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].
Entire Body System
- Pain
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. [symptoma.com]
[…] are : The glands near the ears may swell You may experience pain in your face For Adenoid cystic carcinoma, the symptoms are : Trouble while swallowing food Hoarse voice Swelling on the roof of your mouth Numbness in the jaw Bumps below the jaw 4423 [lybrate.com]
Common presentation of bronchial adenoma is- 1) Dysponea 2) Chest pain 3) Recurrent hemoptysis 4) Cough 5) NULL [upscgk.com]
Pancreas: pain in the abdomen, diarrhea, stomach pain, persistent fatigue, fainting, and weight gain can indicate one of the various types of pancreatic adenomas or pancreatic cancer. [encyclopedia.com]
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]
- 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]
[…] 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]
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]
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]
- Inflammation
Submucosa: Acute inflammation ; non-specific chronic inflammation ; Eosinophilic inflammation (Example: Asthma, Churg-Strauss disease, parasitic infestation such as helminthiasis) ; Granulomatous inflammation : (Example: Sarcoidosis, tuberculosis, allergic [histopathology-india.net]
Disorders characterized by chronic inflammation of the lower respiratory tract. N Engl J Med 1984; 310:235-244. [books.google.com]
However, about one third of carcinoid tumors are somatostatin-negative whereas the rest are weakly positive and, thus, difficult to distinguish from inflammation. [emedicine.medscape.com]
KEY TERMS Adrenal glands — Two glands, one located above each kidney, that secrete hormones to prevent inflammation and to help regulate blood pressure, blood sugar levels, and metabolism. [encyclopedia.com]
This includes chronic smoke inhalation, repeated airway infections, foreign body aspiration, prolonged mechanical ventilation and chronic inflammation in asthma and chronic obstructive pulmonary disease (COPD). [omicsonline.org]
Respiratoric
- Cough
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]
Symptoms bloody sputum cough wheezing recurrent pneumonia slowly resolving pneumonia collapse of a lung lobe or segment cough lasting more than 6 weeks. [medical-dictionary-search-engines.com]
Patients with bronchial adenoma may present with hemoptysis, chronic cough, recurring pneumonia, or simple chest discomfort. [indiacancersurgerysite.com]
For carcinoid tumors, the symptoms are : You may experience wheezing and cough Presence of blood in the cough Chest pain and breathing difficulties Becoming increasingly susceptible to infections such as pneumonia For mucoepidermoid carcinoma, the symptoms [lybrate.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]
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]
(see Hemoptysis, [[Hemoptysis]]): may occur Fever/Weight loss : may occur Development of Higher Grade Malignancy within Bronchial Adenoma : most common with pleomorphic subtype Treatment Bronchoscopic Removal : fulguration/laser may be used for poor [mdnxs.com]
CASE REPORT A 50-year-old white female was admitted to Mercy Hospital in August, 1951, complaining of hemoptysis. Three years FULL TEXT [annals.org]
- 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]
Patients with SSP can be asymptomatic at presentation or present with obstructive symptoms like cough, dyspnea, and hemoptysis. [omicsonline.org]
- 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]
Gastrointestinal
- Diarrhea
Symptoms consist of asthma-like symptoms, flushing, palpitations and diarrhea. Furthermore, a recurrent infectious episode may complicate disease evolution and recognition. [symptoma.com]
Symptoms can include: Facial flushing (redness and warm feeling) Diarrhea Wheezing Fast heartbeat Many people with carcinoid syndrome find that stress, heavy exercise, and drinking alcohol can bring on these symptoms or make them worse. [cancer.org]
Pancreas: pain in the abdomen, diarrhea, stomach pain, persistent fatigue, fainting, and weight gain can indicate one of the various types of pancreatic adenomas or pancreatic cancer. [encyclopedia.com]
Possible side effects from chemo include: Fatigue Nausea and vomiting Hair loss Loss of appetite Diarrhea Increased risk of infection Immunotherapy. This treatment uses medicine to boost your immune system’s ability to find and destroy cancer. [alsehhat.com]
Possible side effects from chemo include: Fatigue Nausea and vomiting Hair loss Loss of appetite Diarrhea Increased risk of infection Immunotherapy. This treatment uses medicine to boost your immune system's ability to find and destroy cancer. [webmd.com]
- Constipation
Parathyroid: weakness, fatigue, constipation, kidney stones, loss of appetite, and bone pain are signs of a condition known as hyperparathyroidism, which occurs in patients with parathyroid adenomas or parathyroid cancer. [encyclopedia.com]
Cardiovascular
- Heart Disease
In the group with adenoid cystic carcinoma, 1 patient died postoperatively, 1 had recurrence of the tumor, 2 were alive and free from disease 16 and 23 years later, and 1 died of heart disease at 11 years. [ncbi.nlm.nih.gov]
Neurologic
- Headache
A benign and malignant pheochromocytoma also has the same symptoms, including headaches, sweating, and chest pains. [encyclopedia.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].
X-Ray
- 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]
Associated airway compression with pulmonary atelectasis may be also seen in some cases. [radiopaedia.org]
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]
Colonoscopy
- Colitis
Pathology showed mature sub-endobronchial adipose tissue, cartilage, and mucous glands, suggestive of hamartoma. ( Figure 2 ) The patient later succumbed to sever sepsis stemming from ischemic colitis during the same admission. [omicsonline.org]
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]
However, there are definite indications for radiation treatment for benign diseases that do not respond to conventional methods of treatment. [books.google.com]
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]
So I think that in some sense I was lucky, the treatment was limited to surgery, which was done quickly and very neatly. [doclandmed.com]
Treatment is by thoracotomy with total excision of the lesion. [ncbi.nlm.nih.gov]
Prognosis
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]
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]
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]
[…] 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]
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]
The pathogenesis of these benign neoplasms has been attributed to chronic inflammatory etiologic factors. [omicsonline.org]
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]
[…] generally good, but cases of carcinoma ex pleomorphic adenom have been reported Terminology Pleomorphic adenoma is also known as mixed tumor Overlaps with “myoepithelioma”, which could be used for lesions with less cartilaginous and ductal differentiation Epidemiology [pathologyoutlines.com]
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]
Pulmonary adenocarcinomas of the fetal lung type: a clinicopathologic study indicating differences in histology, epidemiology, and natural history of low-grade and high-grade forms. Am. J. Surg. [twmu.ac.jp]
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]
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]
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]
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
- 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.
- Jeung MY, Gasser B, Gangi A, et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics. 2002;22(2):351-65.
- Bhatia K, Ellis S. Unusual lung tumours: an illustrated review of CT features suggestive of this diagnosis. Cancer Imaging. 2006;6:72–82.
- Fischer S, Kruger M, McRae K, et al. Giant bronchial carcinoid tumors: A multidisciplinary approach. Ann Thorac Surg. 2001;71:386–93.
- 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.
- 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.
- 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.
- Dixit R, Gupta R, Yadav A, et al. A case of pulmonary carcinoid tumor with concomitant tuberculosis. Lung India. 2009;26:133–5.
- Cetinkaya E, Aras G, Sokucu SN, et al. Treatment of endoluminal typical carcinoid tumor with bronchoscopic techniques. Tuberk Toraks. 2009;57(4):427-30.
- 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.
- Detterbeck FC. Management of carcinoid tumors. Ann Thorac Surg. 2010;89(3):998–1005.