Atypical Presentation of Pulmonary Carcinoid Tumor With Pleural Involvement: Diagnostic and Surgical Challenges

TL;DR

A rare case of a lung tumor initially mistaken for a more aggressive cancer highlights the need for careful diagnosis and tailored treatment.

Contribution

The case challenges standard staging criteria for carcinoid tumors and emphasizes individualized surgical approaches.

Findings

Pleural involvement in a typical carcinoid tumor was not indicative of poor prognosis.

Frozen section diagnosis may be unreliable for neuroendocrine tumors.

Surgical management with lobectomy and lymph node dissection led to a disease-free outcome.

Abstract

This case report presents a diagnostically challenging pulmonary typical carcinoid tumor with localized pleural involvement, initially misdiagnosed intraoperatively as small cell carcinoma. Despite the presence of pleural nodules, typically staged as M1a disease, histopathology confirmed a low-grade neuroendocrine tumor with favorable features, including a low Ki-67 index and absence of necrosis. Somatostatin receptor imaging using 68Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) revealed no distant spread. The patient underwent definitive surgical management with lobectomy, pleurectomy, and lymph node dissection. Postoperative recovery was uneventful, and the patient remains disease-free. This case highlights the limitations of frozen section diagnosis in neuroendocrine tumors and challenges the prognostic implications of pleural involvement in typical carcinoid tumors. Individualized surgical decisions based on tumor biology, rather than rigid staging criteria, may be warranted.

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