Endobronchial Tumor Research Articles

Evaluation of Diagnostics of Endobronchial Tumor Pathology Using a Narrow Spectrum Imaging System

Modern medicine has new equipment and high-tech diagnostic methods. At the same time, when using standard X-ray endoscopic diagnostic methods, 70-80% of newly diagnosed patients with lung cancer have stage III-IV disease. Among the radiation methods of examination for detecting lung cancer, fluorography, chest radiography, and computed tomography are used. The main disadvantage for diagnosing lung cancer is the low level of sensitivity and accuracy, and the proportion of false-positive and false-negative conclusions reaches 30%. According to AJCC recommendations, chest radiography is not recommended for lung cancer screening due to its low efficiency. Computed tomography is recommended for screening in risk groups. However, CT reveals tumor lesions already at the stage of peripheral lymphadenopathy. Modern bronchological examination is the main method for detecting hidden, early forms of lung cancer in the diagnosis.

Synchronous endometrial and minor salivary gland carcinomas – role of molecular diagnostics amid lack of clinical suspicion

Abstract Introduction/Objective Synchronous malignancies account for 3-5% of all tumor diagnoses but can be challenging to detect if one or both tumors are rare histologic subtypes and clinical suspicion is lacking. Molecular diagnostics are critical for accurate diagnosis in these difficult cases to guide appropriate patient care. Methods/Case Report We report the case of a 49-year-old female who was diagnosed with a high-grade, mixed- histology endometrial adenocarcinoma a few years back. She was found to have hilar and mediastinal nodal carcinoma of uncertain differentiation a couple of months after her initial diagnosis, clinically labelled as metastatic endometrial carcinoma. Following neoadjuvant chemotherapy, her hysterectomy showed complete pathologic response, and was found to be POLE ultramutated on NGS. Follow-up PET scan in 2023 showed progression of hilar/endobronchial thickening, as well as interval increase in size of mediastinal nodes, again presumed to be endometrial metastases, despite the POLE mutant status. Repeat sampling was performed from both the sites, along with comprehensive molecular profiling. Cytology from the nodes and surgical pathology from the endobronchial lesion showed similar morphology consisting of hyperchromatic basaloid cells in cribriform arrangement with tubular structures containing myxoid stromal material, negative for PAX-8, ER, p40, and TTF1 immunostains, inconsistent with endometrial metastasis. Molecular studies including FISH and NGS showed MYB1::NFIB fusion characteristic of adenoid cystic carcinoma and absence of POLE mutation, definitively refuting the clinically suspected progression of endometrial metastasis. Molecular testing confirmed that the endobronchial tumor and mediastinal nodal involvement were caused by a second primary, distinct from her POLE-ultramutated endometrial carcinoma which disappeared with chemotherapy. Her extended molecular workup also revealed a pathogenic mutation in BRIP1, suggesting a genetic cancer predisposition syndrome requiring referral for genetic counseling. Results (if a Case Study enter NA) NA Conclusion Molecular pathology is an invaluable tool for unravelling diagnostic complexity. Pathologists must integrate cytomorphology, molecular genetics and knowledge of cancer biology to steer the clinical teams towards the best patient care.

A Rare Endobronchial Tumor in a Pediatric Patient.

A pediatric patient who presented with non-specific respiratory symptoms, including mild hemoptysis, wheezing, and eventual respiratory distress, was found to have a rare endobronchial inflammatory myofibroblastic tumor obstructing her right mainstem bronchus. It was diagnosed and initially debulked using bronchoscopy, which helped to stabilize the patient and eliminate the need for supplemental oxygen. The patient subsequently underwent successful removal of the residual tumor with parenchymal-sparing sleeve resection. This case highlights the importance of pursuing appropriate imaging along with diagnostic and therapeutic bronchoscopy for an endobronchial lesion to help manage pediatric patients with persistent respiratory symptoms.

Tubercular tracheobronchial amyloidosis: a rare complication presenting as an endobronchial mass — a case report

BackgroundPulmonary amyloidosis often occurs as a part of systemic AL (amyloid light chain) amyloidosis. Localized tracheobronchial amyloidosis is a very rare entity. Most often, it is asymptomatic, or if symptomatic, it usually presents with vague symptoms such as cough, dyspnoea, hoarseness, wheezing, haemoptysis, and rarely respiratory failure. It is commonly misdiagnosed as asthma, tuberculosis, COPD, malignancy, or pneumonia.Case presentationWe are presenting a case of an elderly male, aged 64 years, who presented with symptoms of productive cough, dyspnoea, wheezing, and significant weight loss over a period of 6 months. Investigations such as bronchoscopy, histopathology, and imaging studies showed an endobronchial mass and left-sided pleural effusion.ConclusionsEndobronchial amyloidosis generally has a nodular appearance which can imitate an endobronchial tumour. The quality of life is decreased in these patients, and the life expectancy is approximately 8–10 years. Therefore, the early diagnosis of this disease is essential.

Endobronchial tumor in a 40-year-old man

Endobronchial tumor in a 40-year-old man

Computed tomography characteristics of cN0 primary non-small cell lung cancer predict occult lymph node metastasis.

Occult lymph node metastasis (OLNM) is frequently found in patients with resectable non-small cell lung cancer (NSCLC), despite using diagnostic methods recommended by guidelines. To evaluate the risk of OLNM in NSCLC patients using the radiologic characteristics of the primary tumor on computed tomography (CT). We retrospectively reviewed clinicopathologic features of 2042 clinical T1-4N0 NSCLC patients undergoing curative intent pulmonary resection. Unique radiological features (i.e., air-bronchogram throughout the whole tumor, heterogeneous ground-glass opacity (GGO), mainly cystic appearance, endobronchial location), percentage of solid portion, and shape of tumor margin were analyzed via a stepwise approach. We used multivariable logistic regression to assess the relationship between OLNM and tumor characteristics. Compared with the other unique features, endobronchial tumors were associated with the highest risk of OLNM (OR = 3.9, 95% confidence interval (CI) = 2.29-6.62), and heterogeneous GGO and mainly cystic tumors were associated with a low risk of OLNM. For tumors without unique features, the percentage of the solid portion was measured, and solid tumors were associated with OLNM (OR = 2.49, 95% CI = 1.86-3.35). Among part-solid tumors with solid proportion > 50%, spiculated margin, and peri-tumoral GGO were associated with OLNM. The risk of OLNM could be assessed using radiologic characteristics on CT. This could allow us to adequately select optimal candidates for invasive nodal staging procedures (INSPs) and complete systematic lymph node dissection. These data may be helpful for clinicians to select appropriate candidates for INSPs and complete surgical systematic lymph node dissection in NSCLC patients. Lymph node metastasis status plays a key role in both prognostication and treatment planning. Solid tumors, particularly endobronchial tumors, were associated with occult lymph node metastasis (OLNM). The risk of OLNM can be assessed using radiologic characteristics acquired from CT images.

Treatment of benign endobronchial tumors: when, how, and why. Insights, experiences, and interventional pulmonology strategies.

Benign endobronchial tumors are rare clinical entities characterized by considerable variability in etiology and clinical presentation. The authors report four cases of endobronchial hamartomas treated and followed up from 2018 to 2023. Three of these cases, with identical endobronchial localization in the right lower lobe, were radically treated in flexible bronchoscopy with the only use of biopsy forceps. Another case with a different localization in the left main bronchus was treated with a laser through rigid bronchoscopy. In addition, the authors outline the main interventional pulmonological strategies for the treatment of benign tumors with endobronchial growth based on the existing literature.

Endobronchial electrocautery wire snare prior to right middle sleeve lobectomy for adenoid cystic carcinoma of the lung: a case report.

Adenoid cystic carcinoma of the lung grows gradually, and spreads along the bronchial wall, often requiring tracheobronchoplastic procedure during surgery; however, incomplete resection occasionally occurs due to positive surgical margins. To avoid incomplete resection, effort should be exerted to confirm the extent of airway invasion of the tumor before surgery. Herein, we present the utility of combined treatment with bronchoscopic electrocautery wire snare for the endobronchial tumor prior to sleeve lobectomy with curative resection for patients with adenoid cystic carcinoma of the lung. A 56-year-old woman experienced a persistent cough 6months prior. On an annual medical checkup, an abnormal lung shadow was noted. Chest computed tomography (CT) scan demonstrated right middle lobe atelectasis, and a round tumor shadow at the orifice of the right middle lobe bronchus, which protruded into the right intermediate bronchus, was observed. On bronchoscopy, a pedunculated endobronchial tumor in the intermediate bronchus was shown, and the middle lobe bronchus was completely obstructed. Initially, tumor resection via bronchoscopy was performed using an electrocautery wire snare under general anesthesia, and the tumor was pathologically diagnosed as adenoid cystic carcinoma of cT1aN0M0 stage IA. After tumor resection, the extent of tumor progression in the airway was assessed; subsequently, the patient underwent elective right middle sleeve lobectomy and lymphadenectomy. She survived without recurrence 7years after surgery. We present a useful combined treatment strategy of bronchoscopic electrocautery wire snare prior to sleeve lobectomy for patients with endobronchial adenoid cystic carcinoma of the lung.

A case of pulmonary melioidosis in Germany: a rare differential diagnosis in returning travelers from South-East Asia

BackgroundMelioidosis is a bacterial infection associated with high mortality. The diagnostic approach to this rare disease in Europe is challenging, especially because pulmonary manifestation of melioidosis can mimic pulmonary tuberculosis (TB). Antibiotic therapy of melioidosis consists of an initial intensive phase of 2–8 weeks followed by an eradication therapy of 3–6 months.Case presentationWe present the case of a 46-year-old female patient with pulmonary melioidosis in Germany. The patient showed chronic cough, a pulmonary mass and a cavitary lesion, which led to the initial suspicion of pulmonary TB. Melioidosis was considered due to a long-term stay in Thailand with recurrent exposure to rice fields.ResultsMicrobiologic results were negative for TB. Histopathology of an endobronchial tumor showed marked chronic granulation tissue and fibrinous inflammation. Melioidosis was diagnosed via polymerase chain reaction by detection of Burkholderia pseudomallei/mallei target from mediastinal lymph-node tissue.ConclusionThis case report emphasizes that melioidosis is an important differential diagnosis in patients with suspected pulmonary tuberculosis and recent travel to South-East Asia.

The Diagnostic Yield of Bronchoscopic Cryobiopsy Compared to Conventional Forceps Biopsy in Endobronchial Tumors

The Diagnostic Yield of Bronchoscopic Cryobiopsy Compared to Conventional Forceps Biopsy in Endobronchial Tumors

Effective Differences between 2D and 3D Planned Brachytherapy in Lung Cancer: An Institutional Retrospective Study.

Background and Objectives: Advanced lung cancer is usually manifested by endoluminal tumor propagation, resulting in central airway obstruction. The objective of this study is to compare the high dose rate brachytherapy treatment outcomes in non-small-cell lung cancer (NSCLC) depending on the treatment planning pattern-two-dimension (2D) or three-dimension (3D) treatment planning. Materials and Methods: The study was retrospective and two groups of patients were compared in it (a group of 101 patients who underwent 2D planned high-dose-rate endobronchial brachytherapy (HDR-EBBT) in 2017/18 and a group of 83 patients who underwent 3D planned HDR-EBBT between January 2021 and June 2023). Results: In the group of 3D planned brachytherapy patients, there was a significant improvement in terms of loss of symptoms of bronchial obstruction (p = 0.038), but no improvement in terms of ECOG PS (European Cooperative Oncology Group Performance Status) of the patient (p = 0.847) and loss of lung atelectasis (if there was any at the beginning of the disease) (p = 0.781). Two-year overall survival and time-to-progression periods were similar for both groups of patients (p = 0.110 and 0.154). Fewer treatment complications were observed, and 91.4% were in 3D planned brachytherapy (BT) patients. Conclusions: Three-dimensionally planned HDR-EBBT is a suggestive, effective palliative method for the disobstruction of large airways caused by endobronchial lung tumor growth. Independent or more often combined with other types of specific oncological treatment, it certainly leads to the loss of symptoms caused by bronchial obstruction and the improvement of the quality of life of patients with advanced NSCLC. Complications of the procedure with 3D planning are less compared to 2D planned HDR-EBBT.

Anaesthetic Management of Rigid Bronchoscopic Guided Removal of Endobronchial Tumour: A Case Series

Anaesthetic Management of Rigid Bronchoscopic Guided Removal of Endobronchial Tumour: A Case Series

Unraveling the spectrum of inflammatory myofibroblastic tumors in the lung: A comprehensive case series highlighting endobronchial, pleural, and lung parenchymal tumors

ObjectivesDiverse cases of inflammatory myofibroblastic tumors (IMTs) in the lung (pleural, endobronchial, and parenchymal) are presented while discussing the (preoperative) diagnostic challenges and treatment modalities. Other objectives include emphasizing the significance of gene rearrangements and highlighting the multidisciplinary approach in addressing IMTs. MethodsFour cases of IMT in the lung are presented, including a young adolescent girl with an ETV6-neurotrophic tyrosine receptor kinase 3 (NTRK3) gene rearrangement, a 5-year-old boy with challenging preoperative diagnosis, and 2 middle-aged women with respectively pleural and endobronchial tumors with one peribronchial relapse. ResultsThe cases demonstrate the diverse clinical presentations and diagnostic complexities associated with IMT in the lung. Surgical resection remains the primary treatment modality, with complete resection leading to a cure in most patients. Unfortunately, aggressive relapse can occur, as in our last case of an endobronchial tumor. Frozen section may confirm the presence of malignant cells perioperatively and impact further treatment. The presence of gene rearrangements, such as ETV6-NTRK3, suggests potential therapeutic implications. ConclusionsEarly detection and complete surgical removal of IMT are crucial for effective treatment. Identifying gene rearrangements such as ETV6-NTRK3 holds promise for targeted therapies. Diagnostic challenges, including the controversy of biopsies and preoperative evaluations, underscore the importance of a multidisciplinary approach. Anatomopathological recognition of IMT stays demanding. Close surveillance is necessary due to potential relapse, whereas frozen section perioperatively can help further treatment. This case series emphasizes the diagnostic challenges and therapeutic considerations for IMT in the lung.

Complete Regression of Endobronchial Carcinoid Tumor after an Endoscopic Biopsy.

An 80-year-old woman who had been diagnosed with an endobronchial carcinoid tumor visited our hospital for treatment with an endoscopic technique. However, a bronchoscopic examination at our hospital showed spontaneous regression of the tumor at the orifice of the right middle lobar bronchus. Chest computed tomography five months later revealed no local recurrence. This is the second report of an endobronchial carcinoid tumor vanishing after an endoscopic biopsy.

Tout ce qui siffle n’est pas asthme chez l’adulte

Wheezing and stridor are symptoms induced by airflow obstruction. While wheezing evokes a sub-glottic origin, stridor, which consists of an inspiratory noise, can be related to an obstacle in the upper airways, larynx, or trachea. Asthma is one of the most frequent causes of wheezing. However differential diagnoses must be considered, including chronic obstructive pulmonary disease (COPD), laryngeal dysfunction, and other causes of bronchial hyperreactivity. Different aetiologies resulting in airway mechanical obstructions, such as extrinsic compressions or endobronchial obstacles, for example, foreign bodies, tumors, or mucosal injuries, can induce wheezing. The research on the cause of stridor must differentiate supra-glottic and sub-glottic obstructions, and take into account the onset and the rhythm of the stridor, whether acute, intermittent, or chronic. The diagnosis relies on a detailed clinical history, rigorous clinical examinations of the ENT and the respiratory systems, Chest X-Ray and/or CT-scan, analysis of respiratory functional tests and endoscopy.

Cryotherapy in Egyptian patients with central airway obstruction: impacts on clinical pulmonary scores, pulmonary function tests and quality of life, a single center experience

Abstract Background Cryotherapy has emerged as an effective modality to manage patients with central airway obstruction (CAO). The aim was to assess the outcomes of using cryotherapy for managing CAO and its effect on the symptoms, and pulmonary function testing (PFT) in patients with CAO. Patients and methods This prospective protocol was carried out at the Chest Department, Cairo University Hospitals, in collaboration with the Military Chest Hospital over 6 months. Patients with CAO underwent cryotherapy and were assessed by the following: grade of airway obstruction, dyspnea, hemoptysis and quality of life scales, and PFT. Outcomes and safety of cryotherapy were evaluated. Results A total of 30 patients with CAO were enrolled and were divided into two groups: the malignant obstruction group (n=20) and the nonmalignant obstruction group (n=10). Complete restoration of the airway patency was achieved in 53.3% of patients. Only three (10%) cases encountered complications. There were significant postprocedural improvements of dyspnea, cough, hemoptysis, quality of life scales, and PFT. Logistic regression analysis showed that smoking was associated with worse outcomes. Conclusions Cryotherapy is a safe and successful method for both endobronchial exophytic tumor debulking and nonmalignant CAO. These benefits were reflected in the postprocedural improvement of clinical pulmonary scales, PFT, the grade of airway obstruction, and quality of life. Further prospective, multicenter studies are recommended.

Distance between tumor and bronchial resection margin is an independent predictor of recurrence-free survival and overall survival in primary endobronchial neoplasm.

The distance between tumor and bronchial resection margin (DBTM) had no clear standard in lung cancer surgery. We aimed to select the optimal cut-off value to provide a standard for surgery of the patients with primary endobronchial neoplasm. We retrospectively analyzed patients with primary endobronchial neoplasm who underwent surgical resection between 2005 and 2012. The receiver operating characteristic curves and the Youden index were used to calculate the optimal cut-off value of the DBTM. Propensity score matching was applied to reduce selection bias. Survival was assessed with Kaplan-Meier analysis, log-rank test and Cox proportional hazards model. A total of 1048 patients comprised in the study cohort and 1.7cm was determined the optimal cut-off value, including 531 grouped in DBTM ≤ 1.7cm and 517 grouped in DBTM > 1.7cm. Before propensity score matching, the 5-year recurrence-free survival was 38.7% in DBTM ≤ 1.7cm group and 67.1% in DBTM > 1.7cm (hazard ratio 0.48, P < 0.001), while the 5-year overall survival was 30.1% and 50.7%, respectively (hazard ratio 0.64, P < 0.001). After propensity score matching, the 5-year recurrence-free survival was 38.8%in DBTM ≤ 1.7cm group and66.1% in DBTM > 1.7cm (hazard ratio 0.51, P < 0.001), while the 5-year overall survival was34.7% and50%, respectively (hazard ratio 0.81, P = 0.012). Multivariable cox model showed that the DBTM was an independent predictor for recurrence-free survival (hazard ratio 0.51, P = 0.001) and overall survival (hazard ratio 0.84, P = 0.026). The DBTM was an independent predictor for outcomes in primary endobronchial neoplasm, and patients with the DBTM ≤ 1.7cm should actively receive adjuvant therapy after surgery. The distance between tumor and bronchial resection margin (DBTM), the distance between the most proximal border of the macroscopic tumor and bronchial resection margin was measured by pathologist in the fresh specimens before formalin fixation. The DBTM less than 1.7cm had higher recurrence-free survival and overall survival and was an independent prognostic factor for patients with primary endobronchial neoplasm.

Stereotactic body radiotherapy for Ultra-Central lung Tumors: A systematic review and Meta-Analysis and International Stereotactic Radiosurgery Society practice guidelines

BackgroundStereotactic body radiotherapy (SBRT) is an effective and safe modality for early-stage lung cancer and lung metastases. However, tumors in an ultra-central location pose unique safety considerations. We performed a systematic review and meta-analysis to summarize the current safety and efficacy data and provide practice recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS). MethodsWe performed a systematic review using PubMed and EMBASE databases of patients with ultra-central lung tumors treated with SBRT. Studies reporting local control (LC) and/or toxicity were included. Studies with <5 treated lesions, non-English language, re-irradiation, nodal tumors, or mixed outcomes in which ultra-central tumors could not be discerned were excluded. Random-effects meta-analysis was performed for studies reporting relevant endpoints. Meta-regression was conducted to determine the effect of various covariates on the primary outcomes. Results602 unique studies were identified of which 27 (one prospective observational, the remainder retrospective) were included, representing 1183 treated targets. All studies defined ultra-central as the planning target volume (PTV) overlapping the proximal bronchial tree (PBT). The most common dose fractionations were 50 Gy/5, 60 Gy/8, and 60 Gy/12 fractions. The pooled 1- and 2-year LC estimates were 92 % and 89 %, respectively. Meta-regression identified biological effective dose (BED10) as a significant predictor of 1-year LC. A total of 109 grade 3–4 toxicity events, with a pooled incidence of 6 %, were reported, most commonly pneumonitis. There were 73 treatment related deaths, with a pooled incidence of 4 %, with the most common being hemoptysis. Anticoagulation, interstitial lung disease, endobronchial tumor, and concomitant targeted therapies were observed risk factors for fatal toxicity events. ConclusionSBRT for ultra-central lung tumors results in acceptable rates of local control, albeit with risks of severe toxicity. Caution should be taken for appropriate patient selection, consideration of concomitant therapies, and radiotherapy plan design.

Pulmonary Epithelioid Hemangioendothelioma: A Case Report of Sleeve Resection of this Rare Lung Tumour

Reporting a 37 year old male with pulmonary epithelioid hemangioendothelioma (PEH), whom had undergone a sleeve resection of main left bronchus en bloc with the tumour. Presented with shortness of breath &amp; was treated as pneumonia with left lung collapse. Bronchoscopy showed lesion at left main bronchus &amp; unable to pass the obstruction. CT scan showed left main bronchus endobronchial lesion &amp; histopathological reported it as suspected PEH. Mass had regrown 90% stenosis within 2 weeks. PET scan showed solitary disease at left endobronchial region. Left thoracotomy with sleeve resection of left bronchus en bloc with the tumour done. Intraoperative bronchoscopy showed endobronchial tumour located at the main left bronchus 1cm from carina. Histopathology confirmed the resected lesions are PEH. Patient recovered well. PEH is a histological diagnosis, recent reviews showed that radiological CT findings can be associated. No standard guideline treatment for PEH. There are cases reported with good response to combine chemotherapy and immunotherapy. Unilateral lesions, surgery is indicated. If lesion is positive for oestrogen and progesterone receptors, studies showed that hormonal therapy may benefit. Antivascular endothelial growth factor reported as part of treatment. Prognosis is unpredictable. In view of the rarity of the disease, multi-modulated approach is essential in the management and follow-up of the patient.

Endobronchial Sialolipoma: An Uncommon Salivary Gland Tumor at an Uncommon Site.

Sialolipoma is a benign neoplasm composed of neoplastic adipose tissue and normal salivary gland parenchyma. It is commonly seen in the parotid gland. The occurrence of sialolipoma in the main bronchus is exceedingly rare. A 52-year-old diabetic and hypertensive gentleman presented with shortness of breath and cough for the last 3-4 months. Computed tomography bronchial angiography showed a soft tissue lesion in the right intermediate bronchus causing its complete obliteration and subsequent collapse of the right lower lobe. A rigid tracheobronchoscope revealed a polypoidal growth originating in the right intermediate bronchus. Histopathology revealed a sialolipoma. The patient was doing well on follow-up and no recurrence was noted to date. The bronchus as the primary site for sialolipoma is unusual and has to be kept in the differential while dealing with the slow-growing endobronchial tumor.