Benign tumors of the large bronchi and trachea

The OBJECTIVE was to assess the incidence, diagnostic abilities and surgical tactics in case of benign tumors of the large bronchi and trachea.

METHODS AND MATERIALS. Benign tumors of the large bronchi and trachea were diagnosed in 29 (6.3 %) of patients among 445 patients with benign bronco-pulmonary tumors. The diagnosis was made due to X-ray and endoscopic studies. Lung resections were performed in 5 (17.2 %) patients. RESULTS. Clinical symptoms were non-specific. In 10 (35.7 %) cases, the disease was diagnosed during X-ray examination. Computed tomography revealed pulmonary changes caused by bronchial narrowing in 5 patients (17.2 %).
The biopsy taken during bronchoscopy detected the histological form of the tumor in 16 (55 %) patients. The exact morphological type of the tumor was identified after its removal. More often, they were polyps (48.3 %), papillomatosis (20.7 %), chondromas (10.3 %), in single cases – teratomas, sclerosing hemangioma, adenoma, mucoepidermoid tumor, histiocytoma, inflammatory pseudotumors. In 24 (82.8 %) patients, tumors were removed during bronchoscopy by electrosurgical or argonoplasmic destruction methods. The repeated surgery for a recurrence was required in 5 (17.2 %) patients in terms of (8.3±4.7) months, three times for two patients. In three cases, we performed lobectomy; in one case, we performed lobectomy with wedge resection of the intermediate bronchus. Pneumonectomy was made in two patients: one patient suspected of cancer after tumor biopsy, the other – complicated with lung gangrene. The latter patient died of pneumonia of the single lung. The mortality rate was 3.4 %.

CONCLUSION. In presence of non-specific pulmonary symptoms resistant to therapy, it is necessary to rule out benign bronchial tumors using X-ray and endoscopy. Most formations can be removed during bronchoscopy. In case of irreversible lung changes or impossible endoscopic removal, we should use surgery.

1. ESTS textbook of thoracic surgery / eds. by J. Kuzdzal. Cracow, Medycyna Practyczna, 2014:1084.

2. Stevic R., Milencovic B. Tracheobronchial tumors // J. Thorac. Dis. 2016;8(11):3401–3413. Doi: 10.21037/jtd.2016.11.24.

3. Perel’man M. I., Efimov B. I., Biryukov Yu. V. Benign lung tumors. Moscow, Medicina, 1981:240. (In Russ.).

4. Trahtenberg A. H., Chissov V. I. Lung cancer. Guide. Atlas. Moscow, GEOTAR Medicina. 2009:655. (In Russ.).

5. Travis W. D., Brambilla E., Nicholson A. G., Yatabe Y., Austin H. M., Beasley M. B., Chirieac L. R., Dacic S., Duhig E., Flieder D. B., Geisinger K., Hirsch F. R., Ishikawa Y., Kerr K. M., Noguchi M., Pelosi G., Powell C. A., Tsao M. S., Wistuba I. The 2015 World Healty Organization Classification of Lug Tumors. Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification // J Thorac Oncol. 2015;10(9):1243–1260. Doi: 10.1097/JTO.0000000000000630.

6. Jugpal T. S., Garg A., Sethi G. R., Daga M. K., Kumar J. Multi-detector computed tomography imaging of large airway pathology: a pictorial review // World J Radiol. 2015;7(12): 459–474. Doi: 10.4329/wjr.v7.i12.459.

7. Adult Chest Surgery. Second Edition / eds by Sugarbaker D. J., Bueno R., Colson Y. L., Jaklitsch M. T., Krasna M. J., Mentzer S. J. McGraw Hill Education, 2015:1435.

8. Kadamkulam Syriac A., Bhaskarla A. V., Elrifai M., Alraiyes A. H. Incidental endobronchial hamartoma in a patient with enchondroma // BMJ Case Rep. 2019;12(9):229670. Doi: 10.1136/bcr-2019-229670.

9. Akella P., Jindal V., Bhandari B. S., Siddiqui A. D. Meta-analysis of a master mimicker: endobronchial lipoma // Chin Clin Oncol. 2019. Doi: 10.21037/cco.2019.08.17.

10. Chen M., Song L. X., Jiang T., Tang Y. H. Clinical and imaging manifestations of primary benign tracheobronchial tumors // Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2019;41(2):143–148. Doi: 10.388/j.issn.1000-503X.11147.

11. Kotlyarov P. M., Egorova E. V., Rebrikova V. A. Virtual bronchoscopy in the updated diagnosis of lung pathology // Trudnyi patsient. 2018;16(11):50–53. (In Russ.).

12. Das K. M., Lababidi H., Dandan A. I., Raja S., Sakkiiha H., Zoum A. I., AlDosari K., Larsson S. G. Computed tomography virtual bronchoscopy: normal variants, pitfalls, and spectrum of common and rare pathology // Can Assoc Radiol J. 2015;66(1):58–70. Doi: 10.1016/j.carj.2013.10.002.

13. Luo M., Duan C., Qui J., Zhu D., Cai W. Diagnostic value of multidetector CT and its multiplanar reformation, volume rendering and virtual bronchoscopy postprocessing techniques for primary trachea and main bronchus tumors // Can Respir J. 2019:5269728. Doi: 10.1155/2019/5269728

14. Chung H. S., Lee K. M., Eom J. S., Kim I., Park S., Ahn J., Kim A., Lee C. H., Lee G., Lee M. K. Bronchoscopic management of solitary bronchial myelolipoma: a case report // BMC Pulm Med. 2019:19(1):151. Doi: 10.1186/s12890-019-0910-y.

15. Dalar L., Ozdemir C., Sokucu S. N., Nur Urer H., Altin S. Bronchoscopic Treatment of Benign Endoluminal Lung Tumors // Can Respir J. 2019:5269728. Doi: 10.1155/2019/5269728.

16. Zhu Z., Lian X, Yang D. Right main bronchial pleomorphic adenoma: A case report and literature review // Medicine (Baltimore). 2018; 97(42):12648. Doi: 10.1097/MD.0000000000012648.

17. Hady S. M. A., Elbastawisy S. E., Hassabala A. S., Elsayed H. H. Is surgical resection superior to bronchoscopic resection in patients with symptomatic endobronchial hamartoma? // Interact CardioVasc Thorac Surg. 2017;24(5):778–782.

18. Liao H., Song W., Chen N., Chen F., Liu C., Lin F. Left lower lobe sleeve resection for endobronchial schwannoma // Ann Transl Med. 2019;7(3):50. Doi: 10.21037/atm.2018.12.32.

19. Thoracic surgery. Lung resection. bronchoplasty / eds by D. J. Mathisen, C. R. Morse. Wolters Kluwer, 2015:498.

20. Pak P. S., Yanagawa J., Abtin F., Wallace W. D., Holmes E. C., Lee J. M. Surgical management of endobronchial solitary fibrous tumors // Ann Thorac Surg. 2010;90(2):659–661. Doi: 10.1016/j.athoracsur.2010.02.024.

21.