Bronchial adenoma
Introduction
Introduction to bronchial adenoma Bronchial adenoma (bronchialadenoma) is a group of benign tumors originating from bronchial mucous glands, ductal epithelium or submucosal Kulchitsky cells, but with a tendency to malignant. Often occurring in 30 to 50 years old, with an average of 45 years old. The incidence rate for men and women is similar. Surgical resection is currently the only cure for all types of bronchial adenomas. The age of diagnosis of bronchial adenoma is earlier than that of bronchial carcinoma. Symptoms vary with tumor growth site and bronchial lumen, local infiltration and distant metastasis, and the edge of the lung is asymptomatic, often found on X-ray examination. If it occurs in a large bronchi, irritating dry cough occurs at the beginning, repeated blood stasis, tumor enlargement, local obstructive emphysema and localized fixed wheezing. basic knowledge The proportion of sickness: 0.0026% Susceptible people: adults Mode of infection: non-infectious complication:
Cause
Cause of bronchial adenoma
Bronchial carcinoid (30%):
Bronchial carcinoid (Carcinoid adenoma) accounts for 1% to 7% of primary tumors and 80% to 90% of bronchial adenomas. Occurs in the big bronchi. Kulchitsky cells from the bronchial wall. 80% is central, and only 1/5 occurs in the surrounding bronchus below the sub-segment. Tumors tend to grow under the bronchial mucosa. If it grows into the lumen, it will form a polypoid mass with smooth surface and abundant blood vessels, and block the lumen, which may cause obstruction of edema, atelectasis or pneumonia, and even lung abscess; if it grows inside and outside the wall, A typical dumbbell shaped mass can then be formed. Most of the tumors have a complete capsule, and the cut surface is grayish white or reddish. It is clearly demarcated from the surrounding lung tissue and is easily peeled off from the lung. It can also break through the envelope and grow invasively. Microscopic examination: The tumor cells are small, cubic or polygonal, uniform in size, clustered in groups, arranged in a strip or glandular arrangement. The cytoplasm is rich and eosinophilic. The pulp contains dark black silver particles, which are equivalent to the neurosecretory particles seen by electron microscopy. The granules secrete a variety of biologically active substances, leading to ectopic endocrine symptoms of carcinoid. The nucleus is round or oval, the nuclear membrane is clear, and the mitotic phase is rare. The interstitial tissue of the tumor tissue is rich in capillaries, sometimes with glassy changes, amyloidosis, calcification, and even ossification. About 10% of bronchial carcinoids show atypical growth. The cells vary in size and are irregularly arranged; nuclear polymorphism, increased divisional phase, and common necrosis. 70% of patients with atypical carcinoid tumors have local lymph nodes, liver or bone metastases, while the typical metastatic rate of carcinoid tumors is less than 5%.
Adenoid cystic carcinoma (30%):
Adenoid cystic carcinoma (adenoid cystic carcinoma) was originally called cylindromas, accounting for 10-15% of bronchial adenomas. Occurs in the trachea or protuberance, and the large bronchi. Infiltrating along the wall; can invade surrounding tissues and organs; rarely polypoid growth; can block the bronchial lumen. The cut surface is grayish white. Microscopic examination: substantial or lobulated cell nests and cell cords of basal cell-like epithelial cells with a small cytoplasm and a dark, regular cell. There is a transparent matrix deposition in and around the cell cord. Tumor cells are staggered into a cylinder or a tube. It contains epithelial cell mucus positive for PAS staining. Nuclear fission is more common than carcinoid. Its malignancy is the highest in adenomas. It can be partially infiltrated or transferred to liver, kidney and other organs in the distance.
Mucin epithelioid tumor (30%):
Mucoepidermoid tumor is derived from the mucous gland of the bronchioles and is a rare tumor, accounting for 2% to 3% of bronchial adenomas. Generally, the bronchial mass grows without sputum, which can block the lumen and invade the area. See the face with multiple mucus cavities. Microscopic examination revealed keratinocytes, secreting mucin cells and intermediate or transitional cells. Histologically, it is divided into: high-differentiated tumors are more common, the boundary is clear, and the growth is external. It consists of small and regular nucleus, cytoplasm-rich, and mitotic-free cells; more goblet cells, prominent glandular cavity; transition Type and squamous cells are rare. Tumors with low differentiation are rare, with unclear boundaries, ingrowth, local necrosis, large and polymorphous nucleus, sparse cytoplasm and mitosis; goblet cells and squamous cells are rare, glandular cavity formation is rare; transitional cells are more; With local erosion, it can also be malignant.
Prevention
Bronchial adenoma prevention
Smoke, alcohol, and spicy food are strictly prohibited. Temporary fasting of hot leeks, garlic, onions, etc., prawn, crab and allergic food should be avoided.
Complication
Bronchial adenoma complications Complication
Bronchial adenoma is a group of benign tumors of Kulchitsky cells originating from the bronchial gland, ductal epithelium or submucosa, but with a tendency to malignant.
Symptom
Symptoms of bronchial adenoma Common symptoms Squamous cell metaplasia dry hemoptysis wheezing sound tired
The age of diagnosis of bronchial adenoma is earlier than that of bronchial carcinoma. Symptoms vary with tumor growth site and bronchial lumen, local infiltration and distant metastasis. The edge of the lungs is asymptomatic and often found on X-ray examinations. If it occurs in a large bronchus, an irritation of dry cough occurs at the beginning, and blood stasis is repeated. Tumor enlargement, local obstructive emphysema and localized fixed wheezing can occur. The lumen is completely blocked and atelectasis can occur. Blocking the distal lung secondary infection can occur with pneumonia, lung abscess or bronchiectasis. Because the adenoma is benign, the symptoms exist for a long time, and some are diagnosed for 5 to 15 years. In the case of malignant metastasis, the symptoms are similar to those of other cancer metastases. A small number of patients with bronchial carcinoids may develop parotid syndrome such as paroxysmal skin redness, abdominal pain, diarrhea, asthma and tachycardia, or central obesity, hypertension, edema, fatigue, hypokalemia and hyperpigmentation. Esophageal ACTH syndrome.
X-ray examination: the tumor can be negative when it is extremely small. A bronchial adenoma near the hilum may have a round or semi-circular shadow and is located in the periphery of the lung and has a nodular or spherical shadow. May be associated with obstructive emphysema, atelectasis, obstructive pneumonia, and even lung abscess, the tumor is sometimes masked.
Examine
Examination of bronchial adenoma
X-ray examination: the tumor can be negative when it is extremely small. A bronchial adenoma near the hilar may have a round or semi-circular shadow; a patient with a nodular or spherical shadow around the lung. May be associated with obstructive emphysema, atelectasis, obstructive pneumonia, and even lung abscess, the tumor is sometimes masked
Diagnosis
Diagnosis and differentiation of bronchial adenoma
The age of onset of bronchial adenoma is relatively mild, often with long-term cough, hemoptysis and repeated lung infections. Chest X-ray signs are rounded and densely shadowed. In particular, stratified and CT scans clearly show the location, shape, size, bronchial obstruction, and presence or absence of regional lymph node metastasis. Bronchoscopy is one of the important methods for diagnosing this disease. It can not only determine the location of the tumor, but also provide a pathological diagnosis by biopsy. The positive rate of fiberoptic bronchoscopy biopsy can reach 66% to 86%. Because the tumor is rich in blood vessels and the surface is covered with intact mucosal epithelium, it is necessary to repeat the deep biopsy to prevent the rash rate, but the bleeding should be prevented. The sputum exfoliated cells, bronchial washing and brush smears are used to diagnose the disease. No help.
A lung mass that must be differentiated from an adenoma has the following diseases.
(1) Peripheral bronchial carcinoma is relatively older than adenoma and grows fast. The nodular or round foci of adenomas on the X-ray are sharper than lung cancer, but sometimes difficult to distinguish. When the diagnosis is difficult, the chest should be explored in time to avoid losing the opportunity to cure.
(2) Tuberculosis spheroids occur in the posterior segment of the upper lobes of the two lungs or in the dorsal segment of the inferior lobe. There are often satellite foci around, and there are often centripetal or dense calcifications in the lesions.
(3) Pulmonary hamartoma The round or lobulated block has a clear edge, and there are calcifications in the lesion, sometimes with a jade pattern.
