ACTH-PRODUCING PERIPHERAL PULMONARY CARCINOID

The paper describes a clinical example of the topical diagnosis of adrenocorticotropic hormone (ACTH)-producing typical peripheral pulmonary carcinoid. The first stage in its diagnosis was to rule out the production of ACTH by the pituitary gland. The paper presents information on the most common localization of functioning neuroendocrine tumors, as well as a diagnostic algorithm to search for an ectopic focus of the ACTH-secreting tumor that causes hypercorticism. Taking into account that bronchopulmonary neuroendocrine tumors with ectopic hormone production occur rarely (5%), a clinical example is given to demonstrate the capabilities of imaging techniques and standards for their implementation using an integrated approach.

ectopic ACTH secretion, functioning neuroendocrine tumors, CT semiotics of typical peripheral carcinoid, lung scintigraphy

1. Кузнецов Н.С., Латкина Н.В., Добрева Е.А. АКТГ-эктопированный синдром: клиника, диагностика, лечение. Эндокринная хирургия. 2012; 1: 24–36. [Kuznetsov N.S., Latkina N.V., DobrevaE.A. Ectopic ACTH syndrome: clinical picture, diagnosis, treatment. Endokrinnaya Khirurgiya (Endocrine Surgery). 2012; 1: 24–36 (in Russ.).]

2. Гуревич Л.Е., Бессмертная В.С., Бритвин Т.А., Полякова Г.А., Пантелеева Е.И., Богатырев О.П., Самойлов М.А. АКТГ-эктопированный синдром, обусловленный нейроэндокринной опухолью поджелудочной железы (клиническое наблюдение). Анналы хирургии. 2010; 2: 73–5.DOI: 10.18821/1560-9502-20102-73-75 [Gurevich L.E., Bessmertnaya V.S., Britvin T.A., PolyakovaG.A., Panteleeva E.I., BogatyrevO.P., Samoilov M.A. ACTH-ectopic syndrome associated with neuroendocrinal tumor of pancreas (clinical observation). Russian Journal of Surgery. 2010; 2: 73–5. (in Russ.). DOI: 10.18821/15609502-2010-2-73-75]

3. Maragliano R., Vanoli A., Albarello L., Milione M., Basturk O., Klimstra D.S. et al. ACTH-secreting pancreatic neoplasms associated with cushing syndrome (Clinicopathologic study of 11 cases and review of the literature). Am.J. Surg. Pathol. 2015; 39 (3): 374–82. DOI: 10.1097/PAS. 0000000000000340

4. Дедов И.И., Беленков Ю.Н., Беличенко О.И., Мельниченко Г.А. Магнитно-резонансная томография в диагностике заболеваний гипоталамо-гипофизарной системы надпочечников. М.: Медицина; 1997. [Dedov I.I., Belenkov Yu.N., Belichenko O.I., Mel’nichenko G.A. Magnetic resonance imaging in the diagnosis of diseases of the hypothalamicpituitary system of the adrenal glands. Moscow: Meditsina; 1997 (in Russ.).]

5. Тер-Ованесов М.Д., ПолоцкийБ.Е. Карциноидные опухоли торакальной локализации – современное состояние проблемы. Практическая онкология. 2005; 6(4): 220–6. [Ter-Ovanesov M.D., Polotskiy B.E. Carcinoid tumors of the thoracic localization – the state of the problem. Prakticheskaya Onkologiya (Practical Oncology). 2005; 6 (4): 220–6 (in Russ.).]

6. Rekhtman N. Neuroendocrine tumors of the lung. Arch. Pathol. Labor. Med. 2010; 134 (11): 1628–38. DOI: 10.1043/2009-0583-RAR.1

7. Arnold C. Neuroendocrine tumors of the gastrointestinal tract. Schweiz. Rundsch. Med. Prax. 2007; 96 (1–2): 9–28.

8. Кочатков А.В., Замолодчиков Р.Д. Эпидемиология нейроэндокринных неоплазий. В кн.: ГорбуноваВ.А. (ред.) Нейроэндокринные опухоли. Общие принципы диагностики и лечения. М.: Кодекс; 2015: 7–23. [Kochatkov A.V., Zamolodchikov R.D. Epidemiology of neuroendocrine neoplasms. In: Gorbunova V.A. (Ed.) Neuroendocrine tumor. General principles of diagnosis and treatment. Moscow: Kodeks; 2015: 7–23 (inRuss.).]

9. Phan A.T., Oberg K., Choi J., Harrison L.H. Jr, Hassan M.M., Strosberg J.R. et al. North American Neuroendocrine Tumor Society (NANETS). NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the thorax (includes lung and thymus). Pancreas. 2010; 39: 784–98. DOI: 10.1097/МРА.0b013е3181ес1380

10. Travis W., Brambilla E., Burke A., Marx A., Nicholson A. Introduction to The 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart. J. Thorac. Oncol. 2015; 10 (9): 1240–3. DOI: 10.1097/JTO.0000000000000630

11. Пальцев М.А., Кветной И.М. Руководство по нейроиммуноэндокринологии. М.: Медицина; 2008: 256–64. [Pal’tsev M.A., Kvetnoy I.M. Guide to neuroimmunoendocrinology. Moscow: Meditsina; 2008: 256–64 (in Russ.).]

12. Алексеева Т.Р. Дифференциальная диагностика опухолей и диссеминированных процессов в легких: Дис. … д-ра мед. наук. М.; 2006: 197–225. [Alekseeva T.R. Differential diagnosis of tumors and disseminated processes in the lungs. Dr. Med. Sc. Diss. Moscow; 2006: 197–225 (in Russ.).]

13. Гуревич Л.Е., Воронкова И.А., Марова Е.И., Рожинская Л.Я., Лапшина А.М., Бритвин Т.А., Комердус И.В. Клинико-морфологическая характеристика АКТГпродуцирующих опухолей различной локализации с эктопическим синдромом Кушинга. Альманах клинической медицины.2017; 45 (4): 289–301. DOI: 10.18786/20720505-2017-45-4-289-301 [Gurevich L.E., Voronkova I.A., Marova E.I., Rozhinskaya L.Ya., Lapshina A.M., Britvin T.A., Komerdus I.V. Clinical and morphological characteristic of ACTH producing tumors of various localization and the ectopic Cushing’s syndrome. Al’manakh Klinicheskoy Meditsiny (Almanac of Clinical Medicine). 2017; 45 (4): 289–301 (in Russ.). DOI: 10.18786/2072-0505-201745-4-289-301]

14. Алексеева Т.Р., Смирнова Е.А., Чистякова О.В., Райхлин Н.Т., Волкова Н.Л. Лучевая диагностика нейроэндокринных опухолей. В кн.: Горбунова В.А. (ред.) Нейроэндокринные опухоли. Общие принципы диагностики и лечения. М.: Кодекс; 2015: 103–14. [Alekseeva T.R., Smirnova E.A., Chistyakova O.V., Raykhlin N.T., Volkova N.L. Radiation diagnosis of neuroendocrine tumors. In: Gorbunova V.A. (Ed.) Neuroendocrine tumor. General principles of diagnosis and treatment. Moscow: Kodeks; 2015: 103–14 (inRuss.).]

15. Kwekkeboom D.J., Krenning E.P. Somatostatin reseptor imaging. Seminars in nuclear medicine. 2002; 32 (2): 84–91. DOI: 10.1053/snuc.2002.31022

16. Schillaci O., Spanu A., Scopinaro F., Falchi A., Danieli R., Marongiu P. et al. Somatostatin receptor scintigraphy in liver metastasis detection from gastroenteropancreatic neuroendocrine tumors. J. Nucl. Med. 2003; 44: 359–68.

17. Pacak K., Ilias I., Chen C.C., Carrasquillo J.A., Whatley M., Nieman L.K. The role of [18F] fluorodeoxyglucose positron emission tomography and [111In] diethylenetriaminepentaacetate-D-Phe-pentetreotide scintigraphy in the localization of ectopic adrenocorticotropinsecreting tumors causing Cushing's syndrome. J. Clin. Endocrinol. Metab. 2004; 89: 2214–21. DOI: 10.1210/jc.2003-031812

18. Yao J.C., Hassan M., Phan A., Dagohoy C., Leary C. One hundred year after “carcinoid”: epidemiology of and prognosis factors for neuroendocrine tumors in 35825 cases in US. J. Clin. Oncol. 2008; 26: 3063–72. DOI: 10.1200/JCO.2007.15.4377