Background and Clinical Significance: This article explores the complexity of large-cell neuroendocrine carcinoma (LCNEC) by presenting a clinical case involving a 17-year-old admitted for persistent wheezing, with no history of respiratory toxin exposure, a background of atopy, and a suspected diagnosis of bronchial asthma. Given the patient’s age and the nature of the symptoms, the condition was initially diagnosed as asthma, leading to the initiation of maximum inhalation therapy. Case Presentation: Despite proper adherence and correct administration, symptoms persisted, necessitating the use of oral corticosteroids. Imaging revealed an extensive inhomogeneous mass in the cervical esophagus and trachea, along with a similar tumor in the right hilum, prompting bronchoscopy. The diagnosis of LCNEC was confirmed through imaging, histopathological findings, and a detailed immunohistochemical profile. Initially misdiagnosed as adenoid cystic carcinoma, this case highlights the diagnostic challenges and the importance of rigorous evaluation. Conclusions: It emphasizes that recurrent wheezing in adolescents is not always indicative of asthma and requires careful differential diagnosis to uncover less common causes.

The interaction between LC and active TB has been known for many years. The first description of ‘cancerous phthisis’ was reported by Bayle in 1810. The results of subsequent attempts to establish an etiological correlation between the two clinical entities have ranged from insignificant—even antagonistic—to a direct causal relationship. This narrative review explores the relationship between tuberculosis and LC assessing overall and site-specific malignancy risks in individuals with TB compared with the general population. We also examine the timing of cancer development following TB, highlighting periods of elevated risk. Chronic inflammation, immune dysregulation, and metabolic changes associated with TB may contribute to tumor initiation and progression, with organ-specific factors influencing susceptibility to cancers such as lung, head and neck, gastrointestinal, and hematologic malignancies. Clinically, awareness of these interactions supports targeted TB screening in high-risk cancer patients, careful monitoring for TB reactivation during cancer therapy, and consideration of immunological and metabolic factors when planning treatment.

Background: Spirometric airflow obstruction frequently remains unrecognised in community settings, representing a major diagnostic gap in chronic respiratory disease management. Population-based epidemiological data from Romanian coastal communities–characterised by a highly dynamic population including residents, seasonal workers, and tourists–remain scarce. This study aimed to estimate the prevalence of screening-detected pre-bronchodilator airflow obstruction and chronic respiratory diseases, characterise smoking behaviours including novel tobacco product use, identify individuals at elevated risk for sleep apnea, and examine patterns of preventive care and healthcare utilisation across five Black Sea coastal localities. Methods: A cross-sectional survey was conducted among 979 adults from five coastal localities in Constanța County, Romania, as part of a community-based respiratory screening campaign conducted 11–16 August 2025: Neptun (n = 147), Olimp (n = 178), Saturn (n = 187), Mangalia (n = 257), and Jupiter (n = 210). Data were collected using a structured questionnaire covering 22 domains, including medical diagnoses, spirometric measurements (FEV1/FVC%), sleep quality, snoring, anthropometric parameters, comorbidities, and healthcare utilisation. Airflow obstruction was defined as an FEV1/FVC ratio < 70%. The primary outcome of interest was the prevalence of screening-detected pre-bronchodilator airflow obstruction, including among individuals without a prior respiratory diagnosis. Sleep apnea risk was defined by the co-reporting of habitual snoring and witnessed apneic episodes, used as a two-item screening proxy. Results: Among 979 participants (51.4% female; mean age 47.3 ± 13.5 years), 9.3% had at least one CRD: asthma (4.4%), chronic bronchitis (3.0%), COPD (1.7%), and emphysema (0.3%). CRD prevalence increased with age, from 6.1% in individuals <40 years to 24.2% in those aged 71–80 years. Of 973 participants with spirometry data, 17.9% demonstrated airflow obstruction (FEV₁/FVC < 70%), including 15.7% without a prior respiratory diagnosis, representing previously unrecognised airflow limitation rather than confirmed chronic disease. Screening-defined OSA-risk positivity, based on a two-item proxy of habitual snoring and witnessed apnoeic episodes, was identified in 10.9% (n = 107) and was more common among obese participants (19.5% vs. 7.9%; absolute difference 11.6 percentage points; p < 0.001). Current smoking was reported by 35.2%, and 8.9% reported the use of novel tobacco products. Influenza vaccination coverage was 20.0%, while pneumococcal vaccination uptake was 3.4%. Conclusions: One in six adults without a prior respiratory diagnosis demonstrated spirometric airflow limitation, suggesting that opportunistic spirometry in primary care could substantially improve case detection in Romanian coastal communities. OSA risk, assessed by symptom-based screening proxy, was present in 10.9% of participants, with higher BMI as the strongest independent predictor among the variables assessed. High smoking prevalence (35.2%) and critically low pneumococcal vaccination coverage (3.4%) represent additional modifiable public health targets. These findings support a unified community respiratory screening approach incorporating spirometry, sleep apnea risk stratification, and vaccination audit, particularly in primary care settings serving coastal populations with dynamic demographics.

We report the case of a 30-year-old female, non-smoker, with no known allergies or occupational exposures, presenting with a two-year history of recurrent stridor and wheezing, recently exacerbating over the past two months. Physical examination and routine laboratory tests were largely unremarkable. Pulmonary function tests were within normal limits, with no significant bronchodilator response. Chest CT revealed a 15 × 13 mm perihilar right-sided lesion adjacent to the right pulmonary artery. Bronchoscopy identified a nearly obstructive, highly vascularized endobronchial lesion at the origin of the right lower lobe bronchus, with involvement of the carina between the right middle and lower lobe bronchi. Histopathology confirmed a typical bronchial carcinoid. The patient underwent open right middle and lower lobe bilobectomy. What renders this case unusual is the combination of a prolonged two-year diagnostic delay with initial misdiagnosis as asthma, the critical anatomical location of the tumor at the bronchus intermedius with early involvement of the right middle lobe carina, and the consequent necessity of bilobectomy despite an otherwise low-risk, typical carcinoid histology. This case underscores the importance of considering endobronchial neoplasms in young, non-smoking patients with refractory or atypical airway symptoms, and highlights the role of integrated imaging and bronchoscopic evaluation in guiding individualized surgical planning.