Pulmonary mucoepidermoid carcinoma with endobronchial involvement: A case report

Although mucoepidermoid carcinomas (MEC) commonly occur in the salivary glands, they are rarely encountered in the lungs. In this case report, we present a rare case of pulmonary mucoepidermoid carcinoma with endobronchial involvement in a 36-year-old Indian man who presented to our pulmonary outpatient clinic with a 10-year history of recurrent lower respiratory tract infections. A comprehensive workup was performed in his home country, but did not lead to a definitive diagnosis. At our hospital, high-resolution chest computed tomography was repeated, confirming a well-demarcated soft tissue mass measuring 1.7 x 1.8 x 1.1 cm in the right lower lobe bronchus. This was followed by positron emission tomography (PET) showing intense fluorodeoxyglucose (FDG) uptake in the mass with a standardized uptake value (SUV) of 7.9. The final diagnosis was made by histopathological examination of a resected right lower lobe, which confirmed the diagnosis of low-grade mucoepidermoid carcinoma, with no metastases found in the lymph nodes. The patient was then referred to a multidisciplinary oncology team, which opted for regular surveillance and follow-up.

Background. In phthisiology, all recurrent respiratory tract infections are considered risk factors for tuberculosis (TB) in children. A differentiated assessment of the predictive value of recurrent upper and lower respiratory tract infections will improve the effectiveness of selective TB screening.The aim. To carry out a differentiated assessment of the predictive value of recurrent upper and lower respiratory tract infections in children with tuberculosis and HIV coinfection.Materials and methods. We conducted a retrospective study (2010–2020) of the anamnestic prevalence of recurrent respiratory tract infections in 249 children divided into 4 groups: 72 healthy children (HC); TB – 65 children with tuberculosis; TB/HIV – 56 children with HIV-associated TB; HIV – 65 children with HIV infection.Results. Recurrent lower respiratory tract infections were detected in the anamnesis of 15 (23 %) children of the TB group and in 3 (4 %) children of the HC group (p < 0.001; odds ratio (OR) – 8.6). Lower respiratory tract infections were most common during the year preceding TB disease (11 out of 15 cases), within 2 years before the inclusion of children in the study – in 4 out of 15 cases (p = 0.027; OR = 11.0). In the TB/HIV group, the prevalence of lower respiratory tract infections compared to the HIV group was established only during the year preceding TB – 24 out of 33 cases (73 %) versus 10 out of 34 cases (29 %) in the HIV group (χ2 = 10.9; p = 0.001; OR = 6.4). The occurrence of upper respiratory tract infections in pairs of HC group – TB group and HIV group – TB/HIV group had no statistical differences.Conclusion. The predictor of TB in children regardless of their HIV status is the recurrent lower respiratory tract infections, registered during the year preceding the TB disease. The recurrent infections of the upper respiratory tract do not affect the realization of TB in children, regardless of their HIV status.

A RIDDLE WRAPPED IN A MYSTERY: MUCOEPIDERMOID CARCINOMA (MEC) FOUND DURING EVALUATION OF PERSISTENT LUNG COLLAPSE

Histopathologic, immunophenotypic and cytogenetic features of pulmonary mucoepidermoid carcinoma

Recurrent respiratory infections in a 9-year-old girl prompted a chest radiograph and a CT scan, which showed a right middle lobe consolidation. Bronchoscopy revealed a tumor that totally obstructed the middle lobe. Open lung biopsy revealed a low-grade mucoepidermoid carcinoma. Middle and lower right lung lobectomy was performed, followed by an uneventful recovery. Cytogenetic investigation of tumor cells exhibited the translocation t(11;19). This case shows that further diagnostic modalities such as CT scanning should be performed early in children with recurrent lower respiratory tract infections who have suspicious radiographic findings such as persistent atelectasis or recurrent unifocal infiltration. Bronchial mucoepidermoid carcinoma is infrequent, and molecular investigations might shed additional light on the prognosis.

Mounier-Kuhn syndrome (MKS) is a rare disorder characterized by recurrent lower respiratory tract infections and bronchiectasis due to dilation of the trachea and bronchi. Diagnosis is made based on clinical suspicion along with radiographic evidence of tracheobronchomegaly. Mucolytic agents and chest physiotherapy have been shown to offer symptomatic improvement, and definitive surgical treatment is reserved for those with persistent symptoms. Herein, we report a case of MKS in a 72-year-old woman with bronchiectasis and recurrent multidrug-resistant lower respiratory tract infections.

The effect of breastfeeding on asthma is controversial, which may be explained by related and interacting early childhood risk factors. We assessed the joint effects of a risk-triad consisting of maternal smoking during pregnancy, breastfeeding for less than 3 months, and recurrent lower respiratory tract infections (RLRTI) on physician-diagnosed childhood asthma. The association was assessed in the Isle of Wight birth cohort study (1989–1990) using a repeated measurement approach with data collection at birth, and at ages 1, 2, 4, and 10 years. The population consists of 1,456 children recruited between January 1989 and February 1990. Prenatal smoking, breastfeeding for less than 3 months, and recurrent lower respiratory infections (RLRTI) were combined into eight risk-triads. Relative risks (RR) and 95% confidence intervals were estimated with a log-linear model. The risk-triad involving RLRTI in infancy, maternal smoking during pregnancy, and breastfeeding for less than 3 months showed a stronger association with asthma at ages 4 and 10 compared to other risk-triads (RR of 5.79 for any asthma at ages 1, 2, 4, and 10; and 3.1 for asthma at ages 4 and 10). Of the three individual risk factors, RLRTI appeared to be the major driver of the combined effects in the risk-triads. The effect of RLRTI on asthma was modified by breastfeeding. Breastfeeding for ≥ 3 months also attenuated the effect of prenatal smoking on asthma in children without RLRTI. A high proportion of asthma cases in childhood can be prevented by promoting breastfeeding, by preventing smoking during pregnancy, and by avoidance of recurrent lower respiratory tract infections in early childhood.

Recurrent lower respiratory tract infection (LRTI) is a very common problem we encounter in our clinical practice. Failure to recognize the specific cause of this condition may subject the patients to unnecessary and inappropriate treatment. among the various causes of recurrent LRTI, the most frequent causes are abnormalities of general or local impairment of immune mechanism and abnormalities of cilia or mucus of respiratory tract. We report an adult case of recurrent upper and lower respiratory tract infections since childhood along with situs inversus totalis which was diagnosed as Kartagener's syndrome. He had all the classical clinical and radiological features of Kartagener's syndrome which is a rare inherited disorder which is seen in nearly half of the cases of primary cilliary dyskinesia (PCD). One should always keep in mind the possibilities of Kartagener's syndrome in patients presenting with recurrent upper and lower respiratory tract infections, sinusitis or bronchiectasis. Inability to diagnose this condition may subject the patient to unnecessary and repeated hospital admissions, investigations and treatment failure.

Pulmonary mucoepidermoid carcinoma is an extremely rare intrathoracic malignancy, comprising less than 1% of all lung tumours. These are very slow growing and are classified into low grade and high...

e15665 Background: To determine the optimal method of using 3-deoxy-3-18F-fluorothymidine (FLT) positron emission tomography (PET) to estimate gross tumor length in esophageal carcinoma, and compared with that of 18F- fluorodeoxyglucose(FDG) PET. Methods: Twenty patients with esophageal squamous cell carcinoma treated with radical surgery were enrolled and detected by FLT PET, eighteen of them underwent FDG PET scan. Gross tumor volumes (GTVs) were delineated using seven different methods with FLT PET: visual interpretation, standardized uptake value (SUV) 1.3, SUV 1.4, SUV 1.5, and 20% of maximum standard uptake value (SUVmax), 25% SUVmax,30% SUVmax, on FLT PET imaging, and three different methods with FDG PET: visual interpretation, SUV 2.5, and 40%SUVmax on FDG PET imaging. The length of tumors on FLT PET scan were measured and recorded as LFLTvis, LFLT1.3, LFLT1.4, LFLT1.5, LFLT20%, LFLT25%, and LFLT30%, and FDG PET scan were measured and recorded as LFDGvis, LFDG2.5, and LFDG40%, respectively, and compared with the length of gross tumor in the resected specimen measured by pathological examination (LPath). Results: The mean (±SD) LPath was 5.16±2.19cm. The mean LFLTvis, LFLT1.3, LFLT1.4, LFLT1.5, LFLT20%, LFLT25%, and LFLT30%were 5.17±2.40cm, 5.55±2.43cm, 5.17±2.41cm, 4.95±2.44cm, 5.82±2.23cm, 5.32±2.31cm, and 5.04±2.28cm, respectively. Compared with the LPath, the P value were 0.971, 0.045, 0.972, 0.255, 0.066, 0.644, and 0.714, respectively. The correlation coefficients were 0.952, 0.944, 0.959, 0.948, 0.763, 0.783, and 0.800, respectively. The mean LFDGvis, LFDG2.5, and LFDG40% were 5.41±2.27cm, 5.38±2.25cm, and 4.02±1.57cm, respectively. Compared with the LPath, the P value were 0.098, 0.085 and 0.000, respectively. The correlation coefficients were 0.984, 0.990 and 0.932, respectively. On FLT PET, LFLT1.4, and on FDG PET, L FDG2.5 seem more approximate to LPath. The difference between LFLT1.4 and LFDG2.5 was not significantly (P=0.442), the correlation coefficients was 0.960. Conclusions: An SUV cutoff of 1.4 on FLT PET, and an SUV cutoff of 2.5 on FDG PET, provided the closest estimation of GTV length in this study No significant financial relationships to disclose.

Many children experience RLTI. Physicians have to distinguish healthy subjects from those with an underlying chronic disease that requires further investigations.The aim of the study is to evaluate the need of flexible bronchoscopy (FB) in children with RLTI It is a retrospective study among 76 children who consulted our daycare hospital from 2013 to 2015 for RLTI.Every patient had a physical examination,blood count,prick-tests,chest radiography,an EGD-transit or an oesophageal ultrasound and a spirometry. Asthma,gastro esophageal reflux(GER) or upper respiratory tract infections were diagnosed in 57 children who didn9t need further examinations. twenty subjects (26.31%) underwent a FB.It was made immediately in 4 children with bronchiectasis because of abnormal chest x ray. Sixteen FB were made in children with uncontrolled asthma(3 cases),unexplained RLTI (11 cases) or persistent cough after GER treatment(2 cases).FB was normal in 8 children(6 with RLTI).The FB showed tracheal dyskinesia in 2 children with unexplained RLTI. Bacteriological examination of sputum aspirate was performed in 13 subjects and it was positif in 7 of them. Haemophilus Influenzae was isolated in 5 cases (1asthma,1GER,2bronchiectasis,2 unexplained RLTI) and streptococcus pneumonia in 1 case with RLTI. After antibiotic treatment there was an improvement in children with RLTI suggesting the diagnosis of protracted bacterial bronchitis. FB must be performed in case of unexplained RLTI,uncontrolled asthma or in presence of persistent chest x ray abnormalities. It also allows bacteriological analysis and thus to diagnose protracted bacterial bronchitis that is usually under-recognized.

EP1.18-15 Surgical Results of Primary Mucoepidermoid Carcinoma of Lungs: A 9 Years' Experience

Objective: To investigate the clinicopathological characteristics, therapy and prognosis of patients with pulmonary mucoepidermoid carcinoma. Methods: The clinical data of 87 patients diagnosed as pulmonary mucoepidermoid carcinoma at The First Affiliated Hospital of Zhengzhou University from April 2011 to May 2016 were retrospectively analyzed. The clinicopathological features were summarized and the prognoses were analyzed. Results: Among the 87 patients with lung mucoepidermoid carcinoma, 53 were male and 34 were female, the gender ratio between men and women was 1.56∶1.The ages of patients were from 16 to 79 years and the median age was 52.5 years. Seventeen cases were diagnosed as stage Ⅰ, 28 cases were stage Ⅱ, 26 cases were stage Ⅲ, 16 cases were stage Ⅳ.Thirty-six patients were examined by immunohistochemistry, of which 29 cases were cytokeratin (CK) 5/6 positive, 29 cases were CK7 positive, 10 cases were CK positive, 28 cases were p63 positive, 14 cases were p40 positive, 17 cases were thyroid transcription factor-1 (TTF-1) positive, 11 cases were NapsinA positive, 2 cases were epithelial membrane antigen (EMA) positive, 4 cases were CK8/18 positive, 3 cases were surfactant proteins A (SPA) positive, 1 case was CAM5.2 positive and 1 case was CK14 positive. Among the 87 patients, 34 cases were treated by operation alone, 23 cases were treated by operation combined with chemotherapy, 5 cases were treated by radiotherapy combined with chemotherapy, 14 cases were treated by chemotherapy alone, 2 cases were treated by particle implantation combined with chemotherapy, 2 cases were treated by local radiofrequency hyperthermia combined with chemotherapy, and 7 cases without special treatment.Five patients with brain metastasis were treated with cerebral radiotherapy combined with sequential chemotherapy. The 1-year, 2-year and 5-year survival rates of 87 patients were 90.7%, 81.6% and 46.3%, respectively. The median survival time was 60 months. The prognoses of patients with lung mucoepidermoid carcinoma were related with the clinical stage, smoking and operative therapy (all P<0.05). Conclusions: The age distribution of patients with pulmonary mucoepidermoid is a wide range, the incidence of male is higher than that of female. The diagnosis of pulmonary mucoepidermoid carcinoma mainly relies on the morphological diagnosis and the immunohistochemical detection is non-specific. The prognoses of patients with lung mucoepidermoid carcinoma are related with clinical stage, smoking and operative therapy. For patients who are inoperable and with single distant metastasis, local radiotherapy, other local treatment and chemotherapy can significantly improve their prognoses.

Objective To discuss the clinical manifestation, pathological features and prognostic factors of pulmonary mucoepidermoid carcinoma (PMEC). Methods The clinical data of 31 cases of PMEC admitted to the First Affiliated Hospital of Zhengzhou University from May 2012 to May 2017 was retrospectively analyzed, its prognostic factors were also analyzed. Results There were 31 patients in this study, including 17 males and 14 females, age is (52.16±17.15) years (range from 5 to 78 years). The pulmonary shadow was most common in the left upper lobe.15 cases were diagnosed by lung biopsy, 14 cases were diagnosed by bronchoscopy, and two cases were confirmed by operation.One case was diagnosed as PMEC combined adenosquamous carcinoma in the 31 cases.There were 15 patients identified as high-grade PMEC and 16 patients identified aslow-grade PMEC.11 cases were underwent surgery treatment, 20 cases were non-operatived treatment.The follow-up time was 5~72 months.The overall 1-, 3-, 5-year survival rates were 87.1%, 45.2%, 6.5% respectively.The median survival time was 26 months. Conclusions PMEC is a rare malignant tumor of the lung, lacking specific clinical characterization, which mainly characterized as respiratory tract irritation and obstruction symptoms.PMEC can be diagnosed mainly depends on biopsy, bronchoscopy or histopathology, supplemented by immunohistochemical analysis.Surgery is the main treatment method, chemotherapy and molecular targeting therapy are also needed.The prognosis of PMEC relates topathological types, TNM stage and surgery treatment. Key words: Carcinoma, mucoepidermoid; Clinical features; Prognosis

Effects of Aztreonam in Combination with Antipseudomonal Antibiotics against Pseudomonas aeruginosa Isolated from Patients with Chronic or Recurrent Lower Respiratory Tract Infection