EComment. Mucoepidermoid carcinoma: common findings and surgical treatment

Abstract

We read with interest the paper by Papiashvilli and co-authors, reporting on an interesting case of mucoepidermoid carcinoma of the lower trachea in a 9-year old boy [1]. Mucoepidermoid carcinomas are rare neoplasms [2] of the bronchial tree arising from mucous and serous glands of the epithelium. They are rare and represent about 1% to 5% of bronchial adenomas, including also adenoid cystic carcinomas (cylindromas), mucous gland adenomas and carcinoids. The term “bronchial adenomas” is not correct because it refers to a benign process, and experience has demonstrated that these tumours have a broad spectrum of biologic activity and can sometimes have malignant behaviour. The term “bronchial adenomas” has therefore been recently replaced by “bronchial gland tumours”. These slow-growing tumours usually manifest with irritation and obstruction of the tracheobronchial tree and symptoms are related to their site [3]. When these masses are located in the trachea, as with the case presented by Papiashvilli et al, they produce upper respiratory tract occlusion with cough, wheezing and dyspnea. In this young patient, respiratory distress was interpreted as asthma until a CT scan showed the tracheal obstruction. Tracheal obstruction must always be suspected in intractable asthma, also in young patients. In cases of localization in the proximal or segmental bronchi, symptoms are usually related to progressive occlusion of a bronchus and therefore are characterized by relapsing pneumonia. Complete surgical resection is the treatment of choice for mucoepidermoid carcinoma. Endoscopic resection has been attempted, but the incidence of local relapse is high. It has a role only as a temporary option in order to plan and facilitate surgery. The principles of surgery are a clear margin at frozen section, complete locoregional lymph nodes removal and maximum sparing of lung parenchyma with tracheobronchial resection and reconstruction techniques. In the case reported by Papiashvilli and co-workers they performed an excellent and successful operation through a sternotomy, which is an unusual access to the lower trachea. As reported by the authors, the choice was based on “difficulty ventilating the child” and “the existence of immediate cardiopulmonary by-pass facilities”. Being general thoracic surgeons, we would have made the same operation through a right thoracotomy, and would have been ready to use a partial by-pass with peripheral cannulation, if required. We appreciate the report of such an unusual case successfully treated in a young boy. Conflict of Interest: None declared