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Bronchial Adenoma

Bronchus Adenoma

Despite the fact that the term 'bronchial adenoma' suggests a non-neoplastic disease, it really stands for a multitude of tumor types, originating from the bronchial glands or epithelium, like carcinoid, adenoid cystic carcinoma, mucoepidermoid carcinoma or mucous gland adenoma. These neoplasms have a more or less prominent malignant potential that dictates clinical evolution.


Presentation

Bronchial adenoma may be asymptomatic, especially if located in a distal area. In these cases, they are discovered incidentally. When the disease does induce clinical manifestations, these may mimic other conditions, like asthma or pneumonia. Symptoms like a cough (dry or productive), dyspnea, stridor or wheezing are caused by the existence of a bronchial obstruction, while hemoptysis is due to the rupture of the tumor vessels. Carcinoid syndrome is less frequently encountered [1] [2] and more difficult to clinically diagnose [3], but it occurs in most patients that have liver metastases. Symptoms consist of asthma-like symptoms, flushing, palpitations and diarrhea. Furthermore, a recurrent infectious episode may complicate disease evolution and recognition.

When the tumor is big enough to compress neighboring structures, it may induce hoarseness, chest pain or chylothorax. Large tumors are more often found in the right lung rather than the left. The patient may complain of paraplegia, vertebral pain or sensory deficit due to acute spinal cord compression. Upper limbs may be painful and occasionally present with muscular atrophy. Horner syndrome (miosis, hemifacial anhidrosis, and partial ptosis) is caused by Pancoast tumors. Sometimes, the physician encounters a superior vena cava syndrome, characterized by dilated upper extremities and jugular veins, facial edema, papilledema and mental changes. Patients may also exhibit low-grade fever and weight loss. Breath sounds may prove asymmetric on auscultation and this method sometimes reveals condensation (pneumonia or abscess) processes distal to the obstruction site. Auscultation is occasionally consistent with emphysema or pleural effusion [4]. The tumor itself may cause increased work of breathing with intercostal retractions, dyspnea, orthopnea, and cyanosis.

Bronchial carcinoid has also been described in the pediatric population. This age group is often symptomatic and have recurrent pulmonary infectious episodes [5]. If a cough or wheezing do not properly respond to standard therapy, bronchial adenoma or carcinoid suspicion should be rapidly raised and investigated [6].

Fever
  • The diagnosis of bronchial adenoma in children is often delayed due to erroneous interpretation of the secondary manifestations of pneumonitis, fever, or wheezing.[ncbi.nlm.nih.gov]
  • Patients may also exhibit low-grade fever and weight loss. Breath sounds may prove asymmetric on auscultation and this method sometimes reveals condensation (pneumonia or abscess) processes distal to the obstruction site.[symptoma.com]
  • […] diagnostic CXR/Chest CT: atelectasis, post-obstructive pneumonia Clinical Wheezing Stridor Cough Post-Obstructive Pneumonia Lung Nodule (see Lung Nodule or Mass , [[Lung Nodule or Mass]]) Dyspnea Hemoptysis (see Hemoptysis , [[Hemoptysis]]): may occur Fever[mdnxs.com]
  • CASE REPORT A 32-year-old Kashmiri woman was referred to our hospital with chief complaints of hemoptysis, cough, and fever of 2-year duration. She was diagnosed as pulmonary tuberculosis and took antitubercular treatment for 6 months.[ncbi.nlm.nih.gov]
  • A 32-year-old Kashmiri woman was referred to our hospital with chief complaints of hemoptysis, cough, and fever of 2-year duration. She was diagnosed as pulmonary tuberculosis and took antitubercular treatment for 6 months.[lungindia.com]
Cough
  • Abstract Of 16 patients with bronchial adenoma who were operated on at Beilinson Medical Center from 1967 to 1980, only three presented the "triad" of cough, hemoptysis, and recurrent pulmonary infections.[ncbi.nlm.nih.gov]
  • If a cough or wheezing do not properly respond to standard therapy, bronchial adenoma or carcinoid suspicion should be rapidly raised and investigated.[symptoma.com]
  • The commonest presenting symptoms were hemoptysis, persistent cough, dyspnea and chest pain.[ncbi.nlm.nih.gov]
  • The commonest presenting symptoms were haemoptysis, cough, sputum, and repeated chest infections. Positive bronchoscopic biopsy occurred in 35 of 43 cases; five of these were originally reported as carcinomata, of oat-cell type in four.[ncbi.nlm.nih.gov]
  • The majority of patients with this tumor complain of cough and hemoptysis. 4 The cough may be “dry” or productive of copious amounts of sputum, depending on the degree of parenchymal obstruction and secondary infection.[mdedge.com]
Hemoptysis
  • The procedure was safe and none of the patients had massive hemoptysis following bronchoscopic biopsy. Limited follow-up revealed good results following surgery.[ncbi.nlm.nih.gov]
  • The patient also had a long-standing history of bronchial asthma and hemoptysis and the delay in establishing the eventured diagnosis was caused by the minor symptoms mimicking those of asthma.[ncbi.nlm.nih.gov]
  • Abstract Of 16 patients with bronchial adenoma who were operated on at Beilinson Medical Center from 1967 to 1980, only three presented the "triad" of cough, hemoptysis, and recurrent pulmonary infections.[ncbi.nlm.nih.gov]
  • Bronchial adenoma commonly present as : (LQ) A Recurrent hemoptysis B Cough C Dysponea D Chest pain Ans. A Recurrent hemoptysis Bronchial adenoma: Rare, slow-growing. 90% are carcinoid tumours; 10% cylindromas.[gradestack.com]
  • Symptoms like a cough (dry or productive), dyspnea, stridor or wheezing are caused by the existence of a bronchial obstruction, while hemoptysis is due to the rupture of the tumor vessels.[symptoma.com]
Dyspnea
  • Symptoms like a cough (dry or productive), dyspnea, stridor or wheezing are caused by the existence of a bronchial obstruction, while hemoptysis is due to the rupture of the tumor vessels.[symptoma.com]
  • The commonest presenting symptoms were hemoptysis, persistent cough, dyspnea and chest pain.[ncbi.nlm.nih.gov]
  • The 1st case was a 46 year-old female with chief complaints of dyspnea and abnormal chest x-ray. The bronchoscopy revealed a tumor in the left main bronchus, and the biopsy showed a cylindroid type of bronchial adenoma.[jstage.jst.go.jp]
  • […] occurs as sessile or polypoid mass in main or lobar bronchus EBB: diagnostic CXR/Chest CT: atelectasis, post-obstructive pneumonia Clinical Wheezing Stridor Cough Post-Obstructive Pneumonia Lung Nodule (see Lung Nodule or Mass , [[Lung Nodule or Mass]]) Dyspnea[mdnxs.com]
  • Persons with central lesions have symptoms of obstruction and bleeding , which include the following: Dyspnea (difficulty breathing) is caused by partial obstruction of the windpipe or large bronchi.[emedicinehealth.com]
Dry Cough
  • Common Symptoms of Tracheal Cancer: Breathlessness Difficulty swallowing Coughing up blood Frequent chest infections Dry cough or hoarse voice Recurring fever Chills Wheezing or noisy breathing Smoking is also a risk factor.[wvcancercenter.com]
Orthopnea
  • The tumor itself may cause increased work of breathing with intercostal retractions, dyspnea, orthopnea, and cyanosis. Bronchial carcinoid has also been described in the pediatric population.[symptoma.com]
Cutaneous Manifestation
  • Carcinoid syndrome is a clinical entity that includes cardiovascular, gastrointestinal, respiratory, and cutaneous manifestations.[thehealthscience.com]
Anhidrosis
  • Horner syndrome (miosis, hemifacial anhidrosis, and partial ptosis) is caused by Pancoast tumors.[symptoma.com]
Facial Edema
  • Sometimes, the physician encounters a superior vena cava syndrome, characterized by dilated upper extremities and jugular veins, facial edema, papilledema and mental changes. Patients may also exhibit low-grade fever and weight loss.[symptoma.com]
Papilledema
  • Sometimes, the physician encounters a superior vena cava syndrome, characterized by dilated upper extremities and jugular veins, facial edema, papilledema and mental changes. Patients may also exhibit low-grade fever and weight loss.[symptoma.com]

Workup

Blood workup in bronchial adenoma should include a complete blood cell count that will help differentiate pneumonia from other types of pulmonary condensation. The presence of anemia suggests significant blood loss by hemoptysis. A patient with severe respiratory distress should undergo an arterial blood gas determination, that may reveal decreased oxygen and increased carbon dioxide concentrations. A sputum culture is only useful if a distal infectious process exists. More specific markers are synaptophysin, calcitonin, bombesin, serotonin, neuron-specific enolase, corticotropin and antidiuretic hormone, keeping in mind that all of these are also increased in small cell lung cancer. Immunohistochemistry identifies tumor secretory substances.

The presence of a tumor can be suspected on a plain thoracic radiograph, but its type cannot be specified [7]. Supplementary views, like the oblique ones, are sometimes useful. This investigation highlights the presence of different aspects, such as pleural effusion (that masks everything beneath it), a nodule or mass, an atelectasis area due to bronchial obstruction or infiltrative process. Hilar lymphadenopathy may signify infection or tumor [8]. A normal radiological aspect does not necessarily exclude the disease. Therefore, in selected cases, a computed tomography (CT) scan can provide further information regarding calcification, compression, and location, as well as bronchiectasis or peripheral atelectasis. Contrast enhancement is homogeneous in typical carcinoid and less prominent in atypical one. Osseous metaplasia can also be encountered. Two-thirds of patients, those with somatostatin-positive tumors can be identified using octreotide or 99m technetium depreotide single-photon emission CT scanning, which represents alternative diagnosis methods.

Bronchoscopy, despite the fact that it is an invasive procedure, should be performed in uncertain cases [9]. It should also be completed by fine needle aspiration or bronchial biopsy [10] [11].

Atelectasis
  • Therefore, in selected cases, a computed tomography (CT) scan can provide further information regarding calcification, compression, and location, as well as bronchiectasis or peripheral atelectasis.[symptoma.com]
  • Chest radiography Films may demonstrate a nodule, mass, infiltrate or atelectasis, mediastinal or hilar lymphadenopathy, or pleural effusion. Findings may be due to bronchial obstruction. Radiological findings are frequently nondiagnostic.[emedicine.medscape.com]
  • The chest x-ray showed an atelectasis in the right lower lung field, and a tumor was recognized in the right lower bronchus by bronchoscopy and bronchography.[jstage.jst.go.jp]
  • Canalicular adenoma: Sebaceous adenoma: Clinical Endobronchial Nodule/Mass (see Obstructive Lung Disease , [[Obstructive Lung Disease]]) Diagnosis FOB: usually occurs as sessile or polypoid mass in main or lobar bronchus EBB: diagnostic CXR/Chest CT: atelectasis[mdnxs.com]
  • CT scanning should always be performed if the radiograph continues to show atelectasis over a period of 2-3 months. Definitive diagnosis is made with bronchoscopy.[indiacancersurgerysite.com]

Treatment

  • If your cancer does return, your doctor will try the same treatments, or new treatments to stop its spread. Support Treatment for bronchial adenoma can be stressful.[webmd.com]
  • Treatment is by thoracotomy with total excision of the lesion.[ncbi.nlm.nih.gov]
  • Treatment Which treatment you get depends on your: Type and stage of cancer Age Health Preferences Options include: Surgery. This is the main treatment for bronchial adenomas. The surgeon will remove the cancer and some of the tissue around it.[alsehhat.com]
  • We conclude that the long-term prognosis of patients with bronchial adenoma is excellent, and limited surgical procedure should be the treatment of choice whenever possible.[ncbi.nlm.nih.gov]
  • Bronchoscopic CO2-laser ablation is an effective treatment and provides an alternative to aggressive thoracotomy.[ncbi.nlm.nih.gov]

Prognosis

  • We conclude that the long-term prognosis of patients with bronchial adenoma is excellent, and limited surgical procedure should be the treatment of choice whenever possible.[ncbi.nlm.nih.gov]
  • Their prognosis depends on the histology of the tumor, and on the presence of metastasis to the regional lymph nodes and distant organs.[ncbi.nlm.nih.gov]
  • Abstract Continued uncertainty about the prognosis for patients with bronchial adenomata led to a review of the experience of this condition in the Brompton Hospital.[ncbi.nlm.nih.gov]
  • Mucous Gland Adenoma regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful information HERE.[dovemed.com]
  •  Overall prognosis: 75% 15-year survival  Associated with Cushing’s Disease  Rare[learningradiology.com]

Etiology

  • Concerning the possible etiology of bronchial adenoma, Stout 7 in 1943 reported finding all of the features of the oncocytes previously described by Hamperl. 6 Stout stressed the great difference between the oncocytes and other cells in the bronchial[mdedge.com]
  • Etiology Bronchial carcinoids are thought to arise from Kulchitsky cells. These neuroendocrine cells, formerly classified as amine precursor uptake and decarboxylation cells, produce and store biogenic amines and peptides.[thehealthscience.com]
  • […] lesions with less cartilaginous and ductal differentiation Epidemiology Very rare ( 40 cases reported), predominantly in young adults, age range 8 - 74 years Possibly shows slight F M Sites Usually in trachea and major bronchi, rarely in distal bronchi Etiology[pathologyoutlines.com]

Epidemiology

  • Epidemiology xxx Physiology Benign mucoepithelial tumor of the lung Mucoepithelial tumors: rare tumors that arise from the mucous glands of the upper airway (trachea/ bronchi)/ oropharynx (tumor arising from salivary gland is named for that origin, but[mdnxs.com]
  • Epidemiology This is a very rare tumour occurring from childhood to old age. Clinical features Patients usually present with features of obstruction. Radiology The tumour is usually central but may be peripheral, forming a "coin lesion".[e-immunohistochemistry.info]
  • Epidemiology Frequency United StatesBronchial adenomas represent 1-3% of pulmonary malignancies. Carcinoids account for approximately 85% of bronchial adenomas and 1-2% of all lung malignancies.[thehealthscience.com]
  • Epidemiology Frequency United States Bronchial adenomas represent 1-3% of pulmonary malignancies. Carcinoids account for approximately 85% of bronchial adenomas and 1-2% of all lung malignancies.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Symptoms develop from the growth of the tumors within the tracheobronchial tree, with consequent obstruction leading to cough, hemoptysis, atelectasis, or pneumonia.[thehealthscience.com]
  • Pathophysiology Symptoms develop from the growth of the tumors within the tracheobronchial tree, with consequent obstruction leading to cough, hemoptysis, atelectasis, or pneumonia. [1] Adenoid cystic carcinoma behaves very similar to major and minor[emedicine.medscape.com]

Prevention

  • […] these are benign tumors and no malignant transformation is noted Please find comprehensive information on Pulmonary Mucous Gland Adenoma regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention[dovemed.com]
  • Deterrence/Prevention No preventive regimen has been established. Smoking cessation is always a good thing but has no specific effect on these tumors.[indiacancersurgerysite.com]
  • The combined use of two drugs that are prescribed for other conditions, eflonithine and sulindac, may prevent the development of adenomas or the recurrence of colon cancer.[encyclopedia.com]
  • However, the existence of a fibrous, firm sheath around the tumor can prevent adequate tissue sampling in 50% of the cases [ 15 ]. Chondromas Endobronchial Chondroma (EC) is also extremely rare.[omicsonline.org]

References

Article

  1. Ramachandran PV, Harigovind D, Shamsudeen H, et al. Imaging spectrum of bronchial carcinoid--a case of central bronchial obstructing lesion. J Indian Med Assoc. 2002;100(7): 461-4.
  2. Jeung MY, Gasser B, Gangi A, et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics. 2002;22(2):351-65.
  3. Bhatia K, Ellis S. Unusual lung tumours: an illustrated review of CT features suggestive of this diagnosis. Cancer Imaging. 2006;6:72–82.
  4. Fischer S, Kruger M, McRae K, et al. Giant bronchial carcinoid tumors: A multidisciplinary approach. Ann Thorac Surg. 2001;71:386–93.
  5. Rizzardi G, Marulli G, Calabrese F, et al. Bronchial carcinoid tumours in children: surgical treatment and outcome in a single institution. Eur J Pediatr Surg. 2009;19(4):228–31.
  6. Kaplan KA, Beierle EA, Faro A, et al. Recurrent pneumonia in children: A case report and approach to diagnosis. Clin Pediatr. 2006;45:15–22.
  7. Nessi R, Basso Ricci P, Basso Ricci S, et al. Bronchial carcinoid tumors: radiologic observations in 49 cases. J Thorac Imaging. 1991;6(2):47-53.
  8. Dixit R, Gupta R, Yadav A, et al. A case of pulmonary carcinoid tumor with concomitant tuberculosis. Lung India. 2009;26:133–5.
  9. Cetinkaya E, Aras G, Sokucu SN, et al. Treatment of endoluminal typical carcinoid tumor with bronchoscopic techniques. Tuberk Toraks. 2009;57(4):427-30.
  10. Rizzardi G, Marulli G, Calabrese F, et al., Bronchial carcinoid tumours in children: surgical treatment and outcome in a single institution. Eur J Pediatr Surg. 2009;19(4):228–31.
  11. Detterbeck FC. Management of carcinoid tumors. Ann Thorac Surg. 2010;89(3):998–1005.

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Last updated: 2019-07-11 21:37