Bronchial adenoma

Overview bronchial adenoma (bronchial adenoma) originated in bronchial mucous glands, tubular epithelial mucosa, or under the Kulchitsky cells in a tumor group, but the tendency of malignant change. Often occurred in 30 ~ 50 years, with an average age of 45. And the incidence rate similar. Pathogenesis of pathology can be divided into three types : (1) bronchial carcinoid (bronchial Carcinoid) - also known as carcinoid tumors (Garc inoid adenoma) for primary neoplasms of 1% ~ 7% bronchial adenoma accounted for 80% ~ 90%. Occur in large bronchus. From the bronchial wall kulchitsky cells. 80% for central, only 1 / 5 of happened in the following bronchial around. Bronchial mucosa tumors tend to grow. If within the lumen to the growth, many of forming a smooth surface, vascular rich polypoid mass, obstruction of the lumen, can cause obstruction, which is emphysema, atelectasis or pneumonia, and even lung abscess; If the wall to the internal and external growth, may be typical of the dumbbell-shaped mass. Most of the tumors with intact membrane, cut surface or greyish pink, and the surrounding lung tissue boundaries clear, easy and lung removed. Breakthrough was also coated invasive growth. Microscopy : tumor cells smaller, or polygon cube, the same size, and the flocks gathering was arranged or cable line with tubular samples. Abundant cytoplasm, eosinophils, plasma containing dark argyrophilic grain, which is equivalent to the electron microscope can see secretory granule neurons. Granule secretion of a variety of bioactive substances, leading to ectopic endocrine carcinoid symptoms. Nuclear round or oval, combination, mitosis rare. The tumor interstitial capillary containing rich, sometimes glass-like change, amyloidosis, calcification, even ossification. About 10% of bronchial carcinoid tumor growth was not typical. Cell sizes, with irregular; Nuclear pleomorphism, split equivalent increase in common necrosis. Atypical carcinoid patients 70% had local lymph nodes, liver or bone metastases, and the typical carcinoid metastasis rate is below 5%. (2) adenoid cystic carcinoma (adenoid cystic carcinoma) said cylindrical original tumor (cy lindromas), accounting for bronchial adenoma 10 ~ 15%. Occurred in tracheal or carinal, and bronchial large. Growth infiltration along the wall; May violations surrounding tissues and organs; Rarely showed polypoid growth; Bronchial obstruction may cavity. With a cut surface. Microscopy : scarce cytoplasm and nucleus deep color and rules, The small size of the basal epithelial cell-like cells substantive or lobulated nest cells and cell REQUEST. REQUEST cells in and around a transparent matrix deposition. Arrange the tumor cells staggered cylinder or tube. Containing PAS-positive epithelial cell mucin. Mitosis carcinoid styles. Malignant adenomas is the highest. Local infiltration may also be distant metastasis to the liver, kidneys and other organs. (3) mucoepidermoid carcinoma (the most common tumor) from the large bronchial mucous glands is a rare tumor, bronchial adenoma or about 2% - 3%. Cranford was generally the endobronchial tumor growth, can obstruct the lumen and local violations. Plane full of mucus see a number of cysts. Microscopy see keratinocytes, mucin secretion cells and intermediate or transitional-cell tumor components. Histologically further divided into : high tumor differentiation see more, a clear line to the external growth, and the rules of small nuclear and cytoplasmic rich, No mitotic phase of the cell components; goblet cells, glandular formation prominent; transition and squamous cell rare. Low differentiation of tumor is rare, ill-defined, growth inward, partial necrosis, and the large number of nuclear-, scarce cytoplasm and mitosis; goblet cells and squamous cell rare, rare glandular formation; Transitional cell; with partial erosion, hateful change. Clinical manifestations of bronchial adenoma diagnosis of bronchial carcinoma age than earlier. With the growth of tumor symptoms were cavity and bronchial obstruction whether local invasion and distant metastasis varies. Occurred from the brink of lung more asymptomatic, often in X-ray examination found. If it occurred in the larger bronchi, the initial appearance of irritating cough, sputum repeated blood. Increased tumor, a limited obstructive pulmonary emphysema and limitations of fixed wheezing. Lumen totally blocked, there will be atelectasis. Distal pulmonary obstruction secondary infection, pneumonia, lung abscess or bronchiectasis. Because benign adenomas, the symptoms longer exist, some for as long as 5 ~ 15 years before diagnosis. If the malignant transformation of the transfer, and other symptoms similar to cancer metastasis. A few patients with bronchial carcinoid tumor may appear paroxysmal skin redness, abdominal pain, diarrhea, asthma and tachycardia and other carcinoid syndrome, or central obesity, hypertension, edema, fatigue and hypokalemic alkalosis and pigmentation, and other ectopic ACTH syndrome. X-ray examination : an hour of tumor very negative. Near the hilar bronchial adenoma, a round or semi-circular shadow; Around at the Department of lung, were nodular or spherical video. Can be associated with obstructive pulmonary emphysema, pulmonary atelectasis, obstructive pneumonia, lung abscess or tumor sometimes concealed. Diagnosis of bronchial adenoma incidence younger, often for a longer period of time choking, hemoptysis and recurrent pulmonary infections. Chest X-ray showed signs of dense circular shadow. Especially layered photography and CT scan can clearly show the location of the tumor, shape, size, Bronchial obstruction, and whether or not the regional lymph node metastasis. Bronchoscopy diagnosis of the disease is one of the important ways, not only can determine tumor localization and biopsy can provide a pathological diagnosis. Fiberoptic bronchoscopy positive biopsy rate up to 66% ~ 86%. Hypervascular tumor and the surface epithelium complete coverage, I think it would be rash indeed raise rates, must repeat biopsy for deep, But to prevent bleeding; Sputum cells and bronchial washing and brushing smear screening diagnosis of the disease without help. Surgical resection is the treatment cured the current type of bronchial adenoma the only way. Resection of tumor growth depends on the scope and location and the involvement of the distal lung tissue. Principles should radical resection of the tumor, cleaning suspicious regional lymph nodes as possible to retain normal lung tissue and avoid lung resection, can improve survival and reduce complications; Endobronchial resection, whether using electrocautery or laser treatment. apply only for medical contraindications not thoracotomy and had symptoms of central adenoma. Surgical resection after 5-year survival rate was 95%, if the regional lymph node metastasis, the 5-year survival rate of 57-70%. Because lung metastatic carcinoid years unchanged or chronic growth, or like a small-cell cancer growth, therefore, there is no sure method of treatment. However, in response to concrete cases of tumor growth rate and histological evaluation to determine whether chemotherapy ah OK radiotherapy. With the differential diagnosis of lung adenomas differential mass following diseases. (1) peripheral bronchial carcinoma of the age than the relatively large adenoma and growing rapidly. X Buy adenoma round or nodular lesions border lung cancer than sharp, but sometimes difficult distinction. Diagnosis problems should be promptly exploratory thoracotomy, in order to avoid losing the opportunity to cure. (2) TB occurs in the ball on the tip after the lungs of the superior or the next, often around the satellite foci, lesions often concentric or intensive calcifications. (3) pulmonary hamartoma was round or lobulated block area, clear edge and calcification within the lesion, sometimes burglary - was synchronized.