The major impact of proGRP monitoring in advanced atypical lung carcinoid: A case report

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Introduction: Atypical lung carcinoids (aLC) are more aggressive than typical carcinoids, metastasizing more commonly to distant sites, and require vigilant follow-up. However, the surveillance is often hampered by the non-informative Chromogranin A (CgA) levels.

Aim(s): To review a case of the patient with atypical lung carcinoid in which pro-gastrin releasing peptide (proGRP) marker monitoring was valuable in the clinical management.

Materials and methods: A 63-year-old female was referred to the ENETS Center of Excellence clinic for the reassessment of an advanced aLC disease. A year prior to referral, the patient underwent a left lower lobectomy for a preoperative diagnosis of localized lung carcinoid. Pathology revealed a 3.3 cm atypical carcinoid tumor with a mitotic count of 4/2mm2 and KI67 12%. Preoperative and postoperative CgA levels were 65 and 88 ng/ml [ULN 98], respectively. Upon arrival at our clinic, Ga68 DOTATATE PET/CT imaging revealed hepatodominant metastatic disease with photopenic bilobar hepatic lesions and increased radiotracer uptake in mediastinal lymph nodes and bone lesions. Serum proGRP level was 5656 pg/ml [ULN 65]. Pathology from biopsied liver lesion revealed a tumor with features similar to primary lung lesion and Ki67 38%. Somatostatin analogue therapy was initiated and liver transarterial chemoembolization (TACE) was performed.

Conference: 18th Annual ENETS Concerence (2021)

Presenting Author:

Authors: Oleinikov K, Ben-Haim S, Atlan K, Nisman B, Bloom A,

Keywords: pro-GRP, lung carcinoids, biomarker,