In medicine we often come across things that still brings in an element of surprise. We have known the disease but not always expect the diagnosis as it is not the common one and so when we see that then we are surprised . The story that I am going to tell is one such story .
I saw this patient at the request of primary care physician. It is not very common that a primary care physician calls me 'personify'. We do get request to a patient ASAP or STAT. But on rare occasions the physician calls and want to talk to me . This time I had a message that he wanted to talk to me ASAP. He had seen a patient who had cough. He was a 66 years old patient, who had not smoked for 30 years. He had cough and so he saw PCP and was treated with usual medicines - cough syrup, an antibiotic and when that did not work an Inhaler - bronchodilator inhaler. He continued to have cough and and so the PCP did a CT scan of the chest . The CT scan showed a growth in the one of the bronchus and so he was sent to me. I saw the patient and he was little obese male. He had high blood pressure and had no other medical history. He had quit smoking many years ago and he had cough for 6-8 weeks . He had some rattling in the chest and when I asked he did have at one or 2 times blood tinged sputum. The medicines that the PCP had given had not helped much . The CT scan did show a growth in the bronchus and that did noit look like mucous plug The lung segment distant to the growth was collapsed . There was no question that he had a mass in the bronchus and that was blocking the entry of the air going tn the middle part and to some extent lower part of the lung. The mass was irritating the bronchus and to get that out the body was reacting by having bad coughing spells.
I explained the patient that I am concerned about cancer and we will do the work up . He was scheduled for the PET scan - which picks up concentration of the glucose and that tells us the chance of malignancy and if the cancer had spread to other organs . We also ordered breathing test - to know if in case we decide to cut part of the lung that has cancer , he has enough breathing capacity to tolerate the surgery. I also decided to do bronchoscopy and see if we can do the biopsy of the mass. I am not sure why but I also told him that there is a possibility that this Growth could be BENIGN and not a cancer. .I did the bronchoscopy and I saw a shinning smooth surface mass obstructing middle and lower lobe bronchus. The look was that of a benign growth called CARCINOID. The lung cancer has appearance of chewed meat - very irregular friable and not smooth surface mass . The cancers have more blood supply and so they bleed easily. THIS MASS did not have that appearance. The carcinoid tumors are considered benign growth that SOMETIMES CAN SPREAD or the other way to say it is that CARCINOID is a malignant tumor that RARELY SPREADS. In any case the treatment is to do surgery. The carcinoid tumors also bleed when biopsied . So the best option is to have surgeon cut the part of the lung that has carcinoid.
So all that glitter is not GOLD and not a likely to be cancer but is or may be CARCINOID.
