Observation of Short-term and Long-term Efficacy of Bronchoscopic Interventional Therapy in the Treatment of Typical Carcinoid / 中国肺癌杂志

BACKGROUND@#The curative potential of various bronchoscopic treatments such as electric snare, carbon dioxide freezing, argon plasma coagulation (APC), Neudymium-dopted Yttrium Aluminium Garnet (Nd:YAG) laser and photodynamic therapy (PDT) for the treatment of intraluminal tumor has been administered previously, but this regimen is not common in the treatment of typical carcinoid. The aim of this study is to investigate the curative effects both in short-term and long-term of interventional bronchoscopy in the treatment of typical carcinoid.@*METHODS@#We retrospectively reviewed the clinical data of typical carcinoid patients who were treated with interventional bronchoscopy for tumor suppression and they were hospitalized in the Emergency General Hospital from December 2010 to December 2020, and Wilcoxon rank sum test and chi-square test were used for analysis.@*RESULTS@#A total of 32 patients were included, including 18 cases of preoperative bronchial artery embolization (embolization rate 56%, 95%CI: 31%-79%). The grade score of dyspnea decreased from before treatment to after treatment, and the difference was statistically significant [(1.44±1.03) score vs (0.25±0.58) score, P=0.003]; The degree of bronchial stenosis decreased from pre-treatment to post-treatment, and the difference was statistically significant [(87.50%±13.90%) vs (17.50%±6.83%), P<0.001]; There was significant difference in bronchial diameter before and after treatment [(0.14±0.18) cm vs (0.84±0.29) cm, P<0.001].@*CONCLUSIONS@#Bronchoscopic interventional therapy has significant short-term and long-term effects in the treatment of typical carcinoid.

Bronchial carcinoid tumors: second primary neoplasms and outcomes of surgical treatment / Tumores carcinoides brônquicos: segunda neoplasia primária e desfechos do tratamento cirúrgico

ABSTRACT Objective: To analyze determinants of prognosis in patients with bronchial carcinoid tumors treated surgically and the potential concomitance of such tumors with second primary neoplasms. Methods: This was a retrospective analysis of 51 bronchial carcinoid tumors treated surgically between 2007 and 2016. Disease-free survival (DFS) was calculated by the Kaplan-Meier method, and determinants of prognosis were evaluated. Primary neoplasms that were concomitant with the bronchial carcinoid tumors were identified by reviewing patient charts. Results: The median age was 51.2 years, 58.8% of the patients were female, and 52.9% were asymptomatic. The most common histology was typical carcinoid (in 80.4%). Five-year DFS was 89.8%. Ki-67 expression was determined in 27 patients, and five-year DFS was better among the patients in whom Ki-67 expression was ≤ 5% than among those in whom it was > 5% (100% vs. 47.6%; p = 0.01). Concomitant primary neoplasms were observed in 14 (27.4%) of the 51 cases. Among the concomitant primary neoplasms that were malignant, the most common was lung adenocarcinoma, which was observed in 3 cases. Concomitant primary neoplasms were more common in patients who were asymptomatic and in those with small tumors. Conclusions: Surgical resection is the mainstay treatment of bronchopulmonary carcinoid tumors and confers a good prognosis. Bronchial carcinoid tumors are likely to be accompanied by second primary neoplasms.

RESUMO Objetivo: Analisar os determinantes do prognóstico em pacientes com tumores carcinoides brônquicos tratados cirurgicamente e possível segunda neoplasia primária concomitante. Métodos: Trata-se de uma análise retrospectiva de 51 tumores carcinoides brônquicos tratados cirurgicamente entre 2007 e 2016. A sobrevida livre de doença (SLD) foi calculada pelo método de Kaplan-Meier, e os determinantes do prognóstico foram avaliados. As neoplasias primárias concomitantes aos tumores carcinoides brônquicos foram identificadas por meio da análise dos prontuários dos pacientes. Resultados: A mediana de idade foi de 51,2 anos, 58,8% dos pacientes eram do sexo feminino e 52,9% eram assintomáticos. A classificação histológica mais comum foi carcinoide típico (em 80,4%). A SLD em cinco anos foi de 89,8%. A expressão de Ki-67 foi determinada em 27 pacientes, e a SLD em cinco anos foi melhor nos pacientes nos quais a expressão de Ki-67 foi ≤ 5% do que naqueles nos quais a expressão de Ki-67 foi > 5% (100% vs. 47,6%; p = 0,01). Neoplasias primárias concomitantes foram observadas em 14 (27,4%) dos 51 casos. Entre as neoplasias primárias malignas concomitantes, a mais comum foi o adenocarcinoma pulmonar, observado em 3 casos. Neoplasias primárias concomitantes foram mais comuns em pacientes assintomáticos e naqueles com tumores pequenos. Conclusões: A resseção cirúrgica é o principal tratamento de tumores carcinoides broncopulmonares e propicia um bom prognóstico. É provável que tumores carcinoides brônquicos se relacionem com segunda neoplasia primária.

Carcinoma mucoepidermoide bronquial: a propósito de dos casos clínicos / Bronchopulmonary mucoepidermoid carcinoma: apropos of two clinical cases

Resumen El carcinoma mucoepidermoide bronquial es una neoplasia infrecuente, representando el 0,1 a 0,2% de los tumores malignos primarios del pulmón. En general tiene un buen pronóstico, sin embargo, existe un subtipo de alto grado de pronóstico más ominoso. En este artículo se presentan dos casos clínicos de carcinoma mucoepidermoide bronquial de bajo grado, enfocado en su diagnóstico y manejo quirúrgico.

ABSTRACT Bronchopulmonary mucoepidermoid carcinoma is an uncommon neoplasm, accounting for 0.1 to 0.2% of primary malignant tumors of the lung. In general it has a good prognosis, however there is a subtype of high grade of more ominous prognosis. In this paper we present two clinical cases of low grade pulmonary mucoepidermoid carcinoma, focused on their diagnosis and surgical management.

Carcinoma mucoepidermoide bronquial en la infancia: Caso clínico / Bronchial mucoepidermoid carcinoma in childhood: Case report

Los tumores bronquiales son raros en los niños. La mayoría son malignos; el más común es el tumor carcinoide. Con menor frecuencia, se asienta en el árbol traqueobronquial el carcinoma mucoepidermoide. El carcinoma mucoepidermoide representa del 0,1% al 0,2% de los tumores malignos broncopulmonares. Se manifiesta con síntomas de obstrucción de la vía aérea y/o neumonías recurrentes. El diagnóstico precoz y el tratamiento adecuado son de gran importancia en el pronóstico. La broncoscopía con biopsia de la masa endobronquial es el método de elección para confirmar el diagnóstico. El tratamiento consiste en la resección quirúrgica de la lesión. Se presenta a una niña de 11 años con disnea de esfuerzo y tos debidas a un carcinoma mucoepidermoide bronquial de bajo grado de malignidad. Se describen las manifestaciones clínicas, los métodos diagnósticos y el tratamiento de esta rara neoplasia en pediatría.

Bronchial tumors are rare in children. Most of them are malignant, being the carcinoid tumor the most common. Less frequently the mucoepidermoid carcinoma is found in the tracheobronchial tree. Mucoepidermoid carcinoma accounts for 0.1 to 0.2% of all malignant bronchopulmonary tumors. It manifests with symptoms of airway obstruction and/or recurrent pneumonias. Early diagnosis and appropriate treatment are of great importance in the prognosis. Bronchoscopy with biopsy of the endobronchial mass is the method of choice to confirm the diagnosis. Treatment consists of surgical resection of the lesion. We present an 11-year-old girl with dyspnea on exertion and cough due to a low malignant mucoepidermoid carcinoma of the bronchi. We describe the clinical manifestations, the diagnostic methods and the treatment of this rare neoplasia in pediatrics.

Tumores carcinoides pulmonares tratados quirúrgicamente valor pronóstico de la 7ª estadificación TNM

Con el objetivo de evaluar el valor pronóstico de la 7a estadificación TNM se analizaron 43 mujeres (61%) y 28 hombres (39%) con diagnóstico de tumor carcinoide tratados quirúrgicamente desde enero/1975 hasta diciembre/2011. Mediana de edad: 38 años (13-67). Presentaron carcinoide típico (CT) 63 (89%) pacientes y 8 (11%) carcinoide atípico (CA). Mediana de seguimiento: 4 años (1 - 24 años). Los estadios correspondientes a CT fueron: IA = 33 (52%), IB = 10 (16%), IIA = 2 (3%), IIB = 2 (3%), IIIA = 12 (19%) y IIIB = 2 (3%); para los CA fueron: IA = 1 (12.5%), IIB = 1 (12.5%), IIIA = 2 (25%) y IIIB = 4 (50%). No hubo diferencia estadísticamente significativa en la supervivencia global a cinco años en el análisis estratificando por estadios (p = 0.689), ni analizando separadamente cada tipo histológico (CT p = 0.547; CA p = 0.592). El intervalo libre de enfermedad fue significativamente menor (CT: 3 años vs CA: 2 años, p = 0.000) y las recaídas más frecuentes en el grupo de carcinoides atípicos (CA: 50% vs CT: 2%, p = 0.000). Los pacientes con CT presentaron buena evolución aun en estadios avanzados, mientras que los que tuvieron CA presentaron menor tiempo de supervivencia e intervalo libre de enfermedad, y mayor frecuencia de recurrencia. El subtipo histológico resultó un factor significativo de pronóstico, mientras que la 7ª estadificación TNM no contribuyó en predecir la supervivencia en los tumores carcinoides.

We analyzed 43 women (61%) and 28 men (39%) surgically treated for carcinoid tumors from Jan/1975 to Dec/2011. Median age: 38 years (13-67). Typical carcinoid (TC) appeared in 63 (89%) patients, 8 (11%) suffered from atypical carcinoid (AC). Median follow-up: 4 years (1-24). TC stages were: IA = 33 (52%), IB = 10 (16%), IIA = 2 (3%), IIB = 2 (3%), IIIA = 12 (19%) and IIIB = 2 (3%); AC stages were: IA = 1 (12.5%), IIB = 1 (12.5%), IIIA = 2 (25%) and IIIB = 4 (50%). TNM classification did not show significant differences on 5-years survival period by stage (p = 0.689), even according to histological type (TC: p = 0.547; AC: p = 0.592). The disease-free survival rate was significantly lower (TC: 3 years vs. AC: 2 years, p = 0.000) and relapses were more frequent in AC (AC: 50% vs. TC: 2%, p = 0.000). The 7th TNM staging was not influential in estimating survival from carcinoid tumours in our population. The histological subtype was a better prognostic factor.

Ressecção minimamente invasiva por broncoscopia de tumores brônquicos benignos / Minimally invasive bronchoscopic resection of benign tumors of the bronchi

OBJETIVO: Tumores benignos primários da traqueia e dos brônquios principais são incomuns. A broncoscopia intervencionista permite o diagnóstico e o tratamento de algumas dessas lesões. MÉTODOS: Revisamos quatro casos tratados endoscopicamente em nossa instituição. RESULTADOS: Dois pacientes tinham hamartoma, e dois pacientes apresentaram lipoma endobrônquico. Em todos os casos, a técnica de intervenção para a ressecção foi o uso de alça de polipectomia e eletrocautério. A única complicação relatada foi um episódio de broncoespasmo. CONCLUSÕES: O tratamento broncoscópico minimamente invasivo é um método seguro e efetivo para o tratamento bem-sucedido de alguns tumores benignos da via aérea principal, com um baixo índice de complicações.

OBJECTIVE: Primary benign tumors of the trachea and main bronchi are uncommon. Interventional bronchoscopy allows the diagnosis and the treatment of some of these lesions. METHODS: We reviewed four cases endoscopically treated at our institution. RESULTS: Two patients had hamartoma, and two patients had endobronchial lipoma. In all of the cases, the interventional technique for the resection was the use of a polypectomy snare and electrocautery. The only complication reported was one episode of bronchospasm. CONCLUSIONS: Minimally invasive bronchoscopic resection is a safe, effective method for treating selected benign tumors of the main airway and has a low complication rate.

The Endoscopic Cryotherapy of Lung and Bronchial Tumors: A Systematic Review -Can We Expect a New Era of Cryotherapy in Lung Cancer?

No abstract available.

Braquiterapia endobronquial de alta tasa de dosis en pacientes con obstrucción de la vía aérea central: experiencia en el Instituto Nacional del Cáncer y revisión de la literatura / High dose rate endobronchial brachytherapy in patients with central airway obstruction

Introduction: The main indication of modern high dose rate end bronchial brachyherapy (HDR EBBT) is the palliation of symptoms related to the growth of the endobronchial lung cancer. Methods: EBBT was performed to 27 patients who suffered symptomatic tumoral endobronchial or tracheal pathology, due to primary bronchial disease or secondary metastasis cancer, evaluating the rate of clinical benefit. The tumors were located at tracheal, carinal or proximal bronchial level. Fibrobronchoscopy was performed to all the patients to measure the degree of airway obstruction and to install brachytherapy endobronchial catheters. Between 1 to 4 fractions of 7 to 7.5 Gy were administered. Dyspnea, cough and hemoptysis were subjectively registered before and after treatment, according to an international validated scale. Results: After treatment, all symptoms considerably decreased, disappearing all of the severe categories. Hemoptysis and dyspnea resolved in a 100 percent and 40 percent of patients, respectively; and cough disappeared or was reduced to a minimum grade in 90 percent of cases.

Introducción: La indicación principal de la braquiterapia endobronquial moderna (BTEB) de alta tasa de dosis (HDR), es la paliación de síntomas por crecimiento endobronquial de cánceres pulmonares. Métodos: Se realizó BTEB HDR a 27 pacientes sintomáticos de patología tumoral endobronquial o traqueal, debido a patologías primarias bronquiales o secundarias metastásicas. Los tumores se ubicaban en tráquea, carina o a nivel bronquialproximal. Para observar mejorías en la sintomatología clínica, a todos se les realizó una fibrobroncoscopía (FBC) para medir el grado de obstrucción bronquial e instalar catéteres endobronquiales de braquiterapia. Se administraron entre 1 y 4 fracciones de 7 a 7,5 Gy. Se registró subjetivamente la disnea, tos y hemoptisis antes y después del tratamiento, de acuerdo a una escala internacionalmente validada. Resultados: Tras el tratamiento todos los síntomas disminuyeron considerablemente, desapareciendo toda sintomatología severa. La hemoptisis y disnea desaparecieron en el 100 por ciento y 40 por ciento de los pacientes respectivamente, y la tos desapareció o disminuyó a grado leve en el 90 por ciento de los pacientes.

Isolated oesophageal cyst connected with the bronchus

We report an unusual case of a patient with an oesophageal cyst connected to the bronchus. A 24-year old male with a two-year history of repeated attacks of chest infection and haemoptysis was found to have a cyst of 4 x 4 cm affecting the anterior and apical segments of the right upper lobe. The cyst was excised in its entirety and the histopathological study of the cyst showed stratified squamous epithelium with submucosal and muscular layer but no cartilage. The pathological diagnosis was an oesophageal cyst. No previous case of isolated oesophageal cyst connected to the bronchus has been reported according to the available literature.

Hamartoma endobronquial: a propósito de un caso / Endobronchial hamartoma: case report

El hamartoma es el tumor pulmonar benigno más frecuente. En su mayoría se encuentran en el parénquima pulmonar, pero en algunos casos se presentan en bronquios. Los hamartomas endobronquiales pueden ser hallazgos radiológicos, aunque en ocasiones pueden producir tos crónica o neumonías a repetición. El manejo es la resección endoscópica, pero debido al difícil diagnóstico diferencial con las neoplasias malignas pulmonares, la resección pulmonar juega un papel importante. Se presenta el caso de una paciente de 72 años con un cuadro de tos crónica. Se pesquisó en estudio radiológico una masa en lóbulo superior derecho con compromiso bronquial. La fibrobroncoscopía con biopsia y citología no pudo determinar diagnóstico. Se realizó lobectomía superior derecha. El estudio histológico intraoperatorio y diferido confirmaron el diagnóstico de hamartoma.

Tumores primarios malignos de tráquea y bronquios principales / Malignant primary tumors of the trachea and primary bronchi

Los tumores de la tráquea y los bronquios principales son raros, por lo que no existe experiencia importante en el tratamiento de éstos. Los tipos histológicos más frecuentes son el carcinoma adenoideo quístico y el carcinoma de células escamosas. En nuestro caso estos tipos histológicos se presentaron en 2 pacientes respectivamente. El carcinoma mucoepidermoide fue el diagnóstico en otros 2 enfermos y el leiomiosarcoma de tráquea en un caso. La resección quirúrgica fue el tratamiento de elección con resección de carina en 3 enfermos, neumonectomía en 1 y resección de tráquea cervical en 3. La radioterapia adyuvante se utilizó en los cilindromas, los carcinomas de células escamosas y los tumores mucoepidermoides. Solo 1 de 7 pacientes mostró complicaciones y no hubo mortalidad posoperatoria. La mayor supervivencia ha sido de 172 meses en el caso del leiomiosarcoma. Una enferma con un cilindroma falleció a los 74 meses de operada y los 2 enfermos con tumores epidermoides de bronquio principal fallecieron 13 y 15 meses después de su operación, todos por enfermedad metastásica(AU)

As the trachea and primary bronchus tumors are rare, there is no an important experience in their treatment. The most frequent histological types are the adenoid cystic carcinoma and the squamous cell carcinoma. In our case, these histological cases were observed in 2 patients, respectively. The mucoepidermoid carcinoma was diagnosed in 2 other patients and the tracheal leiomyosarcoma in one case. Surgical resection was the election treatment with carina resection, in 3 patients; pneumonectomy, in 1; and cervical trachea resection, in 3. Adjuvant radiotherapy was used in cylindromas, squamous cell carcinomas and mucoepidermoid tumors. Only 1 of 7 patients had complications. There was no postoperative mortality. The highest survival has been of 172 months in the leiomyosarcoma. A female patient with a cylindroma died 74 months after the operation, whereas the 2 patients with epidermoid tumors of primary bronchus died on the13th and 15th months. All of them died due to metastatic disease(AU)

Tumor de células granulares endobrônquico: relato de um caso diagnosticado por biópsia endoscópica / Endobronchial granular cell tumor: report of a case diagnosed by endoscopic biopsy

Tumor de células granulares (TCG) é um termo descritivo para um tumor com histologia distintiva, perfil imunohistoquímico característico e achados ultra-estruturais peculiares. Tem distribuição topográfica ampla e sua localização nas vias aéreas é considerada incomum. Os autores relatam o caso de uma mulher de 40 anos com tosse produtiva e febre há dois meses e exame físico normal. A tomografia computadorizada evidenciou espessamento de parede do brônquio intermediário e a broncoscopia mostrou, nesse nível, hiperemia e elevação da mucosa endobrônquica. Os exames histopatológicos e imunohistoquímico dos tecidos deste local diagnosticaram TCG. O objetivo do presente relato é chamar a atenção para a possibilidade de diagnóstico desse tumor em pequenas biópsias endoscópicas

Bronchial oncocytoma

CONTEXT: Oncocytomas are generally small and present slow growth. Finding of the tumor usually occurs incidentally. Their incidence is higher among male patients. Oncocytomas in mucous bronchial glands are extremely rare. CASE REPORT: A 35-year-old male who presented bronchial oncocytoma. The tumor was found after bronchoscopy that investigated an atelectasis of the upper left lobe. Histological examination with optical microscopy revealed a mature neoplasm formed by ovoid cells with thin, granular, eosinophilic cytoplasm and small nuclei similar to oncocytes. Electron microscopy showed mitochondrial hyperplasia. A three-year follow-up after thoracotomy followed by lobectomy and removal of the bronchial tumor was uneventful

Carcinoide bronquial / Bronchial carcinoid

Se presentan 32 pacientes portadores de tumores carcinoides bronquiales que fueron intervenidos quirúrgicamente. Se hace mención a su histogénesis, morfología, características clínicas y biológicas. Se pone énfasis en la importancia de la broncoscopia para su diagnóstico. No se observó el sindrome carcinoide. Se efectuaron 4 broncotomias, 2 enucleaciones, 14 lobectomias, 2 bilobectomias, 8 neumonectomias, 1 resección segmentaria y 1 toracotomia para explorar. Si bien es un tumor de baja malignidad puede dar metástasis. Tres pacientes presentaban metástasis regionales y 2 a distancia; la tendencia biológica agresiva para esta serie fue del 16.1%. Un paciente falleció por progresión de la enfermedad

Nd: YAG laser bronchoscopy; the first two successful cases in Puerto Rico

Two patients underwent bronchoscopic laser photoresection of tumors in the tracheobronchial tree with no mortality or significant morbidity. One patient had an adenoid cystic carcinoma of the trachea and the other a pleomorphic adenoma of left main stem bronchus. These were the first two cases performerd in Puerto Rico at San Pablo Medical Center. Both patients are symptomless at this time. We can conclude that laser is a safe and cost effective altenative in experienced hands to other procedures in properly selected patients with tumors of tracheobronchial tree in Puerto Rico

Lasers in pulmonology.

Lasers have multiple applications in pulmonary medicine. The Nd: Yag laser is at present widely accepted for the management of respiratory problems. The major indications are central tracheobronchial obstruction due to neoplasms, uncontrolled haemorrhage from malignant lesions and tracheal stenosis. Its role is entirely palliative and only occasionally curative. Two main complications are perforation and bleeding. The basic concepts, techniques and use in various respiratory problems are discussed.

Procedimientos broncoplásticos en cirugía pulmonar / Bronchoplastic procedure in pulmonary surgery

Se presentan 25 pacientes intervenidos quirúrgicamente, en los que se empleó algún procedimiento de plástica bronquial. Las patologías fueron benignas en 4 casos, de baja malignidad en 15 y malignas en 6. El motivo de la presentación fue analizar la evolución alejada de los mismos. Dados los excelentes resultados obtenidos en patologías benignas y en tumores de baja malignidad (carcinoide), se concluye que debe ser considerada técnica de elección. No así para el cáncer de pulmón, donde sólo se la tendrá en cuenta cuando la capacidad funcional del paciente condicione la resecabilidad.