Bronchial Adenoma

Epidemiology

  • xxx

Physiology

  • Benign mucoepithelial tumor of the lung
  • Mucoepithelial tumors: rare tumors that arise from the mucous glands of the upper airway (trachea/ bronchi)/ oropharynx (tumor arising from salivary gland is named for that origin, but otherwise named as below)

Pathology

  • Cystic spaces within the tumor are lined by columnar cells
  • Subtypes:
    • Pleomorphic bronchial adenoma: most common subtype to evolve into malignancy
    • Myoepithelioma:
    • Basal cell adenoma:
    • Adenolymphoma (Warthin tumor): occasionally develops squamous metaplasia or frank neoplasia
    • Oncocytic adenoma (Oncocytoma):
    • Canalicular adenoma:
    • Sebaceous adenoma:

Clinical

  • Endobronchial Nodule/Mass (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
    • Diagnosis
      • FOB: usually occurs as sessile or polypoid mass in main or lobar bronchus
        • EBB: diagnostic
      • CXR/Chest CT: atelectasis, post-obstructive pneumonia
    • Clinical
      • Wheezing
      • Stridor
      • Cough
      • Post-Obstructive Pneumonia
  • Lung Nodule (see Lung Nodule or Mass, [[Lung Nodule or Mass]])
  • Dyspnea
  • Hemoptysis (see Hemoptysis, [[Hemoptysis]]): may occur
  • Fever/Weight loss: may occur
  • Development of Higher Grade Malignancy within Bronchial Adenoma: most common with pleomorphic subtype

Treatment

  • Bronchoscopic Removal: fulguration/laser may be used for poor surgical candidates
  • Surgical Excision ( with wide margins): usually recommended
    • Tumors may locally recur if not completely resected
  • XRT: for positive surgical margins/ recurrent disease
    • Used more commonly with salivary gland origin, less experience with airway origin tumors
  • Chemo: palliative (for metastatic disease)

References

  • xx