Presentation of bronchial mucoepidermoid carcinoma as unilateral hyperlucent lung

The Different Clinical Aspects of Pediatric Primary Airway Tumors in the Larynx, Trachea, and Bronchi

Primary airway tumors are rare in children and no literature reviewed their characteristics each location. We evaluate the clinical characteristics and outcomes of Korean children with primary airway tumors, from the larynx to bronchi. A retrospective chart review of children with primary tumors of the larynx, trachea, and bronchi at Asan Medical Center from January 2000 to July 2016 was conducted. Nineteen children were diagnosed with primary airway tumors of the larynx (47.4%), trachea (10.5%), and bronchi (42.1%). Median follow-up duration was 2.8 years and there were recurrences in 21.1%. Laryngeal tumors were associated with a younger median age at onset (2 months) and diagnosis (4 months), and most were relatively small (median size = 5.3 mm) and symptomatic. Tracheal and bronchial tumors were found in older children (age at onset and diagnosis > 11 years) and large (> 15.0 mm). Most (75%) patients with bronchial tumors were asymptomatic and all the patients with tracheal tumors were symptomatic. This study suggests that we should consider different the locations in primary airway tumor based on the age at onset and diagnosis, initial symptoms or signs, and size of tumor.

Swyer-James-Macleod syndrome mimicking an acute pulmonary embolism: a report of six adult cases and a retrospective analysis

BACKGROUND AND AIM

In patients with pulmonary embolism (PE), a pulmonary radiograph may reveal oligemic fields (the Westermark sign) associated with sites of occlusion of the pulmonary arteries, interruption or loss of the artery line (the knuckle sign), and even unilateral hyperlucency attributable to reduced overall lung vascularity. In Swyer-James-Macleod syndrome (SJMS), which develops as a result of bronchiolitis obliterans, unilateral hyperlucency is evident because of emphysema and hypoplasia of the pulmonary artery and its branches. Therefore, SJMS cases with clinical and laboratory data compatible with PE may in fact be confused with PE. The cases of six adult patients who were initially presumed to have PE but on further investigation were diagnosed with SJMS are presented in this report, which thus can serve as a guide for diagnosis of similar cases in future.

METHODS

We studied six adult patients who presented with dyspnea. Their pulmonary radiographs revealed lobar/unilateral hyperlucency and PE was initially suspected. The pulmonary artery and branches thereof exhibited parenchymal emphysema and hypoplasia, and we thus diagnosed SJMS.

RESULTS

We studied 4 males and 2 females with a mean age of 51 years (range, 20-73 years). Left lung involvement was evident in five cases.

CONCLUSION

Unilateral hyperlucency may be a feature of both PE and SJMS. Although these conditions are very different, both present similarly in radiographic terms and may be easily confused when the clinical data and the anamnesis raise a suspicion of PE, causing unnecessary testing and treatment.

Childhood and adolescent tracheobronchial mucoepidermoid carcinoma (MEC): a case-series and review of the literature

Tracheobronchial mucoepidermoid carcinomas (MEC) are rare in the pediatric population with literature limited primarily to case reports. Here we present our institutional experience treating MEC in three patients and review the literature of 142 pediatric cases previously published from 1968 to 2013. Although rare, tracheobronchial MEC should be included in the differential diagnosis in a child with recurrent respiratory symptoms. Conservative surgical management is often sufficient to achieve complete resection and good outcomes.

Primary lung tumors in children and adolescents: a 90-year experience

PURPOSE

Primary lung tumors in children are rare. A wide range of histopathologic tumor types occurs. The incidence of these lesions and their outcomes are still largely unknown. This study aims to determine the incidence of different primary lung tumors in children and to contribute data leading to the development of evidence-based treatment models.

METHODS

A single institution retrospective review was performed with institutional review board approval. Patients were included if they had primary, nonhematologic lung tumors. Simple squamous papillomas subjected to endoscopic biopsy and not resected, and vascular lesions associated with multisystem lesions, such as hereditary hemorrhagic telangiectasia, were excluded. Medical records and pathologic material for patients from 1918 to 2008 were reviewed.

RESULTS

Forty patients were identified (23 boys, 17 girls) with a mean age of 9.6 years (range, 3 months to 19 years). Fourteen distinct histopathologic tumor types were identified. The most common tumor types were carcinoid (8), inflammatory myofibroblastic tumor (7), and pleuropulmonary blastoma (6). Rare pediatric lung tumors including small cell carcinoma, adenocarcinoma, and pulmonary capillary hemangiomatosis were also seen. The mortality rate was 17.5% (7) in our series. Chemotherapy was used in 23% (9) and radiation in 20% (8) of the patients. Of the 33 survivors, 28 had follow-up with a median duration of 29.5 months (mean, 63.2 months; range, 1-471 months).

CONCLUSIONS

Primary lung tumors in children are rare and histopathologically diverse. The tumor spectrum involves many types not seen in adults, and unlike adults, patients rarely have a history of exposure to external predisposing factors. Although complete resection remains the standard for treatment of most tumors, addition of adjuvant therapy is dependent on both tumor stage and histopathologic type.

Mucoepidermal carcinoma of the lung detected by positron emission tomography in a 5-year-old girl

The authors describe a rare case of mucoepidermal carcinoma of the lung incidentally identified in preoperative assessments for inguinal hernia repair in a 5-year-old girl. This patient was referred for right external inguinal hernia, and a 3.0-cm round-shaped lesion was found in the right lower lung field of a chest x-ray film. She had no respiratory tract complaints, but her serum carcinoembryonic antigen concentration was markedly elevated (21.2 ng/mL). Chest and abdominal computed tomography/magnetic resonance images could not determine the nature of the lesion, but 2-[18 F]fluoro-2-deoxy- d -glucose positron emission tomography (FDG-PET) indicated a malignant tumor pattern. The patient underwent a computed tomography-guided needle biopsy of the lesion (S8), which was soon followed by a right lower pulmonary lobectomy. Histopathology of the resected specimen showed mucoepidermal carcinoma with no regional lymph node metastasis. In childhood asymptomatic pulmonary lesions, it is often difficult to rule out the possibility of malignancy. In the present case, FDG-PET scanning appropriately indicated the therapeutic priority of pediatric thoracic surgery.

Mucoepidermoid carcinoma as an unusual cause for recurrent respiratory infections in a child

Recurrent respiratory infections in a 9-year-old girl prompted a chest radiograph and a CT scan, which showed a right middle lobe consolidation. Bronchoscopy revealed a tumor that totally obstructed the middle lobe. Open lung biopsy revealed a low-grade mucoepidermoid carcinoma. Middle and lower right lung lobectomy was performed, followed by an uneventful recovery. Cytogenetic investigation of tumor cells exhibited the translocation t(11;19). This case shows that further diagnostic modalities such as CT scanning should be performed early in children with recurrent lower respiratory tract infections who have suspicious radiographic findings such as persistent atelectasis or recurrent unifocal infiltration. Bronchial mucoepidermoid carcinoma is infrequent, and molecular investigations might shed additional light on the prognosis.

Clinical, physiologic, and roentgenographic changes after pneumonectomy in a boy with Macleod/Swyer-James syndrome and bronchiectasis

Macleod/Swyer-James syndrome is an uncommon and complex disease characterized by roentgenographic hyperlucency of one lung or lobe due to loss of the pulmonary vascular structure and to alveolar overdistension. This syndrome seems to be an acquired disease that follows viral bronchiolitis and pneumonitis in childhood. It must be differentiated from many other causes of unilateral lung "transradiancy" on the chest roentgenogram, such as those related to congenital bronchial and/or vascular abnormalities. We here describe an 11-year-old patient with Macleod/Swyer-James syndrome and bronchiectasis resulting in severe recurrent bronchopulmonary infections. Despite the severe impairment of pulmonary function, the patient underwent resection of the right lung with progressive improvement of clinical and physiologic parameters.

Tracheobronchial mucoepidermoid carcinoma in childhood and adolescence: case report and review of the literature

In children and adolescents, primary neoplasms of the tracheobronchial tree and lungs are rare, with most tumors involving the respiratory system being metastatic, small, blue cell tumors of childhood. Of the primary pulmonary neoplasms, most are malignant with mucoepidermoid carcinoma representing about 10% of these malignant tumors. We present an 8-year-old Hispanic male with hemoptysis and several episodes of pneumonia which initially was thought to be infectious upon biopsy during bronchoscopy, but proved to be mucoepidermoid carcinoma of the tracheobronchial tree by microscopic examination during an open lung biopsy. This rare tumor is more common in adults than in children, and infrequently presents with hemoptysis. Mucoepidermoid tumors of the tracheobronchial tree carry a more favorable prognosis in children than adults. In the adult population, the overall mortality is slightly less than 30%. In contrast, of the 31 reported cases of tracheobronchial mucoepidermoid carcinoma in pediatrics, all children are free of tumor involvement with a mean follow-up period of 5.8 years (range, 0.7-21 years). Based upon the available clinical outcome and survival data, it would appear that tracheobronchial mucoepidermoid carcinoma may be successfully managed by surgical intervention alone in children and adolescents.

Unilateral hyperlucency with left lower lobe mass in a patient with bronchial asthma

Mucoepidermoid tumors are rare bronchial adenomas whose clinical presentation can mimic that of bronchial asthma. Bronchial adenoma should be included in the differential diagnosis of a patient with a persistent radiographic abnormality and clinical features of bronchial asthma. We present an adolescent female with a history suggestive of bronchial asthma and a persistent left lower lobe atelectasis, who later was found to have a low-grade mucoepidermoid tumor.

Childhood primary pulmonary neoplasms

Nine children (6 boys, 3 girls) were diagnosed with a primary endobronchial or pulmonary parenchymal neoplasm. The average age at diagnosis was 9 years. Presenting complaints included cough (7), fever (5), pulmonary infection (3), respiratory distress (3), weight loss (2), pain (2), and hemoptysis (1). Pulmonary x-rays showed persistent atelectasis, pneumonic infiltrates or mass lesions. A computed tomography scan was performed in 8. Five of six endobronchial tumors were diagnosed with bronchoscopy and biopsy. Treatment consisted of thoracotomy and pulmonary resection in 7 cases and laser resection in 2. The pathologic diagnoses were bronchial carcinoid (3), bronchial mucoepidermoid carcinoma (1), inflammatory pseudotumor (plasma cell granuloma) of the bronchus (2) and of the lung parenchyma (1), fibrosarcoma (1), and rhabdomyosarcoma (1). Postoperative chemotherapy was given only to the patient with pulmonary rhabdomyosarcoma; this child died. One child has developed a local recurrence while 7 children are alive and free of disease at an average of 2.4 years postresection. Pulmonary neoplasms are unusual in the pediatric age group and represent a wide spectrum of pathology. Including the present series, 383 tumors have been described. Seventy-six percent were malignant. Early investigation and surgical intervention are essential in children with persistent pulmonary symptoms or x-ray abnormalities. In most cases, the prognosis is excellent with complete surgical resection; however, malignancies other than bronchial adenoma are associated with significantly mortality.

Clinical manifestations of lung cancer

The initial clinical manifestations of lung cancer are diverse and may occur with or without symptoms. Manifestations of pulmonary malignant lesions are produced by local growth or invasion, metastatic disease, or paraneoplastic processes. Patterns of local invasion such as Pancoast's syndrome or the superior vena cava syndrome are relatively uncommon but well recognized. Metastatic lung cancer can involve almost any anatomic area by hematogenous, lymphatic, or, occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte disturbances, and coexisting diseases influence the initial manifestations. Although individual tumor cell types are associated with characteristic features, no constellation of findings is pathognomonic for a specific histologic variant. Because successful treatment of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is important.