Broncholithiasis mimicking a bronchial carcinoid tumour.

A 29-year-old woman was transferred to our unit with a diagnosis of bronchial carcinoid tumour. She complained of chest pain, dyspnoea, cough and haemoptysis. She smoked 20 cigarettes per day and denied any history of tuberculosis, histoplamosis or occupational exposure and her family history was strongly positive for cancer. She had undergone a contrastenhanced CT scan of the chest in the endocrinology unit which showed a partially calcified mass in the left hilum (fig 1A, arrow). Further pulmonary scintigraphy with In-octreotide showed a concentration of the isotope in the left hilar region (fig 1B, arrow) and a positron emission tomographic scan with F-FDG (FDG-PET) showed that the mass had an uptake suggestive of bronchial carcinoid tumour (fig 1C, arrow). Carcinoembryonal antigen (CEA) and tissue-specific polypeptide (TSP) levels were 7.9 ng/ml (normal 0–4) and 122.0 U/l (normal 0–80), respectively. Fibreoptic bronchoscopy revealed a pedunculated mass which bled easily occluding the left upper bronchus (fig 1D), and a CT-guided fine needle aspiration of the mass yielded inconclusive results. The patient underwent a left superior lobectomy with mediastinal lymphadenectomy. At gross examination, the mass measured 2.5 cm and appeared solid and pale. The histological diagnosis was broncholithiasis of the left upper bronchus (fig 2). One year later the patient is in good health with no sign of recurrence. It is noteworthy that the mass showed significant FDG activity on the PET scan and concentration of In-octreotide on scintigraphy. Furthermore, the values of CEA and TSP were abnormally high, and bronchoscopy revealed an easily bleeding mass suggestive of bronchial carcinoid tumour.