Carcinoid tumors are rare in pediatric population at 2-4% of total cases (approximately 85 new cases per year). Incidence of neoplasms for 15-19 y/o population is 19.8/100,000, of which <5% are primary pulmonary origin. Carcinoids represent the most common of solid primary pulmonary tumors of childhood.

Thought to be of neuroendocrine "Kulchitsky's" cell origin, most prevalent during 5th/6th decade of life. More commonly found in the GI tract (85%) with metastases to bone, lymph nodes, liver and skin. Typically secrete serotonin, but may secrete numerous other vasoactive substances. Only 3-7% exhibit "Carcinoid Syndrome" Sx's of flushing, diarrhea, abdominal discomfort, wheezing, heart lesions or pellagra. Symptoms of pulmonary lesion include hemoptysis, dyspnea and post-obstructive pneumonia. 60% are central lesions and 15% have regional LN metastases at resection.

Based on tumor size, histology, and lack of metastases, W9720 has a 5 year survival of 87% and nearly the same for 10 years.

Radiology. W9720 CXR dated 15APR00 are suggestive of a post-obstructive process in the RML. The pattern is consolidative without air bronchograms. No mass is apparent. The R hemi-diaphragm is elevated by one rib above the L side. While the major fissure appears normal, the minor fissure is rotated caudally in the lateral view, suggesting a partial collapse/atalectasis. This would be consistent with an obstruction of the RML with resorption of air, counteracted by edema/inflammation of a pneumonia. That the RML is not completely collapsed can be demostrated on the lateral view; the RML shows as as a hyperdense wedge, but not a stripe or "pancake". The R heart border is obscured, so (at least) the medial segment is involved. Because of the small relative volume of the RML, the R hilum would not be expected to shift, and the pulmonary vessel markings may appear unchanged.

In the pediatric population, obstruction is most commonly the result of foreign body ingestion or mucous plugging. Neoplasm is more frequent in the >40 y/o population. Congenital abnormalities (webs, slings) would be expected to present earlier in childhood.