A new presentation of neuroendocrine carcinoma of the lung Dr Aisling Fagan 1 , Mr Patrick Coughlin 1 , Dr Judith Babar 2 1 Department of Vascular Surgery, Addenbrooke’s Hospital, Cambridge. 2 Department of Radiology, Addenbrooke’s Hospital, Cambridge. Introduction Pulmonary neuroendocrine tumours make up 20-25% of lung malignancies. They include carcinoid, large-cell, and small-cell carcinomas. 1 These tumours often present with recurrent infections, chest pain, cough (with or without haemoptysis) and dyspnoea. They can often be asymptomatic, and picked up incidentally. 2 Case Report A 65 year-old man presented with an acutely ischaemic right leg. His past medical history included previous bladder cancer and he had a significant smoking history. Investigations CT angiogram of the lower limbs demonstrated an abrupt occlusion of the right superficial femoral artery. The limb was threatened, and so he underwent emergency embolectomy and 4- compartment fasciotomies. The thrombus was sent for histology as per unit protocol. X-ray of the chest demonstrated an incidental finding of a large opacity in the upper zone of the right lung. (Image A) Computerised tomography of the chest revealed a 6cm necrotic mass invading into the superior pulmonary vein. A filling defect in the pulmonary vein represented tumour invasion, with thrombus extending towards the left atrium. (Images B, C) Histology results from the retrieved lower limb embolus confirmed the diagnosis as poorly differentiated neuroendocrine carcinoma, most likely of lung origin. Why is this case important? This is the first known report of a neuroendocrine lung tumour presenting initially with acute limb ischaemia (however there is one previous report of first presentation with embolic stroke 3 ). This case demonstrates the importance of routine histopathological examination of retrieved emboli. A high threshold for investigation of unusual sources of emboli must be considered when dealing with acute limb ischaemia. For references please see handout provided A B C

A new presentation of neuroendocrine carcinoma of the lung · A new presentation of neuroendocrine carcinoma of the lung Dr Aisling Fagan1, Mr Patrick Coughlin1, Dr Judith Babar2

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Page 1: A new presentation of neuroendocrine carcinoma of the lung · A new presentation of neuroendocrine carcinoma of the lung Dr Aisling Fagan1, Mr Patrick Coughlin1, Dr Judith Babar2

A new presentation of neuroendocrine carcinoma of the lung Dr Aisling Fagan1, Mr Patrick Coughlin1, Dr Judith Babar2

1Department of Vascular Surgery, Addenbrooke’s Hospital, Cambridge. 2Department of Radiology, Addenbrooke’s Hospital, Cambridge.

Introduction Pulmonary neuroendocrine tumours make up 20-25% of lung malignancies. They include carcinoid, large-cell, and small-cell carcinomas.1

These tumours often present with recurrent infections, chest pain, cough (with or without haemoptysis) and dyspnoea. They can often be asymptomatic, and picked up incidentally.2

Case Report A 65 year-old man presented with an acutely ischaemic right leg. His past medical history included previous bladder cancer and he had a significant smoking history.

Investigations CT angiogram of the lower limbs demonstrated an abrupt occlusion of the right superficial femoral artery. The limb was threatened, and so he underwent emergency embolectomy and 4-compartment fasciotomies. The thrombus was sent for histology as per unit protocol.

X-ray of the chest demonstrated an incidental finding of a large opacity in the upper zone of the right lung. (Image A)

Computerised tomography of the chest revealed a 6cm necrotic mass invading into the superior pulmonary vein. A filling defect in the pulmonary vein represented tumour invasion, with thrombus extending towards the left atrium. (Images B, C)

Histology results from the retrieved lower limb embolus confirmed the diagnosis as poorly differentiated neuroendocrine carcinoma, most likely of lung origin.

Why is this case important?

This is the first known report of a neuroendocrine lung tumour presenting initially with acute limb ischaemia (however there is one previous report of first presentation with embolic stroke3). This case demonstrates the importance of routine histopathological examination of retrieved emboli. A high threshold for investigation of unusual sources of emboli must be considered when dealing with acute limb ischaemia. For references please see handout provided