Bronchoscopic debulking followed by bronchoplastic procedure helps in limiting lung resection in a bronchial carcinoid: a case report

Surgical management of bronchopulmonary carcinoids: A single center experience

Introduction:

Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors.

Patients and Methods:

This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records.

Results:

Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free.

Conclusions:

Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

Multimodality multistaged management of large endobronchial carcinoid causing respiratory failure: A case report with review of literature

We report the case of a 58-year-old female presenting with central airway obstruction leading to airway compromise thrice, first two times from endobronchial growth of typical carcinoid tissue and subsequently from granulation tissue at anastomotic site after left carinal pneumonectomy. Bronchoscopic resection of carcinoid tumor and granulation tissue was performed successfully with electrosurgical snaring through rigid bronchoscope. Cryodebridement using flexible cryoprobe of the tumor was done postembolization and of the remnant granulation tissue without any complication. A multimodality approach is required for favorable outcome as observed in this case.

Surgical experience of primary salivary gland tumors of lung: A case series

INTRODUCTION

Primary salivary gland type tumors of lung (PSGTTL) are rare intra-thoracic malignant neoplasm. Their description in literature is largely limited to a few case series/case reports. We herewith present our surgical experience of and review its clinical presentation, management options and survival outcomes.

METHODS

This retrospective analysis of prospectively maintained computerized data-base of patients was conducted in a tertiary teaching oncology centre in North India. The case records of all the patients who underwent surgery for PSGTTL were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, histopathological examination, postoperative complications and outcome were retrieved from the case records.

RESULTS

There were seven patients who underwent surgery for PSGTTL during the period from January 2012 to December 2014. Hemoptysis (n = 6, 85.7%) and dyspnoea (n = 6, 85.7%) were common presenting clinical features. Fiber-optic bronchoscopy revealed endobronchial growth in all patients - five patients had growth in left main bronchus while one each had growth in right main bronchus and right intermediate bronchus. Biopsy confirmed adenoid cystic carcinoma in 4 (57.1%) and muco-epidermoid carcinoma in 3 (42.9%) patients. All but one had R'0' resection - pneumonectomy in five and bilobectomy in one patient; one patient was found to be unresectable in view of dense adhesions between lung and heart. Median pathological tumor size was 3.5 cm; none of the patient was found to have metastatic spread to lymph nodes. Overall, six patients are alive after a median follow up of 5 months (range 1-30).

CONCLUSION

Radical surgery to achieve R'0' resection is the main stay of treatment of PSGTTL to achieve prolonged survival.