Bronchial carcinoid tumours are carcinoid tumours principally occurring in relation to the bronchus. These are classified as neuroendocrine neoplasms of the lungs. Endobronchial obstruction is caused due to either benign or malignant growth. Additionally stricture & blood clot pose a significant threat to a patient’s health. Bronchial carcinoids are relatively uncommon, including only 1%–2% of all lung tumours. Some of the major symptoms are cough, fever, expectoration, wheezing, haemoptysis, chest pain and asthma. Complete cure from this disease can be only achieved through total surgical excision.
Case Study: Symptoms & Diagnosis
Recently at Rukmini Birla Hospital, Pulmonology & Interventional Pulmonology department came across one such rare case of endobronchial carcinoid tumour. The patient was a young boy, 24 years of age, only child of his parents. Hailing from a city in Rajasthan, this young boy had been coughing up blood for some time. Initially he was evaluated outside and he took symptomatic treatments but failed respond positively. His CT scan of lungs showed a tumour in the wind pipe of right lung with a further need to do a broncoscopy test.
Broncoscopy test is done to look through the patient’s airways primarily to observe haemoptysis (bleeding). It involves very high risk in view of bleeding during procedure; therefore the patient was referred to the department of Pulmonology at CK Birla Hospitals.
Treatment at RBH – CK Birla Hospital:
The course of treatment for bronchial carcinoid includes endobronchial removal of tissue and restoring passage with bronchoscopy and/or by surgical means. Endobronchial removal of tumour can be considered as the primary modality of treatment in carefully selected patients. Endobronchial removal of tumour/blood clot and relieving or narrowing are preferably done with rigid bronchoscopy under general anaesthesia in dedicated endoscopy suite/OT with team of trained anaesthetist and bronchoscopy technicians.
In the Department of Pulmonology & Interventional Pulmonology of Rukmini Birla Hospital, under Dr. Rakesh Godara’s supervision, the patient was taken for rigid broncoscopy procedure and it was found that there was a large growth that was completely blocking the right side of wind pipe. Dr. Godara then operated the tumour successfully and the bleeding was controlled effectively. Biopsy of the tumour showed typical Carcinoid.
In this particular case, Dr. Godara has commendably operated on a rare endobronchial resection of carcinoid tumour with rigid bronchoscopy, by application of cautery/ APC. This particular patient had an unusual tumour which had a very high risk of bleeding. According to Dr. Godara “this was the first case of rigid bronchoscopy along with endobronchial removal of tumour done in Rajasthan.” This was a great challenge for Dr. Godara and his team, but through their expertise, the procedure was a great success and also the first procedure of such sorts to be done in Rajasthan. Most patients with Endo bronchial tumour blockage are referred to higher centres.
Dr. Prachish Prakash, Unit Head, Rukmani Birla Hospital, Jaipur said “CK Birla Hospital -RBH has dedicated Interventional Pulmonology suite with both flexible and rigid bronchoscopy and medical thoracoscopy instruments. RBH is supported by a team of specialists who offer cure for most of the respiratory diseases”. Dr. Godara is part of this team. He is a trained Pulmonary, Critical care specialist and Interventional Pulmonologist. He has worked previously in Sir Gangaram Hospital, New Delhi and Apollo Hospitals, Bengaluru for almost a decade and for a short stint in cleveland clinic, USA. At RBH all kinds of procedures are done including bronchoalveolar lavage, transbronchial needle aspiration, transbronchial lung biopsy (TBLB), stricture dilatation &balloon bronchoplasty, endobronchial cautery/ argon plasma coagulation (APC), pleuroscopy with pleural biopsy, pleurodesis. Under the strict supervision of Dr. Godara and his team, complete recovery is ensured for each and every patient with utmost care and special focus on post-operative treatment.