Endocrine Abstracts

A 38-year-old lady presented in 2003 with a 2 years history of recurrent pneumonia, with CXR having demonstrated intermittent right lower zone consolidation. CT of chest revealed dense right lower lobe consolidation and a 2.5 cm tumour occluding the right lower lobe orifice was found on bronchoscopy. Strongly positive immunohistochemical staining for chromogranin, NCAM, PGP 9.5 and synaptophysin suggested carcinoid so right lower and middle lobectomy was performed. Histology confirmed a classical carcinoid tumour with complete resection margins. She was discharged from follow up and remained well until 2011 when she was referred to our clinic with a right sided neck swelling associated with weight loss and back pain. The thyroid was enlarged with a firm nodular lump on the right side, and palpable cervical lymph nodes. BP was normal and she was clinically and biochemically euthyroid. Ultrasound revealed multiple suspicious lesions within the thyroid which appeared highly vascular. Enlarged lymph nodes were seen within the neck. Core biopsy suggested recurrent neuroendocrine tumour (NET), and subsequent imaging showed metastatic disease in the mediastinum, abdomen and skeleton. Biochemistry revealed elevated chromogranin A >300 pmol/l, calcitonin <14 ng/l, and normal urinary 5HIAA, catecholamines and metanephrines. Further imaging comprised octreotide scan which showed normal uptake, MIBG scan which found both lobes of the thyroid and some of liver lesions to be MIBG avid, although most of the metastases were not, raising the possibility of two synchronous cancers. FDG-PET scan, however, showed equally FDG avid disease in the skeleton, liver, subcarinal nodes and thyroid. The patient’s main symptom is back pain, so she was treated with radiotherapy to T11 (20 Gy in five fractions) and is receiving opiates and monthly pamidronate. She is eligible for a clinical trial examining the efficacy of everolimus vs. placebo. Octreotide has not been used therapeutically because she has neither symptoms of carcinoid syndrome nor octreotide avid disease on scanning. Carcinoid tumour presenting or recurring as a thyroid nodule is extremely rare, with very few cases previously reported. Although bronchial carcinoid tumours are typically indolent, this case highlights the importance of long term follow up of all patients with these tumours, an approach which is now recommended in a number of consensus guidelines.