Anaplastic lymphoma kinase-positive pulmonary inflammatory myofibroblastic tumour: a case report

BACKGROUND

Pulmonary inflammatory myofibroblastic tumour (IMT) is a rare condition that usually presents in young individuals and is associated with anaplastic lymphoma kinase (ALK)-translocation.

CASE PRESENTATION

We report a case of an 18-year-old Caucasian man with ALK-translocated pulmonary IMT treated with multimodality therapy. The patient presented with breathlessness and was found to have a collapsed left lung. Further investigations revealed an ALK-translocated pulmonary IMT. This is usually treated with an ALK-inhibitor but patient declined after discussing potential side-effects and had repeated rigid bronchoscopic interventions for local disease control. Due to persistent local recurrence, patient received radical external beam radiotherapy (EBRT) with pulse steroids, and one year later started on Ibuprofen, a non-steroidal anti-inflammatory agent (NSAID). Following multimodality treatment, he developed a complete response. He remains treatment-free for the past seven years. Eleven years on from his diagnosis, he remains in remission with a ECOG performance status of zero.

CONCLUSIONS

Achieving long-term local control in pulmonary IMT can be challenging. Multimodality treatment is sometimes needed but the overall outlook remains good.

Interventional treatment of giant tracheal lymphoma under rigid bronchoscopy: A case report and literature review

INTRODUCTION

Lymphoma can appear in all parts of the body and present with different symptoms. However, bronchial lymphoma is rare and can be misdiagnosed as airway malignancy or lung disease.Patient: An older adult woman with tracheal lymphoma experienced severe breathing difficulties, and chest computed tomography indicated severe narrowing of the airway. She did not respond to repeated antibiotic treatment, and she was eventually diagnosed with lymphoma based on pathology after surgical removal of the tumor.

DIAGNOSIS

The patient received a diagnosis of thoracic tracheal stenosis due to intratracheal inflammatory granulomatous lesions or a tumor.

INTERVENTIONS

Treatment involved the use of a high-frequency electrotome, freezing, and argon plasma coagulation.

OUTCOMES

The patient reported improvements in dyspnea, cough, and other symptoms after the operation. The pathological results confirmed follicular lymphoma. Reexamination by fiberbronchoscopy indicated that the degree of stenosis in the middle and upper tracheal segments was significantly reduced following interventional therapy.

CONCLUSION

Endoscopic interventional therapy can be an effective treatment for tracheal lymphoma.

Video-assisted Rigid Endoscopic Laser Ablation for Endobronchial Mucoepidermoid Carcinoma in Pediatrics Without Pulmonary Resections

INTRODUCTION

Mucoepidermoid carcinoma (MEC) is a rare malignancy of primary endobronchial lesions in children. Early diagnosis is crucial for the disease, but it is often misdiagnosed as asthma or lung infection. Chest computed tomography and bronchoscopy are the most important diagnostic tools. Surgical resection is the current treatment of choice for low-grade MEC. In the past, lobectomy, sleeve lobectomy, or segmental resections were the most standard surgeries. Endoscopic treatment was used for lung preservation and effectual removal of the lesions.

METHODS

A retrospective study of pediatric patients with primary endobronchial lesions who underwent rigid bronchoscopic laser ablation since 2010 was conducted. Pre-operative images, endoscopic pictures, post-operative images, histological analyses, and patients' clinical conditions were recorded and illustrated.

RESULTS

Four patients were enrolled. Three patients presented initially with cough or hemoptysis. The lesion sites were the bronchus of the left upper lobe, left lower lobe, left main bronchus, and trachea. All patients underwent bronchoscopic laser ablation for tumor excision without anatomical resection. No major surgical complications were encountered. All patients survived without recurrence after a mean postoperative follow-up of 4.5 years (3-6 years).

CONCLUSION

Video-assisted rigid endoscopic laser ablation for pediatric low-grade endobronchial MEC is a feasible, effective, and safe method. Close follow-up is essential for lung preservation management.

EVIDENCE LEVEL

Level IV.

TYPE OF STUDY

Case series with no comparison group.

Endobronchial mucoepidermoid carcinoma in a child with postinfectious bronchiolitis obliterans

Endobronchial mucoepidermoid tumors are rare neoplasms. Due to nonspecific symptoms, diagnosis can be challenging, but early diagnosis and treatment are crucial for prognosis. We present the case of a boy, with chronic respiratory insufficiency due to bronchiolitis obliterans, that presented worsening exertional dyspnea at 12 years. Spirometry showed unexpected deterioration of respiratory function and a computed tomography scan revealed an obstructive polypoid mass in the intermediate bronchus. Given the severe basal ventilatory compromise and risk associated with surgical treatment, rigid bronchoscopy, and laser photocoagulation were performed, with clinical and functional improvement. The histological examination revealed a low-grade mucoepidermoid carcinoma. The option for a minimally invasive procedure requires careful follow-up due to the risk of tumor recurrence.

Inflammatory myofibroblastic tumour of the central airways: treatment and molecular analysis

Inflammatory myofibroblastic tumours (IMT) are a rare cause of endobronchial masses in adults. Surgery has been the mainstay of treatment of endobronchial IMTs, based on the potential for recurrence. Interventional pulmonology has emerged as a minimally invasive and lung function preserving modality in management of airway obstruction due to tumours. We present a series of three adult patients with IMT treated endobronchially with a short discussion on its potential role. We also discuss how molecular analysis of IMTs for mutations in genes such as ALK and ROS1 might provide insights into clinical behaviour and potential targetable therapy in advanced, unresectable and metastatic cases.

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.

Inflammatory myofibroblastic tumor of the trachea in the pediatric age group: case report and systematic review of the literature

Inflammatory myofibroblastic tumors are uncommon tumors, which present as solitary masses in the pulmonary parenchyma. Tracheal involvement by these tumors is extremely rare and can be misdiagnosed as asthma. The closest histologic differential diagnoses are IgG4-related sclerosing pseudotumors, which are differentiated by IgG4 positivity. Fifty percent of inflammatory myofibroblastic tumors are positive for anaplastic lymphoma kinase gene rearrangements. The treatment modality of choice is surgical resection with therapeutic bronchoscopy reserved for patients presenting with acute airway obstruction or in those unwilling for surgery. New and upcoming treatments include anaplastic lymphoma kinase inhibitors like crizotinib.