Review began 02/28/2021 Review ended 03/11/2021 Published 03/12/2021 © Copyright 2021 Talon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Bronchoscopic Management of Endobronchial Atypical Carcinoid With Argon Plasma Coagulation and Laser: A Rare Case With Literature Review Andrew Talon , Melinda Wang , Ali Saeed 1. Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA 2. Interventional Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA Corresponding author: Andrew Talon, atalonmd@gmail.com Abstract Atypical carcinoid belongs to a spectrum of neuroendocrine tumors that can present as central airway obstruction. We treated a 58-year-old female who presented with recurrent pneumonia. Flexible bronchoscopy showed complete obstruction of the tumor in the right lower lobe. The tumor was excised by electrocautery snare followed by laser and argon plasma coagulation (APC). Endobronchial biopsy showed atypical carcinoid with lymph node metastasis. Succeeding bronchoscopic management, the patient’s symptoms improved. In our patient, bronchoscopy with laser and APC was performed to prevent tumor recurrence after resection and reduce the risk of recurrent postobstructive pneumonia. Surveillance computed tomography at six months showed no evidence of recurrence. Bronchoscopic management should be considered in poor surgical candidates or patients with metastatic disease. Categories: Cardiac/Thoracic/Vascular Surgery, Oncology, Pulmonology Keywords: atypical carcinoid, endobronchial tumor, interventional pulmonology, bronchocele Introduction Atypical carcinoid (AC) is a rare neuroendocrine tumor that can present as an obstructing endobronchial mass [1]. Contrasted to typical carcinoid, ACs have a higher malignant potential with lower survival rates [2,3]. Localized tumors have been historically managed by surgical resection as the mainstay of treatment [2,3]. Recent literature however has shown excellent long-term outcome after first-line bronchoscopic therapy of endobronchial carcinoid tumors in a subgroup of patients [2-4]. Compared to surgical resection, bronchoscopic management is minimally invasive and parenchyma sparing [2,3]. We present a case of endobronchial AC managed with bronchoscopy. Case Presentation A 58-year-old female developed dyspnea and a productive cough. She was diagnosed with pneumonia and received antibiotics. Despite this, her symptoms worsened. Computed tomography (CT) revealed lobulated finger-like opacities with consolidation in the right lower lobe (RLL) (Figure 1A). Flexible bronchoscopy found that the RLL was completely obstructed (Figure 1B). Removal of the mucoid impaction revealed an endobronchial tumor originating from the RLL medial basal segment (Figure 1C). The tumor was then excised piecemeal using an electrocautery snare and cryoprobe (Video 1). Tumor base coagulation was performed using diode laser and argon plasma coagulation (APC) for hemostasis (Video 1). All RLL branches were ultimately visualized following debulking (Figure 1D). The mediastinal staging was then performed with endobronchial ultrasound. Fine needle aspiration biopsy confirmed a neuroendocrine neoplasm favoring primary pulmonary AC with subcarinal and right lower paratracheal lymph node metastasis (Figures 2, 3). The patient was presented to the tumor board, deciding that she was a poor surgical candidate. Following our bronchoscopic intervention, the patient’s cough and dyspnea were immediately improved. She was referred to oncology and was treated with carboplatin- paclitaxel chemotherapy with concurrent fractionated radiotherapy. Surveillance CT at six months showed no evidence of recurrence. 1 1 2 Open Access Case Report DOI: 10.7759/cureus.13862 How to cite this article Talon A, Wang M, Saeed A (March 12, 2021) Bronchoscopic Management of Endobronchial Atypical Carcinoid With Argon Plasma Coagulation and Laser: A Rare Case With Literature Review . Cureus 13(3): e13862. DOI 10.7759/cureus.13862