RESUMO
Endobronchial chondroma is a rare benign bronchial tumor that originates from bronchial cartilage. As the disease progresses, it can obstruct the airway and cause clinical symptoms such as fever and cough. It is difficult to detect Endobronchial chondroma on a Chest X-ray, but chest CT can provide a more accurate diagnosis. Bronchoscopy is an effective means of diagnosing and treating this disease, and the diagnosis of the disease still depends on the pathological results of the biopsy. Currently, most cases of Endobronchial chondroma are treated by bronchoscopic resection or by surgery. Treatment should be based on the size, type and location of the tumor. As long as the diagnosis of Endobronchial chondroma is confirmed, it should be removed as soon as possible to avoid obstructive pneumonia, atelectasis or irreversible damage to lung tissue caused by tumor compression of the bronchi. This article reported a case of Endobronchial chondroma in a 19-year-old man whose main clinical manifestations were fever, cough and chest pain, with no apparent improvement after antibiotic treatment. Chest CT showed consolidation and atelectasis of the left upper lobe, and bronchial foreign body was considered by bronchoscopy in another hospital. However, the patient did not improve significantly after the foreign body was removed. After admission, the patient was considered to have left pulmonary obstructive pneumonia due to bronchial foreign body. A white tough foreign body was seen under bronchoscopy, which was too seriously adhered with the bronchus to be removed as a whole. After two bronchoscopic interventional treatments, the foreign body was successfully removed, and the bronchial lumen blocked by the foreign body was restored to patency. Pathology confirmed the diagnosis of endobronchial chondroma. The patient's symptoms improved and he was subsequently discharged. To date, the patient's symptoms of fever, cough, or chest pain have never recurred, and there is no obvious abnormality on repeat chest CT. This case provides an empirical reference for the diagnosis and treatment of endobronchial chondroma.
Assuntos
Neoplasias Brônquicas , Broncoscopia , Condroma , Humanos , Broncoscopia/métodos , Condroma/cirurgia , Condroma/diagnóstico , Masculino , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Adulto JovemRESUMO
RATIONALE: Endobronchial neurofibroma is an extremely rare neoplastic disease. The majority of endobronchial neurofibroma are symptomatic, but nonspecific. The treatment of endobronchial neurofibroma is controversial that surgery is previously considered to be the main option. With the development of bronchoscopic intervention, most endobronchial neurofibroma can be treated with transbronchial endoscopic resection with few complications. Here we reported a case of diagnosed endobronchial neurofibroma that was successfully resected with transbronchial electrical snaring and laser coagulation. Moreover, the relevant literature was reviewed to raise awareness of this disease. PATIENT CONCERNS: A 57-year-old man presented to our hospital with cough, sputum, and shortness of breath for 2 days. Physical examination was normal. Laboratory tests revealed moderately increased C-reactive protein. Chest computed tomography showed a 10 × 8 mm round, polypoid-shaped nodule located in the left main bronchus, which was heterogeneous after contrast enhancement. It demonstrated a smooth, round, hypervascularized neoplasma obstructing most of the lumen of the upper left main bronchus under bronchoscopy. INTERVENTIONS AND OUTCOMES: The tumor was removed with electrical snaring and laser coagulation completely instead of surgical resection, without any complications. Pathologically, it was confirmed of endobronchial neurofibroma. Repeated bronchoscopy showed no recurrence of the tumor, and the procedure site healed with a little of fibrotic scar formation. LESSONS: Endobronchial neurofibroma is rare. Although the standard treatment for endobronchial neurofibroma is surgery, transbronchial endoscopic resection (electrical snaring and laser coagulation) is an applicable option, especially for those lesions strictly in the lumen.
Assuntos
Neoplasias Brônquicas , Broncoscopia , Neurofibroma , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibroma/cirurgia , Neurofibroma/patologia , Neoplasias Brônquicas/cirurgia , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/diagnóstico por imagem , Broncoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Fotocoagulação a Laser/métodosAssuntos
Neoplasias Brônquicas , Humanos , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/diagnóstico por imagem , Diagnóstico Diferencial , Criança , Masculino , Broncoscopia , Tuberculose Pulmonar/diagnóstico , Carcinoma Mucoepidermoide/diagnóstico , Carcinoma Mucoepidermoide/diagnóstico por imagem , Carcinoma Mucoepidermoide/cirurgia , Tomografia Computadorizada por Raios X , Feminino , Tuberculose/diagnósticoRESUMO
Bronchial fibroepithelial polyps are exceedingly rare with few cases have been reported. They can manifest with a wide array of symptoms; ranging from being totally asymptomatic, cough, refractory dyspnea, and hemoptysis. In our case, our patient's condition was diagnosed and was managed as asthma. It is one of the rare benign conditions to be encountered, shares similar morphology with other tumors such as angiomyofibroblastoma, aggressive angiomyxoma, and cellular angiofibroma. These lesions have a slow growth pattern which may end up with obstruction. According to the tumor size and symptoms caused by it, treatment varies from observation to complete resection. This case describes an incidental finding of fibroepithelial polyp in the main bronchus for a patient with long-term refractory cough for 5 years, was misdiagnosed to have asthma. Diagnosis typically involves imaging and bronchoscopy, followed by appropriate therapeutic measures and careful monitoring to assess the prognosis.
Assuntos
Asma , Neoplasias Brônquicas , Broncoscopia , Erros de Diagnóstico , Pólipos , Humanos , Asma/diagnóstico , Pólipos/patologia , Pólipos/diagnóstico , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/cirurgia , Masculino , Tomografia Computadorizada por Raios X , Pessoa de Meia-Idade , Tosse/etiologia , Feminino , Neoplasias Fibroepiteliais/patologia , Neoplasias Fibroepiteliais/diagnóstico , Neoplasias Fibroepiteliais/cirurgia , Brônquios/patologiaRESUMO
INTRODUCTION: Electrocautery with a snare probe offers a tool for the treatment of endobronchial polyps. The aim of this study was to demonstrate the efficacy of the snare probe in patients undergoing rigid bronchoscopy due to central airway obstruction. METHODS: This retrospective descriptive study included patients who underwent rigid bronchoscopy with an electrocautery snare probe for the diagnosis and/or treatment of endobronchial polyps in an interventional pulmonology unit. RESULTS: The mean age of the 47 patients (38 men) with endobronchial polypoid lesions was 61.5 years. Six lesions (12.8%) were located in the trachea, 6 (12.8%) in the right main bronchus, 11 (23.4%) in the left main bronchus, and 24 (51.1%) in the lobar bronchi. Twenty-eight lesions (59.5%) were malignant. Prior to the procedure, 6 (12.8%) patients had grade 1 obstruction, 6 (12.8%) had grade 2 obstruction, 15 (31.9%) had grade 3 obstruction, and 20 (42.6%) had grade 4 obstruction. In terms of airway obstruction after the procedure, grade 1 was present in 46 (97.9%) patients and grade 2 was present in 1 (2.1%) patient. No major complication developed in 93.6% of the patients. During a mean follow-up period of 48 months, 85.1% of the patients did not experience recurrence. CONCLUSION: Our results demonstrate that the snare probe can be used to effectively and reliably establish airway patency in patients with central airway obstruction due to endobronchial polypoid lesions.
Assuntos
Obstrução das Vias Respiratórias , Broncoscopia , Eletrocoagulação , Pólipos , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Eletrocoagulação/métodos , Eletrocoagulação/instrumentação , Estudos Retrospectivos , Broncoscopia/métodos , Broncoscopia/instrumentação , Idoso , Pólipos/diagnóstico , Pólipos/terapia , Pólipos/patologia , Pólipos/cirurgia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Obstrução das Vias Respiratórias/diagnóstico , Adulto , Resultado do Tratamento , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Neoplasias Brônquicas/terapia , Idoso de 80 Anos ou maisAssuntos
Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Diagnóstico Diferencial , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/patologia , Masculino , Broncoscopia , Linfoma de Células B/diagnóstico , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/patologia , Idoso , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Primary pulmonary salivary gland-type tumours (PPSGT) are rare lung neoplasms arising from submucosal seromucinous glands in the central airway. METHODS AND RESULTS: We retrospectively analysed the clinicopathological features of 111 PPSGTs diagnosed at our institute between 2003 and 2021. The mean age at diagnosis was 43.8 years(range 6-78 years) and a male-to-female ratio of 2:1. On imaging, 92 % of cases had centrally located tumours and 37.3 % were early stage. The histopathological types included 70 cases (63 %) of mucoepidermoid carcinoma (MEC), 31 cases (27.7 %) of adenoid cystic carcinoma (ADCC), two cases of myoepithelial carcinoma, one case each of acinic cell carcinoma (ACC), clear cell carcinoma (CCC), epithelial myoepithelial carcinoma (EMC) and 5 others [including adenocarcinoma of minor salivary gland origin(n = 3), carcinoma with sebaceous differentiation(n = 1) and poorly differentiated carcinoma of salivary gland type(n = 1)]. The size of the tumours found in the resection specimens ranged from 1 cm to 13 cm, with an average size of 4.9 cm. High-risk attributes such as lymphovascular invasion (LVI), perineural invasion (PNI), pleural involvement, positive resection margins, and nodal metastasis were identified in 15.3 %, 15.3 %, 13.6 %,15.2 % and 6.7 % of cases, respectively. These attributes were found to be more frequent in ADCC than in MEC. Surgery was the main treatment modality [68/84 (80 %) cases]. ADCC cases had more recurrence and distant metastasis than MEC cases. The 3- year overall-survival (OS) and recurrence-free survival(RFS) were better in patients with age lesser than 60 years(p-value <0.0001), low pT stage (p-value 0.00038) and lower grade of MEC(p-value-0.0067). CONCLUSION: It is crucial to have an acquaintance with the morphologic spectrum and immunophenotypic characteristics of PPSGT to recognize them in this unusual location. In tandem, it is crucial to differentiate them from conventional primary non-small cell lung carcinoma, as the management protocols and prognostic implications differ significantly.
Assuntos
Neoplasias Pulmonares , Neoplasias das Glândulas Salivares , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Adulto , Idoso , Adolescente , Neoplasias Pulmonares/patologia , Neoplasias das Glândulas Salivares/patologia , Neoplasias das Glândulas Salivares/diagnóstico , Adulto Jovem , Criança , Carcinoma Mucoepidermoide/patologia , Carcinoma Mucoepidermoide/diagnóstico , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/diagnóstico , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/diagnósticoRESUMO
The disease failure patterns and optimal treatment of bronchus-associated lymphoid tissue (BALT) lymphoma are unknown. This retrospective study involved 71 patients with primary BALT lymphoma who had received radiotherapy (RT), surgery, immunochemotherapy (IC), or observation. The median follow-up time was 66 months. The 5-year overall survival and lymphoma-specific survival were 91.2% and 96.1%, respectively, and were not significantly different among treatments. The 5-year cumulative incidence of overall failure for RT, surgery, IC, and observation was 0%, 9.7% (p = .160), 30.8% (p = .017), and 31.3% (p = .039). There was no grade ≥3 toxicity in RT group according to the CTCAE 5.0 reporting system. Quality of life (QoL) was at similarly good levels among the treatment groups. BALT lymphoma had a favorable prognosis but persistent risk of relapse after IC or observation. Given the very low disease failure risk and good QoL, RT remains an effective initial treatment for BALT lymphoma.
BALT lymphoma has a favorable prognosis but a persistent progression and relapse risk.Radiotherapy is associated with lower failure of disease progression and relapse, low toxicity and good quality of life.
Assuntos
Linfoma de Zona Marginal Tipo Células B , Qualidade de Vida , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Resultado do Tratamento , Estudos Retrospectivos , Linfoma de Zona Marginal Tipo Células B/terapia , Linfoma de Zona Marginal Tipo Células B/mortalidade , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Terapia Combinada/efeitos adversos , Prognóstico , Idoso de 80 Anos ou mais , Neoplasias Brônquicas/terapia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/mortalidade , Seguimentos , Estadiamento de NeoplasiasRESUMO
Cowden syndrome (CS) is a rare genetic condition due to the various germline mutations in the phosphatase and tensin homologue on chromosome ten (PTEN) tumour suppressor gene. As a result, CS is characterised by an increased risk of developing various benign and malignant tumours, such as thyroid, breast, endometrial and urogenital neoplasms, as well as gastrointestinal tract tumours. However, the neuroendocrine tumour association with CS is not elucidated yet. We present a case of a 46-year-old male patient diagnosed with testicular seminoma and follicular thyroid cancer in his medical history. Our patient met the clinical diagnostic criteria of Cowden syndrome. Genetic analysis established the clinical diagnosis; a known heterozygous PTEN mutation was detected [PTEN (LRG_311t1)c.388 C > T (p.Arg130Ter)]. Incidentally, he was also seen with multiple pulmonary lesions during his oncological follow-up. A video-assisted thoracoscopic left lingula wedge resection and later resections from the right lung were performed. Histological findings revealed typical pulmonary carcinoid tumours and smaller tumorlets. Somatostatin receptor SPECT-CT, 18F-FDG-PET-CT and 18F-FDOPA-PET-CT scans and endoscopy procedures could not identify any primary tumours in other locations. Our patient is the first published case of Cowden syndrome, associated with multifocal pulmonary carcinoids. Besides multiple endocrine neoplasia type 1, we propose Cowden syndrome as another hereditary condition predisposing to multiple pulmonary tumorlets and carcinoid tumours.
Assuntos
Tumor Carcinoide , Síndrome do Hamartoma Múltiplo , Humanos , Síndrome do Hamartoma Múltiplo/genética , Síndrome do Hamartoma Múltiplo/complicações , Síndrome do Hamartoma Múltiplo/patologia , Síndrome do Hamartoma Múltiplo/diagnóstico , Pessoa de Meia-Idade , Masculino , Tumor Carcinoide/complicações , Tumor Carcinoide/genética , Tumor Carcinoide/patologia , Tumor Carcinoide/diagnóstico , Neoplasias Brônquicas/genética , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/diagnóstico , PTEN Fosfo-Hidrolase/genéticaRESUMO
BACKGROUND: While cutaneous melanomas are well-documented, primary melanoma of the lung (PMML), particularly with endobronchial origin, remains rare and poorly characterized. This case report addresses gaps in understanding by presenting a comprehensive case of a 71-year-old male with primary endobronchial melanoma and conducting a systematic review of PMML cases. CASE PRESENTATION: The patient, a former smoker, presented with dyspnea, cough, and hemoptysis. Imaging revealed left lung atelectasis and a suspicious nodule. Bronchoscopy identified an endobronchial mass, subsequently treated with argon plasma coagulation and resection. Biopsy confirmed melanoma. Extensive examinations ruled out a primary skin lesion. Despite initial treatment, recurrence led to pneumonectomy. Histopathology confirmed melanoma. The patient received treatment with pembrolizumab and ipilimumab, but with poor clinical benefit. CONCLUSIONS: Primary endobronchial melanoma is a rare entity, comprising 0.01% of lung tumors. This case underscores diagnostic challenges and emphasizes histological criteria to distinguish primary from metastatic lesions. The pathogenesis remains unclear, with theories proposing foetal melanocyte migration or squamous metaplasia. Prognosis varies, necessitating radical surgical extirpation. A systematic review revealed diverse outcomes, supporting the need for further research. In conclusion, endobronchial melanoma involves an endoscopic and surgical management, but evolving therapies, such as immunotherapy, may reshape treatment paradigms. This case contributes to our understanding of PMML, guiding future research and clinical management. As therapeutic options evolve, continued research is crucial to refine our understanding and improve outcomes for this rare malignancy.
Assuntos
Neoplasias Brônquicas , Broncoscopia , Melanoma , Humanos , Masculino , Melanoma/patologia , Melanoma/diagnóstico , Melanoma/terapia , Idoso , Neoplasias Brônquicas/terapia , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/diagnóstico , Pneumonectomia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Ipilimumab/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To analyze features of surgical treatment of central tracheal and bronchial carcinoid. MATERIAL AND METHODS: A retrospective analysis included 115 patients with carcinoid tracheal and bronchial tumors who have been examined and treated from 1974 to the present. The majority of patients (97, 84.3%) had central form of carcinoid of the trachea, bronchi and lungs. Of these, 95 (97.9%) ones underwent surgical treatment. RESULTS: We used pre- and intraoperative diagnostics including bronchotomy. This approach provided organ-sparing surgery with resection and reconstruction of the bronchi and trachea in 71 (74.7%) patients including complete preservation of lung function in 20 (21.1%) cases and lobectomy/segmentectomy with resection and reconstruction of the bronchi in 51 (53.7%) cases. Two patients underwent pneumonectomy with wedge-shaped and marginal resection and reconstruction of tracheal bifurcation. Postoperative complications developed in 4 (4.2%) patients, and 2 (2.1%) ones died. Overall 5-year survival after radical surgeries was 89.2% (100% in typical carcinoid and 78.0% in atypical carcinoid).
Assuntos
Neoplasias Brônquicas , Tumor Carcinoide , Humanos , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Traqueia/cirurgia , Traqueia/patologia , Estudos Retrospectivos , Brônquios/cirurgia , Pneumonectomia/efeitos adversos , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgiaRESUMO
INTRODUCTION: Ectopic Cushing's syndrome (CS) is a rare condition nevertheless well-known to endocrinologists. The pneumologist may be called upon to treat CS not only because bronchial carcinoid tumors are the most frequent source of ectopic ACTH secretion, but also due to the fact that the immunosuppression induced by hypercorticism favors lower respiratory tract infections. CASE REPORT: We report the case of a female patient presenting with acute respiratory failure secondary to Enterobacter cloacae pneumonia exacerbated by SC. Further investigations confirmed ectopic ACTH secretion and revealed a right upper lobe pulmonary nodule. After appropriate antibiotic therapy, the patient received preoperative adrenolytic treatment. Management by right upper lobectomy resulted in the extraction of a 12mm tumor. Pathological analysis was consistent with the diagnosis of a typical carcinoid tumor. Immunohistochemistry confirmed ACTH secretion by the tumor. Even though the postoperative course showed CS regression, the patient developed adrenal insufficiency. CONCLUSION: Ectopic CS induces immunosuppression, which aggravates lower respiratory tract infections. Search for a pulmonary neuroendocrine tumor should be systematic. Following control of the secretory syndrome by adrenolytic treatment, and if the diagnosis of carcinoid tumor is confirmed, surgical treatment is the preferred option.
Assuntos
Síndrome de ACTH Ectópico , Neoplasias Brônquicas , Tumor Carcinoide , Síndrome de Cushing , Pneumonia , Infecções Respiratórias , Humanos , Feminino , Síndrome de Cushing/etiologia , Síndrome de Cushing/complicações , Síndrome de ACTH Ectópico/complicações , Síndrome de ACTH Ectópico/diagnóstico , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Infecções Respiratórias/complicações , Hormônio Adrenocorticotrópico , Antagonistas AdrenérgicosRESUMO
OBJECTIVES: Bronchial carcinoid tumors (BC) are exceptionally rare in childhood, with an incidence of <0.2/1,000,000 per year. Typical low-grade BCs are distinguished from atypical, intermediate-grade BCs. Little is known about BCs in pediatric patients and management guidelines are missing. In this study, we explored characteristics and outcome of pediatric patients with BC prospectively registered with the Malignant Endocrine Tumor studies. MATERIAL AND METHODS: We performed a retrospective multicenter study in children, adolescents, and young adults (aged 0-20 years) with BC reported to the German MET registry between January 1997 and December 2022. Data were last updated on 28 of February 2023. RESULTS: Thirty-two patients were diagnosed at a median age of 15.0 years (range, 9.8-19.2). Atypical BCs (23.3%) were less frequent than typical, but more common than in adulthood. Lymph node metastases were present in 14.3% of cases (atypical BC: 28.6%, typical BC: 10.5%), distant metastases in one (3.1%) patient with atypical BC. 92.6% of patients were in complete remission after surgical resection (median follow-up: 2.7 years). The patient with metastatic spread and one patient with atypical BC and multiple recurrences were on treatment at last follow-up. 5-year event-free survival of typical BC was 100% and 83.3% in atypical BC. CONCLUSIONS: Completely resected localized BCs in pediatric patients have a favorable outcome also with lung tissue sparing surgery. Atypical BC with risk of metastatic spread and recurrence occurred more frequently compared to adults. Interdisciplinary management and collaborative efforts are needed to improve our understanding and the management of pediatric BC.
Assuntos
Neoplasias Brônquicas , Tumor Carcinoide , Neoplasias Pulmonares , Adulto Jovem , Humanos , Adolescente , Criança , Adulto , Neoplasias Pulmonares/patologia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/epidemiologia , Neoplasias Brônquicas/terapia , Pneumonectomia , Metástase Linfática , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/terapia , Intervalo Livre de Progressão , Estudos RetrospectivosRESUMO
Neuroendocrine neoplasms (NENs) are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise mainly due to an improvement on diagnostic techniques and awareness. Earlier detection, along with steadfast improvements in therapy, has led to better prognosis over time for advanced gastrointestinal and pancreatic neuroendocrine tumors. The aim of this guideline is to update evidence-based recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification, and therapeutic options, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are reviewed and discussed, and treatment algorithms to guide therapeutic decisions are provided.
Assuntos
Neoplasias Brônquicas , Carcinoma Neuroendócrino , Tumores Neuroendócrinos , Humanos , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/terapia , Algoritmos , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/terapiaRESUMO
Lung carcinoids (LC) comprise neuroendocrine lung tumors of low (typical carcinoid) and intermediate (atypical carcinoid) grade of malignancy accounting for less than 2% of all lung neoplasms. In Europe, annual incidence of LC varies from 0.2 to 2 per 100 000. This value increased dramatically over the past 30 years. One of the causes is improvement of diagnostic methods. Compared to aggressive high-grade neuroendocrine lung cancer, natural course of early-stage LC is usually indolent. Therefore, surgery with preservation of as much normal lung tissue as possible is preferable for resectable tumors. Nevertheless, the number of isolated bronchial resections with preservation of the entire lung tissue is relatively small, and these procedures remain technically complex interventions. We present isolated resection of interlobular spur, lower medial wall of distal part of the left main bronchus and proximal part of the lower lobular bronchus for typical carcinoid with monobronchial anastomosis and preservation of the entire lung parenchyma.
Assuntos
Neoplasias Brônquicas , Tumor Carcinoide , Neoplasias Pulmonares , Tumores Neuroendócrinos , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Tumores Neuroendócrinos/patologia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Brônquios/cirurgia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgiaRESUMO
Tracheal tumors are rare, accounting for 0.1% of all malignancies. Squamous cell carcinoma and adenoid cystic carcinoma are the two most prevalent tracheal cancers. Less than 20 cases of extramedullary plasmacytoma in the trachea and main bronchus have ever been documented in the literature, making it extremely uncommon. Although the origin of these lesions is unclear, viral pathogenesis and persistent inflammation are thought to be the main causes. Clinically, these individuals exhibit vague symptoms such as stridor, a persistent cough, dyspnea, or wheezing, making a correct diagnosis difficult.
Assuntos
Neoplasias Ósseas , Neoplasias Brônquicas , Plasmocitoma , Neoplasias da Traqueia , Humanos , Traqueia/patologia , Plasmocitoma/diagnóstico , Plasmocitoma/patologia , Neoplasias da Traqueia/diagnóstico , Brônquios/patologia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/patologia , Neoplasias Ósseas/patologiaRESUMO
PURPOSE: We aimed to evaluate and compare the clinical, biochemical and radiological profile and outcomes of patients with ectopic ACTH syndrome (EAS) and Cushing disease (CD) treated over a period of 10 years (2013-2022). METHODS: In this ambispective observational study, we collected data for 146 patients with ACTH-dependent CS (EAS, n = 23; CD, n = 94; occult ACTH source, n = 29). Relevant details were filled in a predesigned proforma and outcomes were ascertained at the most recent visit. RESULTS: EAS was more common in males (65.2 vs. 27.6%, p < 0.001). Patients with EAS had a shorter duration of symptoms [12 (6-12) vs. 31.5 (15-48) months, p < 0.001] and were more likely to have hypokalemia (82.6 vs. 21.0%, p = 0.001), pedal edema (65.2 vs. 34.2%, p = 0.015), weight loss (34.8 vs. 4.0%, p < 0.001) and systemic infection (30.4 vs. 6.5%, p = 0.006). They also had significantly higher 8 a.m. serum cortisol, midnight serum and salivary cortisol and 8 a.m. plasma ACTH levels. Bronchial carcinoid (n = 10, 43.5%) was the most common etiology of EAS. Bilateral adrenalectomy was performed in 11 (47.8%) patients with EAS. Eight patients (34.8%) with EAS died at the last follow-up, of whom 7 (87.5%) had metastatic disease. In CD group, overall remission rate was 69.4% (56.1%, early and 13.3%, delayed) and 26.3% of patients with an initial remission had recurrence. CONCLUSIONS: Bronchial carcinoid was the most common cause of EAS in our cohort. Bilateral adrenalectomy was performed in approximately every 1 in 2 patients with EAS and approximately every 1 in 3 patients expired till the last follow-up.