70 year old female with dry cough and history of Stage 1 Carcinoid

• 7 years ago
  • Mass  in left upper lobe
  • multiple other nodules
  • 

    Growth in 1 Year

    

• PET
  • Focal moderate uptake in a left apical subpleural pulmonary
    nodule.
  • No suspicious lymph node tracer uptake.
• CT guided biopsy
  • positive for neurendocrine tumor
    • POS for STAINING OF THE LESIONAL CELLS FOR
      • SYNAPTOPHYSIN AND
      • C HROMOGRANIN.
      • TTF-1 IS FOCALLY POSITIVE.
      • KI-67 SHOWS A LOW PROLIFERATIVE NUCLEAR STAINING PATTERN.
      • THIS IMMUNOPROFILE SUPPORTS
        THE DIAGNOSIS.
• 4 years ago re thyroid
  • prior benign FNA of right mid thyroid nodule, (5years ago)
  • prior left lobectomy
• dry cough for > 6 years that feels
• minimal smoking exposure (5 py),
• 4 YEARS AGO
  • PFTs in
    • no obstruction
    • reduced spiro (potentially due to cough)
    • normal lung volumes
    • moderately reduced DL.
  • CT imaging
    • subtle mosaicism and
    • lung nodules.
  • 1 YEAR AGO
    • cough is unchanged
    • CT Imaging 1 year ago
      • diffuse mosaicism – actual air trapping
        – PFTs with 6MWT ordered today, can be scheduled with follow up
        – follow up CT chest ordered for 6/2023 by cardiothoracic surgery ; will request that this include insp/exp images

Slowly Growing Nodules

6 yrs Ago

Current

 

 

• • Important considerations
    • Mosaicism is actually air trapping becasue the study is performed in expiration
    • Nodules have enlarged since 6 years prior particularly the largest in the middle lobe