kwon, MD and
Tae Sung Kim, MD
1 From the Department of Radiology and Center for Imaging Science (S.C., K.S.L., M.J.C., T.S.K.), Department of Pathology (J.H.), and Department of Medicine (O.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received March 21, 2005; revision requested April 19 and received May 2; accepted May 4. All authors have no financial relationships to disclose. Supported by the SRC/ERC program of MOST/KOSEF (R11-2002-103).
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Figure 1. Typical carcinoid. Photomicrograph (original magnification, x 100; hematoxylineosin stain) shows small nests of uniform cells.
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Figure 2. Atypical carcinoid. Photomicrograph (original magnification, x 400; hematoxylineosin stain) shows nuclear pleomorphism and mitosis (arrow).
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Figure 3a. Typical carcinoid in a 25-year-old man. (a) Chest radiograph shows a lobulated mass below the right hilum. (b) Axial thin-section (1.0-mm section thickness) computed tomographic (CT) scan of the right middle lobe shows the large (60-mm-diameter) mass with punctate calcifications (arrowheads). (c) Photograph of the gross specimen obtained with right lobectomy shows the large endobronchial mass with central ossification (arrowheads). (d) Photomicrograph (original magnification, x 100; hematoxylin-eosin stain) shows metaplastic bone (arrows) in the tumor.
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Figure 3b. Typical carcinoid in a 25-year-old man. (a) Chest radiograph shows a lobulated mass below the right hilum. (b) Axial thin-section (1.0-mm section thickness) computed tomographic (CT) scan of the right middle lobe shows the large (60-mm-diameter) mass with punctate calcifications (arrowheads). (c) Photograph of the gross specimen obtained with right lobectomy shows the large endobronchial mass with central ossification (arrowheads). (d) Photomicrograph (original magnification, x 100; hematoxylin-eosin stain) shows metaplastic bone (arrows) in the tumor.
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Figure 3c. Typical carcinoid in a 25-year-old man. (a) Chest radiograph shows a lobulated mass below the right hilum. (b) Axial thin-section (1.0-mm section thickness) computed tomographic (CT) scan of the right middle lobe shows the large (60-mm-diameter) mass with punctate calcifications (arrowheads). (c) Photograph of the gross specimen obtained with right lobectomy shows the large endobronchial mass with central ossification (arrowheads). (d) Photomicrograph (original magnification, x 100; hematoxylin-eosin stain) shows metaplastic bone (arrows) in the tumor.
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Figure 3d. Typical carcinoid in a 25-year-old man. (a) Chest radiograph shows a lobulated mass below the right hilum. (b) Axial thin-section (1.0-mm section thickness) computed tomographic (CT) scan of the right middle lobe shows the large (60-mm-diameter) mass with punctate calcifications (arrowheads). (c) Photograph of the gross specimen obtained with right lobectomy shows the large endobronchial mass with central ossification (arrowheads). (d) Photomicrograph (original magnification, x 100; hematoxylin-eosin stain) shows metaplastic bone (arrows) in the tumor.
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Figure 4a. Typical carcinoid in a 47-year-old woman. (a) Lateral chest radiograph shows atelectasis of the left lower lobe (arrows) and a central mass (arrowheads). (b) Axial CT scan (5.0-mm section thickness) obtained at the level of the left atrium shows a 20-mm-diameter endobronchial nodule (arrowhead) in the left basal trunk with attendant atelectasis of the left lower lobe (arrow).
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Figure 4b. Typical carcinoid in a 47-year-old woman. (a) Lateral chest radiograph shows atelectasis of the left lower lobe (arrows) and a central mass (arrowheads). (b) Axial CT scan (5.0-mm section thickness) obtained at the level of the left atrium shows a 20-mm-diameter endobronchial nodule (arrowhead) in the left basal trunk with attendant atelectasis of the left lower lobe (arrow).
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Figure 5a. Typical carcinoid in a 48-year-old man. (a) Chest radiograph shows a well-defined round mass in the right upper lobe. (b) Axial CT scan (5.0-mm section thickness) obtained with a mediastinal window shows the homogeneous mass.
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Figure 5b. Typical carcinoid in a 48-year-old man. (a) Chest radiograph shows a well-defined round mass in the right upper lobe. (b) Axial CT scan (5.0-mm section thickness) obtained with a mediastinal window shows the homogeneous mass.
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Figure 6a. Typical carcinoid in a 24-year-old woman. (a) Axial CT scan (5.0-mm section thickness), obtained at the level of the right middle lobar bronchus, shows a 13-mm-diameter nodule (arrow) in the superior segmental bronchus of the right lower lobe with distal mucus plugging (arrowheads). (b) Same image displayed with a mediastinal window shows significant enhancement of the endobronchial nodule (arrow). (c) Photograph of the gross specimen shows the yellow polypoid endobronchial nodule (arrow). Note the distal mucus plugging (arrowhead).
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Figure 6b. Typical carcinoid in a 24-year-old woman. (a) Axial CT scan (5.0-mm section thickness), obtained at the level of the right middle lobar bronchus, shows a 13-mm-diameter nodule (arrow) in the superior segmental bronchus of the right lower lobe with distal mucus plugging (arrowheads). (b) Same image displayed with a mediastinal window shows significant enhancement of the endobronchial nodule (arrow). (c) Photograph of the gross specimen shows the yellow polypoid endobronchial nodule (arrow). Note the distal mucus plugging (arrowhead).
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Figure 6c. Typical carcinoid in a 24-year-old woman. (a) Axial CT scan (5.0-mm section thickness), obtained at the level of the right middle lobar bronchus, shows a 13-mm-diameter nodule (arrow) in the superior segmental bronchus of the right lower lobe with distal mucus plugging (arrowheads). (b) Same image displayed with a mediastinal window shows significant enhancement of the endobronchial nodule (arrow). (c) Photograph of the gross specimen shows the yellow polypoid endobronchial nodule (arrow). Note the distal mucus plugging (arrowhead).
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Figure 7a. Typical carcinoid in a 41-year-old man. (a) Axial CT scan (5.0-mm section thickness), obtained at the level of the distal left main bronchus, shows a nodule (arrow) in the left upper divisional bronchus. (b) CT scan (mediastinal window) obtained 10 mm inferior to a shows the low-attenuation mass (arrow) in the lingular segmental bronchus. There was no associated atelectasis or obstructive pneumonia.
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Figure 7b. Typical carcinoid in a 41-year-old man. (a) Axial CT scan (5.0-mm section thickness), obtained at the level of the distal left main bronchus, shows a nodule (arrow) in the left upper divisional bronchus. (b) CT scan (mediastinal window) obtained 10 mm inferior to a shows the low-attenuation mass (arrow) in the lingular segmental bronchus. There was no associated atelectasis or obstructive pneumonia.
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Figure 8a. Typical carcinoid in a 60-year-old woman. (a) Axial CT scan (2.5-mm section thickness), obtained at the level of the left lower lobar bronchus, shows a multilobulated mass in the lingular segmental bronchus and at the lingular division. The mass has both endobronchial (arrow) and extrabronchial (arrowheads) components, producing a so-called iceberg tumor. (b) CT scan (mediastinal window) obtained 10 mm inferior to a shows the slightly heterogeneous parenchymal mass (arrowheads) at the lingular division. (c, d) Coronal reformatted images (2.5-mm section thickness) show the endobronchial (arrow in c) and extrabronchial (arrowheads in d) components of the tumor.
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Figure 8b. Typical carcinoid in a 60-year-old woman. (a) Axial CT scan (2.5-mm section thickness), obtained at the level of the left lower lobar bronchus, shows a multilobulated mass in the lingular segmental bronchus and at the lingular division. The mass has both endobronchial (arrow) and extrabronchial (arrowheads) components, producing a so-called iceberg tumor. (b) CT scan (mediastinal window) obtained 10 mm inferior to a shows the slightly heterogeneous parenchymal mass (arrowheads) at the lingular division. (c, d) Coronal reformatted images (2.5-mm section thickness) show the endobronchial (arrow in c) and extrabronchial (arrowheads in d) components of the tumor.
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Figure 8c. Typical carcinoid in a 60-year-old woman. (a) Axial CT scan (2.5-mm section thickness), obtained at the level of the left lower lobar bronchus, shows a multilobulated mass in the lingular segmental bronchus and at the lingular division. The mass has both endobronchial (arrow) and extrabronchial (arrowheads) components, producing a so-called iceberg tumor. (b) CT scan (mediastinal window) obtained 10 mm inferior to a shows the slightly heterogeneous parenchymal mass (arrowheads) at the lingular division. (c, d) Coronal reformatted images (2.5-mm section thickness) show the endobronchial (arrow in c) and extrabronchial (arrowheads in d) components of the tumor.
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Figure 8d. Typical carcinoid in a 60-year-old woman. (a) Axial CT scan (2.5-mm section thickness), obtained at the level of the left lower lobar bronchus, shows a multilobulated mass in the lingular segmental bronchus and at the lingular division. The mass has both endobronchial (arrow) and extrabronchial (arrowheads) components, producing a so-called iceberg tumor. (b) CT scan (mediastinal window) obtained 10 mm inferior to a shows the slightly heterogeneous parenchymal mass (arrowheads) at the lingular division. (c, d) Coronal reformatted images (2.5-mm section thickness) show the endobronchial (arrow in c) and extrabronchial (arrowheads in d) components of the tumor.
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Figure 9. Typical carcinoid in a 42-year-old man. Dynamic contrast-enhanced CT scans (2.5-mm section thickness), obtained after intravenous injection of 120 mL of contrast medium (iodine concentration, 36 g), show an 18-mm-diameter enhancing nodule in the right lower lobe. The attenuation of the nodule is 48 HU on the unenhanced image (T0), 102 HU (54 HU of net enhancement) on the 2-minute image (T120), and 92 HU (10 HU of wash-out) on the 15-minute image (T900).
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Figure 10. Atypical carcinoid in a 44-year-old woman. Dynamic contrast-enhanced CT scans (2.5-mm section thickness), obtained after intravenous injection of 120 mL of contrast medium (iodine concentration, 36 g), show a 28-mm-diameter enhancing nodule in the right middle lobe. The attenuation of the nodule is 39 HU on the unenhanced image (T0), 80 HU (41 HU of net enhancement) on the 90-second image (T90), and 66 HU (14 HU of wash-out) on the 15-minute image (T900).
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Figure 11a. Typical carcinoid in a 56-year-old man. (a) Coronal reformatted image (2.5-mm section thickness) shows a 41-mm-diameter, moderately enhancing, homogeneous mass (arrow) in the right lower lobe. (b) On a PET image, the mass demonstrates little FDG uptake (arrow).
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Figure 11b. Typical carcinoid in a 56-year-old man. (a) Coronal reformatted image (2.5-mm section thickness) shows a 41-mm-diameter, moderately enhancing, homogeneous mass (arrow) in the right lower lobe. (b) On a PET image, the mass demonstrates little FDG uptake (arrow).
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Figure 12a. Atypical carcinoid in a 42-year-old woman. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the basal segmental bronchi shows a small (10-mm-diameter), well-defined nodule (arrow) in the left lower lobe. (b) CT scan (mediastinal window) obtained at the level of the left basal trunk shows enlarged left hilar lymph nodes (arrows). (c) FDG PET image shows a hypermetabolic lesion (standardized uptake value = 11.2) at the left hilum (arrow), a finding suggestive of malignancy. The small pulmonary nodule shown in a demonstrated little FDG uptake. At histopathologic analysis of the specimen obtained with left pneumonectomy, the small pulmonary nodule was an atypical carcinoid and the ipsilateral hilar lymph nodes were metastatic with extracapsular invasion.
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Figure 12b. Atypical carcinoid in a 42-year-old woman. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the basal segmental bronchi shows a small (10-mm-diameter), well-defined nodule (arrow) in the left lower lobe. (b) CT scan (mediastinal window) obtained at the level of the left basal trunk shows enlarged left hilar lymph nodes (arrows). (c) FDG PET image shows a hypermetabolic lesion (standardized uptake value = 11.2) at the left hilum (arrow), a finding suggestive of malignancy. The small pulmonary nodule shown in a demonstrated little FDG uptake. At histopathologic analysis of the specimen obtained with left pneumonectomy, the small pulmonary nodule was an atypical carcinoid and the ipsilateral hilar lymph nodes were metastatic with extracapsular invasion.
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Figure 12c. Atypical carcinoid in a 42-year-old woman. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the basal segmental bronchi shows a small (10-mm-diameter), well-defined nodule (arrow) in the left lower lobe. (b) CT scan (mediastinal window) obtained at the level of the left basal trunk shows enlarged left hilar lymph nodes (arrows). (c) FDG PET image shows a hypermetabolic lesion (standardized uptake value = 11.2) at the left hilum (arrow), a finding suggestive of malignancy. The small pulmonary nodule shown in a demonstrated little FDG uptake. At histopathologic analysis of the specimen obtained with left pneumonectomy, the small pulmonary nodule was an atypical carcinoid and the ipsilateral hilar lymph nodes were metastatic with extracapsular invasion.
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Figure 13. LCNEC. Photomicrograph (original magnification, x 100; hematoxylin-eosin stain) shows a neuroendocrine appearance with peripheral palisading and rosettes. Note the area of necrosis (arrow).
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Figure 14. LCNEC in a 52-year-old man. Axial CT scan (5.0-mm section thickness) obtained at the level of the right middle lobar bronchus shows a well-defined, 8-cm-diameter mass abutting the chest wall in the right lower lobe.
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Figure 15a. LCNEC in a 64-year-old man. (a) Dynamic contrast-enhanced CT scans (2.5-mm section thickness), obtained after intravenous injection of 120 mL of contrast medium (iodine concentration, 36 g), show a 23-mm-diameter peripheral nodule in the right lower lobe. The attenuation of the nodule is 44 HU on the unenhanced image (T0), 92 HU (48 HU of net enhancement) on the 2-minute image (T120), and 80 HU (12 HU of washout) on the 15-minute image (T900). (b) Photograph of the pathologic specimen shows a well-defined, whitish tan, soft nodule (arrow).
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Figure 15b. LCNEC in a 64-year-old man. (a) Dynamic contrast-enhanced CT scans (2.5-mm section thickness), obtained after intravenous injection of 120 mL of contrast medium (iodine concentration, 36 g), show a 23-mm-diameter peripheral nodule in the right lower lobe. The attenuation of the nodule is 44 HU on the unenhanced image (T0), 92 HU (48 HU of net enhancement) on the 2-minute image (T120), and 80 HU (12 HU of washout) on the 15-minute image (T900). (b) Photograph of the pathologic specimen shows a well-defined, whitish tan, soft nodule (arrow).
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Figure 16a. LCNEC in a 57-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the thoracic inlet shows a 32-mm-diameter mass with a lobulated margin in the right upper lobe. (b) CT scan obtained at the level of the right upper lobar bronchus shows enlarged lymph nodes in the right lower paratracheal area (arrowhead) and at the right hilum (arrow). At mediastinoscopic examination, the right lower paratracheal nodes contained malignant cells.
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Figure 16b. LCNEC in a 57-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the thoracic inlet shows a 32-mm-diameter mass with a lobulated margin in the right upper lobe. (b) CT scan obtained at the level of the right upper lobar bronchus shows enlarged lymph nodes in the right lower paratracheal area (arrowhead) and at the right hilum (arrow). At mediastinoscopic examination, the right lower paratracheal nodes contained malignant cells.
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Figure 17a. LCNEC in a 72-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the hepatic dome shows a 20-mm-diameter nodule (arrow) in the right lower lobe. (b) Axial PET image shows that the nodule (arrow) is hypermetabolic (peak standardized uptake value = 8.2).
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Figure 17b. LCNEC in a 72-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the hepatic dome shows a 20-mm-diameter nodule (arrow) in the right lower lobe. (b) Axial PET image shows that the nodule (arrow) is hypermetabolic (peak standardized uptake value = 8.2).
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Figure 18a. LCNEC in a 63-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the distal right main bronchus shows a 37-mm-diameter mass (arrow) in the right upper lobar bronchus. (b) CT scan (lung window) shows the proximal end of the endobronchial mass (arrow) and peripheral mucus plugging (arrowhead). (c) Photograph of the gross specimen shows the yellow endobronchial mass (arrow) and distal mucus plugging (arrowheads).
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Figure 18b. LCNEC in a 63-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the distal right main bronchus shows a 37-mm-diameter mass (arrow) in the right upper lobar bronchus. (b) CT scan (lung window) shows the proximal end of the endobronchial mass (arrow) and peripheral mucus plugging (arrowhead). (c) Photograph of the gross specimen shows the yellow endobronchial mass (arrow) and distal mucus plugging (arrowheads).
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Figure 18c. LCNEC in a 63-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the distal right main bronchus shows a 37-mm-diameter mass (arrow) in the right upper lobar bronchus. (b) CT scan (lung window) shows the proximal end of the endobronchial mass (arrow) and peripheral mucus plugging (arrowhead). (c) Photograph of the gross specimen shows the yellow endobronchial mass (arrow) and distal mucus plugging (arrowheads).
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Figure 19. SCLC. Photomicrograph (original magnification, x 400; hematoxylin-eosin stain) shows high cellularity; the small round cells have scanty cytoplasm and coarse chromatin. Note the frequent mitoses.
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Figure 20a. SCLC in a 55-year-old man. (a) Chest radiograph shows bilateral enlargement at the pulmonary hilum. (b) Coronal contrast-enhanced reformatted CT scan (2.5-mm section thickness) shows enlargement of right hilar and left superior mediastinal (arrowhead) lymph nodes. (c) Coronal PET image shows strong FDG uptake in bilateral hilar (straight arrows), subcarinal (curved arrow), and left lower paratracheal (arrowhead) lymph nodes.
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Figure 20b. SCLC in a 55-year-old man. (a) Chest radiograph shows bilateral enlargement at the pulmonary hilum. (b) Coronal contrast-enhanced reformatted CT scan (2.5-mm section thickness) shows enlargement of right hilar and left superior mediastinal (arrowhead) lymph nodes. (c) Coronal PET image shows strong FDG uptake in bilateral hilar (straight arrows), subcarinal (curved arrow), and left lower paratracheal (arrowhead) lymph nodes.
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Figure 20c. SCLC in a 55-year-old man. (a) Chest radiograph shows bilateral enlargement at the pulmonary hilum. (b) Coronal contrast-enhanced reformatted CT scan (2.5-mm section thickness) shows enlargement of right hilar and left superior mediastinal (arrowhead) lymph nodes. (c) Coronal PET image shows strong FDG uptake in bilateral hilar (straight arrows), subcarinal (curved arrow), and left lower paratracheal (arrowhead) lymph nodes.
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Figure 21a. SCLC in a 59-year-old man. (a) Axial contrast-enhanced CT scan (5.0-mm section thickness) obtained at the level of the aortic arch shows enlarged lymph nodes in the right paratracheal (arrows) and bilateral prevascular (arrowheads) areas with extracapsular invasion. (b) CT scan obtained at the level of the right middle lobar bronchus shows enlarged subcarinal (arrow) and right hilar (arrowhead) lymph nodes.
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Figure 21b. SCLC in a 59-year-old man. (a) Axial contrast-enhanced CT scan (5.0-mm section thickness) obtained at the level of the aortic arch shows enlarged lymph nodes in the right paratracheal (arrows) and bilateral prevascular (arrowheads) areas with extracapsular invasion. (b) CT scan obtained at the level of the right middle lobar bronchus shows enlarged subcarinal (arrow) and right hilar (arrowhead) lymph nodes.
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Figure 22a. Peripheral SCLC in a 46-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the ventricles shows a 22-mm-diameter nodule with a well-defined margin in the left lower lobe. (b) Photograph of the gross specimen shows the white solid nodule (arrow).
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Figure 22b. Peripheral SCLC in a 46-year-old man. (a) Axial CT scan (5.0-mm section thickness) obtained at the level of the ventricles shows a 22-mm-diameter nodule with a well-defined margin in the left lower lobe. (b) Photograph of the gross specimen shows the white solid nodule (arrow).
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Figure 23. Peripheral SCLC in a 62-year-old man. Dynamic contrast-enhanced CT scans (2.5-mm section thickness), obtained after intravenous injection of 120 mL of contrast medium (iodine concentration, 36 g), show a 17-mm-diameter peripheral nodule in the right lower lobe. The attenuation of the nodule is 51 HU on the unenhanced image (T0), 101 HU (50 HU of net enhancement) on the 4-minute image (T240), and 98 HU (3 HU of washout) on the 15-minute image (T900).
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Copyright © 2006 by the Radiological Society of North America.
