Benign Endobronchial Tumors Research Articles

Argon plasma coagulation in bronchology: a new method--alternative or complementary?

Argon plasma coagulation (APC) is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. APC has been used in surgery for more than 20 years, particularly for the hemostasis of superficial bleeding. Although APC has become well established in gastrointestinal endoscopy since its introduction in 1991, very few reports of its use in bronchoscopy exist to date. From June 1994 to June 1998, 364 patients (80 women, 284 men), 88% with a confirmed malignant tumor, were treated prospectively in a total of 482 sessions. The single most common indication was recanalization of malignant airway stenoses (186 patients). The defined therapy objective was achieved with good results in 67% of patients. More than 90% of interventions were performed with rigid bronchoscopy. Despite less penetration compared with Nd:YAG laser, extensive bronchial tumors were treatable, in which coagulated tumor fractions were removed either with forceps or bronchoscope tip. The second indication was bleeding in the central airways (119 patients). Acute hemostasis was achieved in 118 patients, 20% in whom the flexible technique under local anesthesia was used. In 34 patients, APC was successfully used to recanalize occluded stents. Rare indications included benign endobronchial tumor, fistula conditioning before fibrin adhesion, and the treatment of scar tissue stenosis. Summarizing all complications, a rate of 3.7% "per treatment" was recorded. Two patients died within 24 hours; their deaths were not directly related to APC. APC is an effective and safe technique for the treatment of bronchologic tumor ablation and hemostasis and can be used with local anaesthetic with flexible bronchoscopy or rigid bronchoscopy with general anesthesia. Compared with Nd:YAG laser, APC is an economic alternative technique offering more effective hemostasis. Furthermore, APC is of particular value as a compliment to well-known techniques, increasing the options in interventional bronchoscopy.

Argon Plasma Coagulation in Bronchology: A New Method—Alternative or Complementary?

Argon plasma coagulation (APC) is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. APC has been used in surgery for more than 20 years, particularly for the hemostasis of superficial bleeding. Although APC has become well established in gastrointestinal endoscopy since its introduction in 1991, very few reports of its use in bronchoscopy exist to date. From June 1994 to June 1998. 364 patients (80 women. 284 men), 88% with a confirmed malignant tumor, were treated prospectively in a total of 482 sessions. The single most common indication was recanalization of malignant airway stenoses (186 patients). The defined therapy objective was achieved with good results in 67% of patients. More than 90% of interventions were performed with rigid bronchoscopy. Despite less penetration compared with Nd:YAG laser, extensive bronchial tumors were treatable, in which coagulated tumor fractions were removed either with forceps or bronchoscope tip. The second indication was bleeding in the central airways (119 patients). Acute hemostasis was achieved in 118 patients, 20% in whom the flexible technique under local anesthesia was used. In 34 patients. APC was successfully used to recanalize occluded stents. Rare indications included benign endobronchial tumor, fistula conditioning before fibrin adhesion, and the treatment of scar tissue stenosis. Summarizing all complications, a rate of 3.7% “per treatment” was recorded. Two patients died within 24 hours; their deaths were not directly related to APC. APC is an effective and safe technique for the treatment of bronchologic tumor ablation and hemostasis and can be used with local anesthetic with flexible bronchoscopy or rigid bronchoscopy with general anesthesia. Compared with Nd:YAG laser. APC is an economic alternative technique offering more effective hemostasis. Furthermore. APC is of particular value as a compliment to well-known techniques, increasing the options in interventional bronchoscopy. Journal of Bronchology7:109-117, 2000. APC, argon plasma coagulation; HF currency, high-frequency electrical current

Pathological-radiological correlations: pathological and radiological correlation of endobronchial neoplasms: part II, malignant tumors.

The majority of lung neoplasms are malignant. Many of these are central and have an associated endobronchial component. Most such neoplasms are of surface epithelial origin; however, neoplasms of submucosal gland, mesenchymal, and lymphoreticular origin may also demonstrate an endobronchial component. Because of their endobronchial location and associated symptoms, these patients often present at an earlier stage than purely parenchymal lung malignancies. The radiographic features in such cases may be similar to those associated with benign endobronchial tumors; however, there are certain radiological signs that are more suggestive of a malignant process. Despite these circumstances, conservative management such as endoscopic excision are inappropriate in most instances. The clinicopathologic and radiological features of these lesions are detailed.

Benign Tumors of the Tracheobronchial Tree: Endoscopic Characteristics and Role of Laser Resection

We conducted a review of all the bronchoscopies performed at our institutions for benign tumors from 1980 to 1991 to determine the endoscopic characteristics of these lesions. We reviewed the charts, the endoscopic characteristics from our video records, and finally the pathologic findings of these cases. We tried to identify the effectiveness of laser resections in each group. Of a total of 3,937 patients, 185 (4.7%) were benign tumors. On these patients, 317 procedures were carried out. There were 3 myoblastomas, 53 papillomas, 1 adenoma, 8 chondromas, 4 fibromas, 45 hamartomas, 15 hamartochondromas, 6 lipomas, 19 angiomas, 5 leiomyomas, 4 schwannomas, 1 neurofibroma, and 21 amyloidomas. Results of laser resection were "very good" in 115 (62%) and "good" in 70 (38%). Complications were minimal: two mediastinal emphysemas, one pneumothorax, and one anesthesia-related cardiac arrest leading to the single death in this series. In general, benign tumors of the proximal endobronchial tree responded well to laser resection when their endoscopic appearance is recognized and prognosis known. Even when recurrent, repeated procedures can be performed easily with good results. This series is probably the largest in the world's literature about endoscopic recognition and the role of laser resection in patients presenting with benign endobronchial tumors.

中枢気道発生良性腫瘍の臨床所見および内視鏡的 Nd-YAG レーザー治療に関する検討

中枢気道発生良性腫瘍の臨床所見および内視鏡的 Nd-YAG レーザー治療に関する検討

Bronchial sleeve resection with and without pulmonary resection

Sleeve resection with and without pulmonary resection is safe, effective, and appropriate treatment for a wide range of endobronchial lesions including neoplasms of low-grade malignant potential and selected cases of bronchogenic carcinoma. Sixty-three patients underwent 64 sleeve resection procedures (47 with concomitant pulmonary resection and 17 without) at the Massachusetts General Hospital between 1962 in 1986 with a 30 day mortality rate of 4.7%. Applicability of the technique for bronchial lesions which do not require concomitant pulmonary resection is emphasized. Types of disease included a heterogeneous collection of 31 benign tumors, neoplasms of low-grade malignant potential, and bronchostenosis and 33 bronchogenic carcinomas. Actuarial disease-free survival rate for the former group was 100% at 5 years. Quality of life was excellent for this group. Five-year survival rates for bronchogenic carcinoma (24 squamous cell, seven adenocarcinoma, two undifferentiated) were 58% +/- 25% (+/- standard error), 69 +/- 18%, and 38% +/- 13% in Stages I, II, and III, respectively. The 5 year survival rate of 31% +/- 16% in 14 patients selected because of decreased respiratory reserve compared with 60% +/- 14% in 19 patients for whom sleeve was the operation of choice on the sole basis of anatomic suitability. Sleeve resection is the ideal form of excisional therapy for benign endobronchial tumors, bronchostenosis, tumors of low-grade malignant potential, and for selected cases of carcinoma.

Endobronchial Lipoma

An endobronchial lipoma has been studied with light, scanning, and transmission electron microscopes, and the literature has been reviewed. Endobronchial lipoma is a type of hamartoma unique only in terms of its specific adult-type fat cell and its location. Of 49 endobronchial lipomas, eight have been reported in obese persons. The neoplasm appears to propagate at its peripheral zone through continuous incorporation and fusion of globules of fat in the spindle-shaped precursor cells. Although benign pulmonary tumors make up about 3 percent and endobronchial lipomas only about 0.1 percent of all pulmonary tumors, benign endobronchial tumors may cause unnecessary morbidity and mortality if not properly managed.

BENIGN TUMORS OF BRONCHI: WITH SPECIAL REFERENCE TO VASCULAR ADENOMA

In the rapidly accumulating literature on benign bronchial tumors, one type stands out as deserving special consideration. Variously designated as "bronchial adenoma," "adenomatous polyp" and "vascular adenoma," it is a type of growth which can now be fairly accurately identified histologically and recognized clinically. Being the most common, it deserves to be considered apart from the motley group of benign endobronchial tumors which have been thrown together under one heading in the literature. Any bronchial growth if left untreated ultimately produces occlusion of a bronchus with resulting atelectasis, drowned lung and pulmonary suppuration. Earlier recognition, which is now occurring with increasing frequency, permits treatment before irreparable damage to the lungs has been done. Of the bronchial new growths the benign vascular adenomas appear to show the most constant clinical course. Study of the case histories in the literature bears this out. Since publication of the opinion of Jackson and Jackson,¹