Is bronchial adenoma removed in hospital No. 57? Benign tumors of the lungs and bronchi: X-ray and CT diagnostics
Bronchial adenomas- relatively low-grade tumors arising from glandular epithelium tracheobronchial tree - carcinoid tumor, cystadenocarcinoma (cylindroma) and mucoepidermoid carcinoma.Carcinoid tumors (carcinoids) account for 80-90% of bronchial adenomas; mainly affects the proximal bronchi (in 20% of cases - the main ones, in 60% - lobar or segmental, in 20% - bronchioles)
Adenoid cystic carcinomas (cylindromas) account for about 10% of bronchial adenomas
Mucoepidermoid carcinoma (less than 1% of bronchial adenomas)
Bronchial adenoma is a benign tumor that has the appearance of a polyp, sometimes lobulated, covered with epithelium, reddish or gray-red in color, soft consistency, hanging on a stalk into the lumen of the bronchus or located on a broad base. The size of endobronchial adenomas does not exceed 3-4 cm in diameter.
Based on their microscopic structure, they are distinguished into several forms.
Bronchial adenoma of the mucoid type (mucoid adenoma) is a true bronchial adenoma that develops from the mucous glands. Rarely seen. Microscopic examination reveals cavities of different sizes filled with mucous contents. The wall of the cavities is formed by connective tissue covered with tall columnar or flattened epithelium.
Bronchial adenoma of the cylindromatous type (cylindroma) has a lobular structure and consists of small lamellar or round cells with hyperchromic nuclei. The cells are arranged in layers in which numerous, round-shaped cavities without a pronounced membrane are visible, which gives the tumor a cribriform appearance. Along with this, there are tubular formations lined with 1-2 rows of epithelial cells. The lumen of the cavities and tubes contains mucus or hyaline-like masses.
Mucoepidermoid adenoma of the bronchus is characterized by a combination of highly differentiated mucus-producing cells and cells resembling squamous epithelium.
Malignant transformation of bronchial adenomas occurs in 9% of cases; adenomas of the cylindromatous and mucoelidermoid type show the greatest tendency to malignancy.
Symptoms of bronchial adenoma
This is the most common view benign lung tumors (40-60%), accounting for 2% of all lung tumors. It is observed relatively more often in women (60%), usually significantly more at a young age than cancer (average 42.3 years), clinical symptoms associated with endobronchial tumor growth predominantly in large, lobar, segmental and main bronchi are similar to those lung cancer. Often endobronchial growth is accompanied by more significant peribronchial growth (“iceberg type”). In the initial stage, the disease may be asymptomatic, but more often there is a cough with scanty sputum. Hemoptysis is one of the early and persistent symptoms. Subsequently, with the usually eidobronchial location of the adenoma, transient and then permanent phenomena of bronchostenosis develop with inevitable atelectasis of a lobe or, less commonly, of the entire lung. Secondary inflammatory changes occur in the bronchi and lung tissue(pneumonitis) resulting in chronic pulmonary suppuration with abscess formation, carnification of lung tissue, often empyema.
Stages of bronchial adenoma
Depending on the degree of bronchial narrowing and accompanying changes in the lung tissue, three stages of the disease are distinguished:
Stage I - tumor without obstruction of bronchial obstruction;
Stage II - transient bronchial obstruction with intermittent atelectasis and recurrent pneumonia (pneumonitis);
Stage III - complete closure of the bronchus by a tumor with profound irreversible changes in the corresponding area of the lung.
Peripheral adenomas, found in 9% of the total number of these tumors, are associated with small and minute bronchi, are located within the pulmonary parenchyma, rarely reach significant volumes, do not produce symptoms, and are often a radiological finding.
The course of the disease is slow (years). Periods of relative well-being are followed by deterioration of the condition as a result of exacerbation inflammatory process. However, with adenoma there is no progressive deterioration of the patient’s condition characteristic of cancer.
Diagnosis of bronchial adenoma
The nature of the disease is established taking into account the gender, age of the patient and anamnesis (duration of suffering) based on data x-ray examination(hypoventilation, atelectasis of a lobe or lung, possibly valvular swelling of the corresponding lobe, with bronchography - a defect in the filling of the bronchus with clear contours or a symptom of a stump, with tomography - the presence of a tumor node in the lumen of the bronchus). With bronchography, it is important to determine the condition of the bronchi to the periphery of the tumor (bronchiectasis), if it is possible to enter contrast agent for the site of bronchial obstruction. Crucial The final diagnosis of bronchial adenoma is bronchoscopy with biopsy, which reveals a tumor with a smooth surface, displaceable, while maintaining mobility of the unchanged bronchial wall in the immediate vicinity of the tumor. Bronchoscopy allows you to simultaneously assess the possible volume.
Differential diagnosis of bronchial adenoma
Differential diagnosis carried out with central cancer and chronic nonspecific suppurative processes of the lungs of other etiologies. Sometimes the differential diagnosis between cancer and adenoma is extremely difficult and even impossible (if its localization is peribronchial). For peripheral adenoma, the diagnosis is made by general principles for spherical formations and usually in the form of a benign lung tumor in general, with confirmation after removal of the tumor.
Treatment of bronchial adenoma
The only treatment is surgical - removal of the affected lobe or lung. In some cases, if there is no suppurative process in the lung tissue (bronchiectasis), bronchotomy and removal of the bronchial adenoma with part of the mucous membrane or circular resection of the bronchial tube are possible, and therefore bronchotomy is the first stage of the operation and the final point of diagnosis, clarifying the scope of the intervention. Removal of an adenoma through a bronchoscope is impractical due to the possibility of significant bleeding, non-radical intervention with subsequent relapse and malignancy. For rare peripheral adenomas, surgery is usually limited to wedge-shaped or segmental resection of the lung.
Prognosis for bronchial adenoma
The prognosis without surgical treatment is poor due to the steady progression of the suppurative process in the lung and possible transition adenomas to cancer.
The article was prepared and edited by: surgeonLung adenoma is large group benign tumors in pulmonology. The disease appears due to pathologies of the tissue of the lungs and bronchi. Gender is not observed. Lung tumors most often appear in people under 35 years of age. Lung adenoma comes in different structures and origins. Various benign lung tumors have their own characteristics and clinical manifestations. Lung adenoma is not cancer, but some types have the ability to undergo malignant transformation. Benign quality is characterized by slow growth. A benign lung tumor, located in a certain part, forms a capsule of connective tissue around itself.
Lung adenoma: classification
Depending on the location, pulmonary adenoma can be:
- central;
- peripheral;
- mixed.
Peripheral pulmonary adenoma is more common than other types. It can be localized in both the right and left lungs. Almost 90% of all cases lung adenomas occur in the bronchi (bronchial adenoma). In this case, they speak of a central tumor. There is the following classification of lung adenomas:
- carcinoid tumor type;
- cylindromatous type;
- mucoepidermoid type.
Adenoma easy first type - carcinoid - occurs more often than others. This adenoma consists of carcinoid cells that have the ability to accumulate certain substances that are similar to biogenic amines. Next, the disease decarboxylates them, as a result of which the cells become a biologically active substance, such as serotonin and adrenaline. Lung adenoma has the following symptoms: fever that engulfs the arms, neck, and head in an attack. The disease is accompanied by digestive disorders, skin manifestations, mental disorders. Lung adenoma causes an increase in serotonin in the blood. Malignancy provokes systematic attacks. Carcinoid lung adenoma differs clinically from lung cancer in that it develops slowly, as a result of which metastasis begins later.
Lung adenoma. Treatment
The surgical method is the most radical and most reliable method. Surgery necessary as soon as possible to avoid complications of the disease and its progression. The higher the consequences, the more irreversible consequences, the greater the volume of lung tissue that will have to be removed.
Economical resection is performed for bronchial adenoma, which allows the tumor to be removed without affecting the lung tissue. If the base of the tumor is small, it is removed by bronchotomy. Circular resection is performed when extensive damage lungs. If irreversible consequences are identified, central resection with concomitant removal of the affected lobes and anastomosis is also used. Lung adenoma is removed at an early stage using a bronchoscope. But this method is fraught with bleeding and the need for subsequent endoscopic monitoring. The radicality of the bronchoscope is very low. The tumor may not be completely removed. An additional biopsy of the bronchial walls will be required to identify the remaining bronchial adenoma.
Benign tumors peripheral type are removed using enucleation. Segmental and marginal lung resection is also applicable. It is necessary to take into account the localization of the tumor deep in the lung tissue. Large peripheral adenoma is removed by lobectomy. The prognosis for timely surgical removal of the tumor is favorable. To prevent malignancy, it is necessary to diagnose the disease at early stages. This is why it is so important to monitor your health and attend consultations.
Bronchial adenoma
Among the many types of lung adenoma, bronchial adenoma should be highlighted. This benign tumor is characterized by a lobulated polyp that is covered with gray-red soft epithelial formations. The bronchial tumor itself is located on a stalk or broad base, and hangs into the lumen of the bronchus. Bronchial adenoma has a diameter of 30-40 mm. The disease has 3 stages. At the first stage there is a violation bronchial obstruction. At the second stage, there is bronchial obstruction with concomitant atelectasis, and pneumonia recurs. The third stage is characterized by complete blockage of the bronchus, irreversible changes take place.
Classification of bronchial adenoma
There are several types of bronchial adenomas depending on their microscopic appearance:
- Mucoid type.
- Mucoepidermoid type.
- Cylindromatous type.
- Malignant type.
The mucoid type of adenoma is a true bronchial adenoma, but it is rare. Its development occurs from the mucous glands of the bronchi. Bronchial adenoma of the mucoid type also consists of cavities that are filled with mucus. Cavities may be different sizes. Their walls contain connective tissue, and are covered with thickened epithelium.
The mucoepidermoid type means that the bronchial adenoma consists of two types of cells: those that are differentiated and secrete mucus, and those that are shaped like squamous epithelium.
The cylindromatous type is characterized by a lobular structure. The cells of the lobules, the nuclei of which are hyperchromic, have rounded shape. Arranged in layers. As a result, bronchial adenoma has a cribriform type. IN in this case There are formations of the tubular type, sent out by one or two layers. There is mucus in the lumen of the cavities between the rows.
The malignant type of bronchial adenoma is a rare phenomenon and arises from mucoepidermoid and cylindromatous bronchial adenoma.
Diagnosis and treatment
Bronchial adenoma is diagnosed by X-ray examination. The gender and age of the patient should be taken into account. Bronchography is also performed, the purpose of which is to study the condition of the bronchi. But the most important thing in diagnosing the disease is, perhaps, bronchoscopy followed by a biopsy. This procedure not only identifies and examines the tumor, but also helps estimate the extent of the operation.
Treatment of bronchial adenomas is only possible surgical method. It is produced by lung removal or part damaged by a tumor. On initial stages disease, it is possible to remove only the tumor and its mucous membrane. This is possible with the help of a bronchoscope. Peripheral bronchial adenomas are removed by pulmonary, segmental or wedge-shaped resection. Treatment without surgical intervention has an unfavorable outcome due to the non-radical nature of the procedures. The suppurative process that progresses during the disease, lung adenoma, has the likelihood of developing into a malignant tumor.
Inna Bereznikova
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Bronchial adenoma is a neoplasm that appears from epithelial cells or glands of the bronchi. There are several types of the disease: cylindrical, mucoepidermoid, carcinoid and mixed adenoma.
Carcinoid adenomas can be malignant or benign. For malignant carcinoid tumors characteristic features is slow progression and late formation of metastases in internal organs(stomach, kidneys, bones, brain and liver), as well as an optimistic prognosis for recovery with radical treatment.
Carcinoid adenomas are mainly malignant. Only 9% of patients may experience progression of mucoepidermoid and columnar tumors to cancer.
Symptoms of bronchial adenoma
The nature of the course and symptoms of the disease depend on its location, obstruction and complications.
Bronchial adenoma long time may remain undetected due to its small size and slow growth. It may be disguised against the background of symptoms chronic bronchitis, bronchial asthma or bronchiectasis (irreversible and localized dilatation bronchial tree due to obstruction of the same name, improper discharge of sputum).
Symptoms of the disease depend on its central or peripheral location in the respiratory tract. With a central location, the following signs are noted:
- stridor in the large bronchi (an abnormal sound produced by turbulent air flow through narrowed airways);
- difficulty breathing due to partial obstruction of large bronchi;
- fever, cough, sputum production due to complete bronchial obstruction. In this case, the bronchioles stick together, collapse, infection and decomposition of the lung tissue occurs in the affected pulmonary area;
- wheezing due to obstruction in the small bronchi;
- cough with blood particles due to ulcers on the mucous membrane respiratory tract.
With peripheral damage to the bronchi, the disease often does not show any symptoms. Basically, peripheral lesions are single formations in the chest area and are detected by radiography. There may be periodic flushes of blood to upper limbs, pain, diarrhea, feeling hot. Due to the malignancy of carcinoid adenoma, the severity and frequency of attacks may increase.
Carrying out diagnostic studies
Bronchial adenoma is not always detected during fluorography. More clearly pathological disorders the bronchial wall can be seen on a tomogram.
Also detailed information can be obtained by CT or MRI of the lungs, scintigraphy.
To clarify the nature of the tumors and the degree of their progression, bronchography (x-ray contrast examination) is performed.
Choice of treatment methods
Because of possible complications(malignancy, bleeding or suppuration), the adenoma is removed surgically V short terms. The size and type of intervention is determined by the size, location, growth and histology of the adenoma.
On initial stage If the disease is characterized by endobacterial growth and central localization, endoscopic removal can be performed. But such an operation will require a repeat biopsy and endoscopic examination.
When a bronchial adenoma is identified, it is removed using lung surgery or bronchoscopic surgery. For this purpose, video cameras and gentle invasive therapy techniques are used. 
Bronchoscopic surgery may be prescribed to remove small tumors localized in the respiratory tract. But with such an intervention, tumors cannot be completely removed, and there remains a risk of developing heavy bleeding. Therefore, experts recommend this method for contraindications to open surgery in the pulmonary zone for health reasons.
For irreversible limited tissue changes in the lungs (fibrosis, poststenotic abscesses and bronchiectasis), bilobectomy, marginal resection, lobectomy and segmentectomy are performed. If pathological process has spread to the entire lungs, a pneumonectomy is performed.
Also, bronchial adenoma can be removed using a laser and a bronchoscope. But this method cannot be used as the main one and is usually used to eliminate recurrent tumors.
The most reliable method is surgical resection, in which the survival rate of patients is high percentage. According to the results of long-term examinations, there are no distant metastases or local relapses with surgical removal adenomas.
Prognosis for pathology
If bronchial adenoma is not detected in a timely manner, gentle interventions to eliminate the tumor cannot be performed. Large lung resections are permitted. 
The survival rate is 96% after radical resection. Sometimes there may be relapses, formation distant metastases and malignancy of the neoplasm. Patients who have undergone surgery to remove bronchial adenoma should be observed by a pulmonologist and undergo periodic endoscopic and x-ray examinations.
Bronchial adenoma is benign neoplasm on the wall of the bronchus. The tumor is formed from the cells of the mucous glands and takes the form of a polyp. The disease is determined by its pronounced clinical symptoms which, gradually intensifying, force the patient to seek medical care. The patient is plagued by constant shortness of breath along with hemoptysis, coughing is accompanied by chest pain. With the development of a strong inflammatory process, body temperature rises.
How to treat bronchial adenoma
The disease progresses rapidly, often causing complications. When bronchial adenoma occurs, there is a high risk of developing suppuration or internal bleeding. To warn so negative consequences, immediately after diagnosis, surgical treatment is prescribed. Conservative methods therapies are not used because they are ineffective and take a long period of time.
To eliminate the tumor, so-called endoscopic removal of the adenoma is used. Surgical procedure carried out using a bronchoscope, which neutralizes the formation with a laser beam or electric shock. It is worth noting that this method of tumor removal is effective only in the initial stages of its development. In addition, during the operation there is a risk of bleeding.
The most common and effective methods of treating adenoma are open types surgical interventions. IN medical practice fenestrated resection of the bronchus, as well as bronchotomy, are used.
What diagnostics should be performed for bronchial adenoma?
Determining the disease at an early stage is not always possible, since preventive fluorography does not show compactions on the walls of the bronchi. As a rule, the patient goes to a medical facility when alarming symptoms which indicate tumor progression. Diagnosis of bronchial adenoma is carried out by a pulmonologist, and the primary examination is also performed by a therapist. After clarifying the complaints and compiling a history of the disease, screening of the patient's respiratory tract is required. The patient is given a referral to a functional diagnostician who performs one or more of the following procedures:
- radiography;
- computed tomography;
Consequences of bronchial adenoma
Therapy in the early stages of adenoma development gives an encouraging prognosis, and a rehabilitation course leads to recovery. If the disease has been neglected, in most cases it ends with damage to the lung.