Recurrent carcinoid twenty-two years following bronchial carcinoid resection.

We present the case of a 52-year-old woman who developed a cough and had subsequent investigations revealing hepatic metastases of carcinoid tumor. The patient was in her usual state of good health when she noted a cough persistent for 2 months. Her past medical history was notable for resection of a right middle lobe (RML) bronchus carcinoid when she was 5 months pregnant at 30 years of age. This was identified due to hemoptysis. She is Gr4, P4 and has had mild right paresis due to cerebral palsy. Family history is notable for dementia in her mother and an undefined normocytic normochromic (N/N) anemia in her father. Social history and review of systems is negative except for a N/N anemia. Physical exam was unchanged. A chest x-ray revealed RML stranding. A chest CT was done and revealed RML scarring and four lesions in the liver. A CT of the abdomen and colonoscopy were done and were negative. Serologic markers of carcinoid were obtained and were elevated. Specialist consultations were obtained and the patient opted for conservative therapy of metastatic carcinoid with octreotide given her asymptomatic state. Recurrent metastatic carcinoid tumors have been described but not at such a large interval as 22 years. Chemotherapy, radiation, thermal ablation and resection are becoming standard therapy for symptomatic metastases. Patients without symptoms present a therapeutic dilemma. Close clinical monitoring and octreotide therapy are indicated in this setting. Vigilance for late metastases of remote carcinoid tumors may be indicated.

Jama Peacock, MD, Holly Wasniewski, DO, and Gary R Dunkerley, MD. St Clare's Hospital, Family Practice Residency, Schenectady, NY.