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Bronchial carcinoid tumours
A pulmonary carcinoid is a low-grade (typical) or intermediate-grade (atypical) neuroendocrine tumour, usually appearing as a central endobronchial mass in a relatively young patient with recurrent pneumonia or haemoptysis; treatment is surgical resection with node dissection, and when possible a parenchyma-sparing resection such as sleeve resection.
Why it matters in the exam
The distinction between typical and atypical carcinoid by WHO rests on the number of mitoses and on necrosis: typical — under 2 mitoses per 2 mm², without necrosis; atypical — 2 to 10 mitoses per 2 mm² and/or punctate necrosis. Above 10 mitoses it is already a neuroendocrine carcinoma (large cell or small cell carcinoma). Prognosis differs greatly: for typical carcinoid 5-year survival is above 90%, and for atypical it is lower, with more nodal involvement and recurrence. The typical patient is younger than other lung cancer patients, sometimes a non-smoker, and presents with recurrent pneumonia in the same lobe, unilateral wheeze or haemoptysis. Carcinoid syndrome is rare in a lung tumour and appears mainly when there are liver metastases; sometimes the tumour secretes ACTH and causes Cushing syndrome.
On bronchoscopy a smooth, reddish, vascular endobronchial tumour is seen; biopsy may bleed, so it is done with care. Imaging: CT, and PET with a somatostatin receptor tracer (Ga-68 DOTATATE) is more sensitive than FDG-PET in a typical tumour, which sometimes does not take up FDG. Treatment is surgery: lobectomy or sleeve resection (which avoids pneumonectomy for a central tumour), always with systematic node dissection, because even typical tumours involve nodes in a minority of cases. Endoscopic removal alone is not standard curative treatment. Adjuvant treatment is not routinely given after complete resection of a typical tumour.
Long-term follow-up is required, because late recurrence is possible even years after surgery, especially in an atypical tumour.
Key points
- Central endobronchial mass in a young patient.
- Typical — fewer than 2 mitoses, no necrosis.
- Somatostatin receptor PET.
- Parenchyma-sparing surgery with node dissection.
- Long-term follow-up.
Summary table
| Type | Mitoses and necrosis | Prognosis | Treatment |
|---|---|---|---|
| Typical carcinoid | Fewer than 2 per 2 mm², no necrosis | 5-year survival above 90% | Resection with node dissection |
| Atypical carcinoid | 2–10 per 2 mm² or punctate necrosis | Lower; more nodes and recurrence | Resection and dissection; further treatment by stage |
| Neuroendocrine carcinoma | Above 10 per 2 mm² | Poor | By guidelines for high-grade lung cancer |
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Sources
- ESMO Clinical Practice Guideline: Lung and thymic carcinoids, 2021 — Diagnosis, treatment and follow-up
- WHO Classification of Tumours: Thoracic Tumours, 5th edition (2021) — Lung neuroendocrine neoplasms
- NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors, 2025 — Lung neuroendocrine tumors
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.