HEMATEMESIS AS UNIQUE PRESENTING SYMPTOM OF TYPICAL PULMONARY CARCINOID IN A 13-YEARS-OLD GIRL

Pulmonary carcinoids (PCs) are rare tumors and the most common primary lung neoplasm in children and adolescents. Respiratory symptoms (recurrent chest infections, cough, hemoptysis, chest pain, wheezing) are generally present only in forms originated from the center of the bronchial tree, while peripheral forms are generally discovered as an incidental finding in the course of radiological procedure carried out for other reasons. A 13-years-old girl was referred to our pediatric emergency unit for hematemesis. She never complained in recent weeks of any respiratory symptom, fever or fatigue. On physical examination, she was eupnoic and her oxygen saturation was 96% in room air. Additional negative exam findings included absence of nasal varicose vessels, oral or upper airway lesions, and gastric bleeding. Laboratory test including coagulation tests were normal. A chest X-ray was concerning for a consolidation area in the lower right lobe with pleural effusion obliterating the costophrenic angle. The patient was admitted to the hospital and a computed tomography scan of the chest demonstrated a solid tissue density completely occluding the proximal aspect of the lower right bronchus. She subsequently underwent bronchoscopy with biopsy and partial disobstruction with laser diode of the highly vascularized endobronchial mass. Histological analysis revealed typical carcinoid (TC). A later thoracic surgery was undertaken with the requisite to macroscopic removal of the mass with inferior bi-lobectomy and lymph node dissection. Her postoperative course was uncomplicated. Histology of the removed tissue confirmed a TC without pleural involvement. The girl was enrolled for long term follow-up.