Carcinoma mucoepidermoide bronquial: tumor raro en niños / Bronchial mucoepidermoid carcinoma: rare tumor in children

Introducción. Las neoplasias pulmonares son raras en niños. La tráquea y la vía aérea superior contienen glándulas mucosas y serosas similares a las de las glándulas salivales mayores. De estas glándulas surge un grupo de tumores, muy poco comunes, que incluye el carcinoma adenoideo quístico, el carcinoma mucoepidermoide, el adenoma pleomórfico, el carcinoma de células acinares y el oncocitoma. El carcinoma mucoepidermoide representa 0.2% de los casos de cáncer pulmonar a cualquier edad. A la fecha, en la literatura mundial se han reportado solamente alrededor de 100 niños con esta entidad. Antiguamente se clasificaban como adenomas bronquiales, término inapropiado para una neoplasia que, aunque de crecimiento lento, puede ser localmente invasiva. Presenta un curso relativamente benigno cuando corresponde a tumores de bajo grado de malignidad. Se manifiesta como neumonías recurrentes o de lenta resolución. La evaluación de estos pacientes debe ser exhaustiva. El tratamiento más aceptado es la resección quirúrgica del lóbulo pulmonar afectado, con los respectivos ganglios linfáticos hiliares lobares. Caso clínico. Paciente de sexo femenino de 10 años de edad, con historia de infecciones recurrentes de vías aéreas y dos veces neumonía en el pulmón izquierdo. Se realizó tomografía de tórax y se encontró estenosis del bronquio izquierdo, que se corroboró mediante un estudio endoscópico. Después de la neumonectomía, el estudio histológico y el inmunohistoquímico indicaron carcinoma mucoepidermoide de bajo grado. Conclusiones. El carcinoma mucoepidermoide de bajo grado de malignidad presenta buen pronóstico al realizarse su extirpación completa.

Background. Lung neoplasms are rare in children. Mucous and serous glands from trachea and upper airway contain similar cells to those of the major salivary glands. Of these glands there is a group of very rare tumors including adenoid cystic carcinoma, mucoepidermoid carcinoma, pleomorphic adenoma, acinic cell carcinoma and oncocytoma. Mucoepidermoid carcinomas represent 0.2% of cases of lung cancer at any age, and slightly more than 100 children have been reported with this entity in the world literature. Formerly classified as bronchial adenoma, this term is inappropriate for a slow-growing neoplasm and may be locally invasive. These tumors present a relatively benign course when they correspond to tumors of low-grade malignancy and may be manifested as recurrent pneumonia or slow resolution. Children with these clinical manifestations should be thoroughly evaluated including endoscopic and tomographic studies. Surgical resection of the affected lung lobe with the respective lobar hilar lymph nodes is the most accepted treatment. Case report. We report the case of a 10-year-old female with a history of recurrent airway infection and two left lung pneumonias. Chest tomography showed a left bronchus stenosis confirmed by endoscopy. Following pneumonectomy, the histopathological and immunohis-tochemical findings reported a low-grade mucoepidermoid carcinoma. Conclusions. Mucoepidermoid carcinoma of low-grade malignancy has a good prognosis with complete tumor excision that requires a comprehensive approach that includes bronchoscopy.

Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case

This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.