Childhood bronchial mucoepidermoid tumors

Pulmonary mucoepidermoid carcinoma in children: two case reports and a review of the literature

Pulmonary mucoepidermoid carcinoma (PMEC) is a rare tumor, particularly in children, and its clinical manifestations vary. When the tumor is small, it may be asymptomatic; however, with larger tumors, patients may present with symptoms such as recurring pneumonia, atelectasis, persistent cough, chest pain, and even hemoptysis. PMEC appears as an exophytic intrabronchial mass. This study aims to report on the clinical manifestations, imaging findings, treatment approaches, and prognosis of two children diagnosed with PMEC at our hospital between January 2018 and December 2022. The age of onset for both children was 9 years, and the masses were located in the right upper lobe bronchi. Following surgical treatment, both patients showed a good prognosis. In addition, we conducted a comprehensive review of the relevant literature to enhance the overall understanding of PMEC.

Mucoepidermoid carcinoma of the trachea in a 9-year-old male child: case report and review of literature

Mucoepidermoid carcinoma (MEC) is the most common malignancy of minor salivary glands in adults. Pulmonary MEC is extremely uncommon, comprising only 0.1–0.2% of the primary lung malignancies and <1% of primary bronchial tumors. It is even rarer in children, and literature is limited to a few case reports only. Here we present a case report of a 9-year-old boy diagnosed with primary MEC of the trachea along with a review of the literature. A 9-year-old male child presented with complaint of dry cough for two years which was later associated with shortness of breath after one year. Bronchoscopic examination revealed a growth arising from right lateral wall of carina occluding 50% of the lumen and detailed histopathological examination revealed it to be a MEC of the trachea. The patient underwent local excision of the tumor with primary anastomosis. Because of positive margin, adjuvant radiotherapy of 60 Gy in 30 fractions was given to the tumor bed. The patient tolerated the treatment well and is disease free at 6 months follow-up. Experience with MEC of the trachea in children is limited, and optimal treatment protocols have not been defined, with current treatment mainly extrapolated from MEC of the salivary glands.

Childhood and adolescent tracheobronchial mucoepidermoid carcinoma (MEC): a case-series and review of the literature

Tracheobronchial mucoepidermoid carcinomas (MEC) are rare in the pediatric population with literature limited primarily to case reports. Here we present our institutional experience treating MEC in three patients and review the literature of 142 pediatric cases previously published from 1968 to 2013. Although rare, tracheobronchial MEC should be included in the differential diagnosis in a child with recurrent respiratory symptoms. Conservative surgical management is often sufficient to achieve complete resection and good outcomes.

Endobronchial tumor in children: Unusual finding in recurrent pneumonia, report of three cases

We are reporting 3 cases of pediatric endobronchial tumors presented with recurrent pneumonia. The median age of patients, at time of presentation, was 10.6 years. All patients presented with recurrent pneumonia with a mean time to occurrence, after onset of symptoms, of 14 mo. Bronchoscopy was early performed as part of diagnostic work-up and it revealed an endobronchial mass in every case. Complete surgical resection was performed in all cases, with lung preservation in two of them. Neither post-operative chemotherapy nor radiotherapy was required. The mean duration of follow-up was 7 years and all patients are still alive and disease-free. Recurrent pneumonia, in pediatrics, should raise the suspicion of an obstructing lesion, congenital malformation or systemic disease. A systematic approach is useful for organize the clinicians initial workup. Prompt diagnosis allows parenchymal-sparing surgery, which offers the best chance of cure and reduces clinical and functional complications in these patients.

Characteristics of endobronchial primitive tumors in children

Primary endobronchial tumors are rare in children and they include a broad spectrum of lesions. The aim of this study was to determine the characteristic features, treatments and outcomes of these tumors. We report a retrospective analysis of all patients treated for endobronchial tumor in nine French hospitals between 1990 and 2010 and a comparison of the results with those reported in the medical literature. Twelve tumors were reported: five low grade muco epidermoid carcinomas, two inflammatory myofibroblastic tumors, two hemangiomas, one anaplastic large cell lymphoma, one carcinoid tumor, and one juvenile xanthogranuloma. The mean age of the patients was 7.5 ± 3.5 years. The most common sign revealing the disease was persistent atelectasis or recurrent pneumonia (eight cases). The other revealing signs were a persistent bronchospasm (three cases) and hemoptysis (one case). The clinical presentation, biology, serum tumor markers, and chest X-ray abnormalities were not specific to a particular histological diagnosis. Chest CT scan revealed the presence of an endobronchial tumor in 11 cases. Nine tumors could be diagnosed from a biopsy obtained by video endoscopy. Complete surgical resection was performed in seven patients. Bronchoscopic removal was performed in five cases and was successful in three. There were no deaths. Endobronchial tumors are rare in childhood and their histology is diverse. Chest CT scan and per-endoscopic endobronchial biopsies are required for diagnosis, when possible. Surgical or endoscopic treatment should be discussed by a multidisciplinary team. Despite the multiple etiologies, the prognosis of these tumors is good if diagnosis is early and if resection is complete. Long-term recurrences have been described, so long-term follow-up of these children is recommended.

Childhood bronchial mucoepidermoid tumors: A case report and literature review

Primary pulmonary neoplasms rarely occur in children, but the majority of those that do are malignant. Mucoepidermoid carcinoma (MEC) represents ~10% of all primary pulmonary malignant tumors. However, MEC is not usually considered in the clinical differential diagnosis in pediatric practice. The present study presents the case of a seven-year-old female with a one-year history of recurrent hemoptysis. Computerized tomography (CT) scans revealed a tumor originating in the right lower lobe bronchus. The patient did not receive any radiation and chemotherapy following a lobectomy on the right lower lung. The tumor was histopathologically determined to be an MEC of the tracheobronchial tree. Subsequent to a six-year follow-up, the MEC was undetectable in this patient, according to the clinical and radiological evidence. The literature with regard to pediatric MEC is also reviewed in this study.

Chinese pediatric and adolescent primary tracheobronchial tumors: a hospital-based study

OBJECTIVES

To investigate the clinical characteristics and treatment outcomes in Chinese pediatric and adolescent patients with primary tracheobronchial tumors by focusing upon the exploration of prognostic factors.

METHODS

A retrospective review of medical records collected from January 1996 through June 2009 was conducted within a single institution, inclusive of the total 19 treated pediatric and adolescent patients (3 benign tumors, 16 malignant tumors). A parallel comparison of adult cases with tracheobronchial tumor was performed to the pediatric and adolescent cases.

RESULTS

The chart review of pediatric and adolescent case reports revealed 19 cases with primary tracheobronchial tumors. Final pathologic diagnosis included 14 (73.68%) mucoepidermoid carcinoma (ME), 2 (10.53%) carcinoid tumor, 2 (10.53%) papillomatosis and 1 (5.26%) neurofibroma. Median age upon diagnosis was 12 years (range 4-18 years). Chest imaging revealed common abnormal radiographic atelectasis (12/19). Patients with localized disease received surgical tumor resection. There were a total of 8 (42.1%) sleeve resections, 4 (21.1%) resection of anatomically related lung parenchyma (1 bilateral lobectomies, 2 lobectomies, 1 pneumonectomy) and 7 local tumor resections. No surgery-related deaths or complications were observed. 16 patients (84.2%) remained disease free with a median follow-up of 70.5 months (range 44-168 months).

CONCLUSIONS

Our hospital data indicated a high incidence of ME, presenting the difference in the incidence rates between Chinese and western populations. Sleeve lobectomy provides efficient treatment with excellent prognosis among Chinese pediatric and adolescent patients.

Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management

Primary tracheal malignant neoplasms are very rare. Histologically, squamous cell and adenoid cystic carcinomas are the most common types of malignant primary tracheal tumors when all age groups are studied. In the past 5 years, we treated 2 children with tracheal mucoepidermoid carcinoma. Herein we report both cases and review the literature on the subject with particular emphasis on diagnosis and surgical management.

[Malignant pulmonary tumors in children]

Pulmonary neoplasms in children are rare. The majority of tumors involving the respiratory system are metastatic and primary lung tumors are even more rare. Approximately 75% of primary lung tumors are malignant, the most frequent of which are adenoma, bronchogenic carcinoma, and pleuropulmonary blastoma. Due to the rarity of these malignancies, and the usually nonspecific clinical symptoms, they are often not considered in the differential diagnosis in children who present with persistent pneumonitis, coughing, and atelectasis. This often results in delayed definitive treatment and, in general, a worse prognosis. The role of the radiologist is that by using modern imaging techniques, to facilitate early recognition and staging, enabling adequate treatment and follow-up and thus, a better clinical prognosis. This article provides an overview of the most relevant entities of primary childhood pulmonary malignancies, with a particular emphasis on the imaging characteristics.

Mucoepidermoid carcinoma of the lung: High-resolution CT and histopathologic findings in five cases

OBJECTIVE

The purpose of this study was to characterize the high-resolution computed tomography (HRCT) findings of mucoepidermoid carcinoma of the lung and correlate them with the histopathological features.

METHODS

The study included five patients with pathologically proven mucoepidermoid carcinoma who underwent HRCT before treatment. The HRCT findings were then compared with the histopathological features in all patients.

RESULTS

The HRCT images showed lesions in the central lung in four patients and in the peripheral lung in one. All the lesions were well defined nodules or masses with a smooth margin. The contour of the tumours was oval (n=3), round (n=1) or lobulated (n=1). The contrast-enhanced CT images showed marked heterogeneous enhancement with foci of relatively low attenuation in four of the five lesions and mild heterogeneous enhancement in the other lesion. There was an admixed distribution of areas that are heterogeneous in the densities of blood vessels, as highlighted by immunohistochemical staining of CD31. Most mucin-secreting areas of the tumours showed more densely distributed blood vessels, mostly capillaries, in between tumour cell nests, whereas other areas did less. All five patients in our series underwent lobectomy plus lymph node dissection or sampling. All the patients are alive without evidence of disease an average of 50.4 months after surgery (range, 15-82 months; median, 57 months).

CONCLUSION

Mucoepidermoid carcinoma of the bronchus is often visualized as marked heterogeneous contrast enhancement on HRCT images. The results of this study suggest that the presence of abundant microvessels, detected immunohistochemically by microscopic examination, affects the enhancement pattern on HRCT.

Pediatric pulmonary tumors: primary and metastatic

Pediatric pulmonary tumors are rare. There is often a significant delay in diagnosis of pulmonary tumors secondary to their rarity and nonspecific presenting physiologic and radiographic findings. A high index of suspicion in pediatric patients with recurrent or persistent pulmonary symptoms is of paramount importance in diagnosing pulmonary tumors at an early stage. Malignant pulmonary tumors are more frequently diagnosed than benign lesions, with metastatic cancers being the most common. Complete surgical resection remains the basis of therapy for primary lesions, and its role in secondary cancers is becoming more established. Adjuvant therapies are frequently employed depending on the precise tumor involved. Mortality rates vary greatly depending on tumor location, stage, and type.

Primary salivary gland-type lung cancer: spectrum of clinical presentation, histopathologic and prognostic factors

BACKGROUND

Primary salivary-type lung cancers are rare tumors that include adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC). The clinicopathologic profiles, symptoms on presentation, and long-term outcomes of patients with ACC and MEC as an overall group have not been defined recently.

METHODS

In this study, the authors analyzed clinical outcome data from 62 patients who presented with a diagnosis of primary salivary-type lung cancer at the Mayo Clinic (Rochester, Minn) from 1972 to 2002.

RESULTS

The median age at diagnosis for patients with MEC was 40 years (range, 6-78 years); and, for patients ACC, the median age at diagnosis was 54 years (range, 21-76 years). ACC was observed more frequently among women and girls. The main presenting symptom for both tumors was cough (70%), followed by dyspnea (51.7%), wheezing (38.3%), obstructive pneumonia (30%), hemoptysis (28.3%), and fever (16.7%). Tissues were available for review from all patients. Among the ACC tumors, 29 (74.4%) were cribriform, 7 (17.9%) were tubular, and 3 (7.7%) were the solid type. Most MEC tumors (65%) were intermediate grade (grade 2), and 30% were low grade (grade 1). Most salivary-type lung cancers presented in the trachea, in the carina, or in a main stem bronchus (70.7%). This location was observed more often (82.5%) for ACC tumors compared with MEC tumors (44.4%). Involvement of the lymph nodes was observed in 20% of patients and was more common among the patients with ACC (30.8%). Distant metastases were observed in 30.4% of the patients (15 patients in the ACC group [40.5%] compared with only 2 patients in the MEC group [10.5%]; P = .03). For patients who underwent complete surgical resection, the 3-, 5-, and 10-year survival rates were 82%, 70%, and 63%, respectively. The survival rates for surgical MEC patients were 94% at 3 years and 87% at both 5 years and 10 years. For surgical ACC patients, the survival rates were 73%, 57%, and 45% at 3, 5, and 10 years, respectively. The survival rate for patients with ACC who did not undergo surgery was 74% at 3 years, 53% at 5 years, and 31% at 10 years. The difference in survival between surgical and nonsurgical patients was statistically significant (P < .01).

CONCLUSIONS

Patients with MEC and ACC frequently have a good long-term prognosis but do not always have indolent diseases. Local recurrence is likely if complete surgical resection is not achieved. ACC has a higher likelihood than MEC to metastasize. Overall, patients with MEC survive better than patients with ACC.

[Prognosis of mucoepidermoid carcinoma of the bronchi]

BACKGROUND

Mucoepidermoid cancer is exceptional in the respiratory tract, accounting for only 0.2% of primary lung cancers.

CASE REPORTS

We report three cases of mucoepidermoid carcinoma. The inaugural signs were hemoptysia in a 10-year-old child, recurrent lower respiratory tract infections in a 13-year-old child, and dyspnea with chest pain in a 32-year-old adult. Bronchial fibroscopy disclosed a proximal endobronchial tumor in all three patients. Pathology study of the operative specimen identified low-grade malignant mucoepidermoid carcinoma in the two children and high-grade malignant mucoepidermoid carcinoma in the adult. Surgical resection was performed for the pediatric cases. Outcome was favorable with recurrence-free survival at eight years in the first child. The surgical resection was less radical in the second child due to locoregional extension. This child was lost to follow-up. The clinical course was rapidly fatal in the third patient who presented metastatic spread at diagnosis and died one month later.

DISCUSSION

The prognosis of mucoepidermoid tumors of the bronchi is closely related to tumor grade and extension at diagnosis. Unlike high-grade mucoepidermoid carcinoma, the progression of low-grade tumors, which predominate in children, is generally slow, enabling good prognosis if diagnosis is established early. Early search for these tumors in patients presenting chronic or recurrent respiratory manifestations would avoid late diagnosis and improve prognosis.

Carcinoid and mucoepidermoid bronchial tumours in children

The aim of the study was to determine the characteristic features and outcome of carcinoid or mucoepidermoid tumours in children. A retrospective analysis of all patients treated for a carcinoid or mucoepidermoid tumour in France between 1984 and 2001 was performed. There were 11 cases of carcinoid tumour and 6 cases of mucoepidermoid tumour. The mean age of the patients was 10.5+/-3.0 years, with a range of 5 to 15 years. Twelve and 6 patients presented with evidence of bronchial obstruction and haemoptysis, respectively. Fibre optic bronchoscopy confirmed the presence of a bronchial tumour in all cases and endobronchial biopsies were diagnostic in 11 of 12 cases. A chest CT scan revealed the presence of a hypervascular tumour in 8 of 12 patients. The distribution of the location of the tumours was equal between the right and the left lung, and, in 9 cases, the airways were totally occluded by the tumour. Complete surgical resection (lobectomy in 15 patients and pneumonectomy in 2 patients) was performed in all cases without pre-operative chemotherapy or radiotherapy. The mean duration of follow-up was 4.0+/-3.0 years. In 2 patients, auscultation assymetry and an episode of haemoptysis revealed the recurrence of a mucoepidermoid tumour, successfully cured by removal of the tumour and chemotherapy and radiotherapy in one child. No death was observed.

CONCLUSION

Pulmonary carcinoid and mucoepidermoid tumours are rare in children. Bronchoscopic removal should not be performed. With aggressive surgical therapy, the prognosis is excellent. Fibre optic bronchoscopy confirms the presence of an endobronchial mass. A biopsy is needed for diagnosis and complete surgical removal is the treatment of choice. Long-term results are excellent but a clinical follow-up is recommended.

Mucoepidermoid carcinoma as an unusual cause for recurrent respiratory infections in a child

Recurrent respiratory infections in a 9-year-old girl prompted a chest radiograph and a CT scan, which showed a right middle lobe consolidation. Bronchoscopy revealed a tumor that totally obstructed the middle lobe. Open lung biopsy revealed a low-grade mucoepidermoid carcinoma. Middle and lower right lung lobectomy was performed, followed by an uneventful recovery. Cytogenetic investigation of tumor cells exhibited the translocation t(11;19). This case shows that further diagnostic modalities such as CT scanning should be performed early in children with recurrent lower respiratory tract infections who have suspicious radiographic findings such as persistent atelectasis or recurrent unifocal infiltration. Bronchial mucoepidermoid carcinoma is infrequent, and molecular investigations might shed additional light on the prognosis.

Bronchoscopic Nd-YAG laser surgery for tracheobronchial mucoepidermoid carcinoma--a report of two cases

Mucoepidermoid carcinoma (MEC) of the tracheobronchial tree represents 0.2% of all lung tumours. It arises from the excretory ducts of the bronchial mucosa and is classified into low- and high-grade tumours using criteria derived from similar tumours of the major salivary glands. Low-grade MEC behaves in a benign fashion with less parenchymal and hilar lymph nodal invasion. The traditional method of treatment is by thoracotomy. The bronchoscopic approach to this lesion using lasers has rarely been reported. This article reports two cases of low-grade tracheobronchial MEC, which were both managed through bronchoscopic neodymium yttrium aluminium garnet (Nd-YAG) laser surgery. The patients were free from disease, 26 and 36 months after surgery. Bronchoscopic laser surgery promises to be an effective alternative treatment modality for tracheobronchial MEC. It is minimally invasive, results in less hospital stay and does not impair pulmonary functions.

Mucoepidermoid carcinoma of the bronchus presenting with a negative chest X-ray and normal pulmonary function in two teenagers: two case reports and review of the literature

Two adolescents presented with a history of dyspnea upon exertion and cough. In both cases, the chest X-ray and pulmonary function testing, including flow-volume loop, were normal. A bronchial tumor was diagnosed by CT scan, which was ordered after each patient had an episode of hemoptysis. The sedimentation rate was the only abnormal laboratory test in both cases. Mucoepidermoid carcinoma of the bronchus, a rare tumor in childhood, was found at pathology in both cases. There was no evidence of metastases to local lymph nodes or distal sites. There were 47 previously reported cases in children. Recurrent pneumonia and persistent cough were the most common presenting findings. These tumors are of low-grade malignant potential but they can become locally invasive, extending into cartilage and surrounding soft tissue. Prognosis is good with complete resection.

Endobronchial tumors in children: Institutional experience and literature review

BACKGROUND/PURPOSE

Endobronchial tumors are rare in children and often misdiagnosed as benign conditions resulting in delayed definitive treatment. The authors reviewed their experience to highlight pertinent aspects of diagnosis and treatment.

METHODS

A retrospective chart review was conducted of children with endobronchial tumors diagnosed between 1980 and 2002.

RESULTS

Nine patients had endobronchial tumors (5 girls, 4 boys), with average age of 13 years (range, 8.5 to 15 years). There were 5 carcinoid tumors, 3 mucoepidermoid carcinomas, and one pseudotumor. Preoperative bronchoscopic biopsy confirmed the diagnosis in 6 patients, was inconclusive in one, and not done in 2. All except one (pseudotumor) underwent surgical resection. Laser ablation was performed in 2 cases with complete cure in one. All had an uneventful postoperative course except one patient in whom ipsilateral pneumonia developed. Long-term follow-up was obtained with clinical examination, pulmonary x-ray, abdominal ultrasound scan, chest computed tomography scan, and serum 5-HIAA in those with carcinoid tumor. Bronchoscopy was performed twice yearly for the first 2 years, then yearly. No evidence of local or distant recurrence was reported.

CONCLUSIONS

Endobronchial lesions should be considered in children with persistent pneumonia despite adequate treatment or with undiagnosed respiratory symptoms. Prognosis is excellent with surgical resection. Specific follow-up protocol is recommended.

Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report

We report what we believe to be the first case of video-assisted sleeve lobectomy in an adolescent girl who had experienced recurrent episodes of lobar pneumonia and received a diagnosis of low-grade mucoepidermoid carcinoma of the left lower lobar bronchus.

Mucoepidermoid bronchial tumors: a review of 34 operated cases

OBJECTIVE

Pulmonary mucoepidermoid tumors are commonly included with adenoid cystic carcinoma and carcinoid tumors under the misleading rubric 'bronchial adenomas'. These neoplasms are extremely rare and little is known about their oncologic behaviour. They are considered to be of high, or low malignancy.

METHODS

During a 16-year-period 34 consecutive patients (24 male and 10 female with an average age of 53 years) underwent surgery for pulmonary mucoepidermoids in our clinic (0.5% of all resected lung tumors). Fourteen patients were complaint free, in the others obstructive symptoms dominated. In 23 patients the tumors were located in the upper lobes. In 24 cases lobectomy, in four instances limited resection and in six cases pneumonectomy were performed without hospital mortality.

RESULTS

Twenty-nine tumors proved to be high grade and five low grade malignancy by histology. In the latest group the 5-year-survival amounted to 80% (all of these tumors were observed in stage T1-2 N0), on the other hand, however, that rate accounted only 31% at high grade malignant mucoepidermoids. There was no 5-year-survivor among patients having N2-disease (n=5).

CONCLUSION

Mucoepidermoid tumors have to be treated by radical surgery with lymph node sampling and dissection. Patients with low grade tumors can be expected to be cured following complete resection, on the other hand, however, in cases of high grade malignant neoplasms surgery results in significantly worse prognosis. Careful histological typing plays a key role in prediction of late results.

Mucoepidermoid carcinoma of the tracheobronchial tree: radiographic and CT findings in 12 patients

PURPOSE

To determine the radiographic and computed tomographic (CT) findings and clinical features of mucoepidermoid carcinoma of the tracheobronchial tree.

MATERIALS AND METHODS

Chest radiographic and CT findings and clinical features of 12 histopathologically proved mucoepidermoid carcinomas in 12 consecutive patients (five male, seven female; age range, 9-72 years; mean age, 36 years) were reviewed retrospectively.

RESULTS

The tumors were located at the distal trachea (n = 1) or at a main (n = 2), lobar (n = 1), or segmental (n = 8) bronchus. On chest radiographs, the tumors appeared as central masses with post-obstructive pneumonia or peripheral atelectasis in four patients and as solitary pulmonary or endotracheobronchial nodules in eight. At CT, the tumors were all smoothly oval (n = 6) or lobulated (n = 6) in shape (ranging 9-40 mm in diameter), adapting to the branching features of the airways. Punctate calcification within the tumor was seen in six patients. Neither metastasis nor recurrence was seen after the surgical resection (follow-up of 8-103 months; mean, 30 months).

CONCLUSION

Mucoepidermoid carcinoma of the tracheobronchial tree, usually located in a segmental bronchus, appears at CT as a smoothly oval or lobulated airway mass. It adapts to the branching features of the airways.

Tracheobronchial mucoepidermoid carcinoma in childhood and adolescence: case report and review of the literature

In children and adolescents, primary neoplasms of the tracheobronchial tree and lungs are rare, with most tumors involving the respiratory system being metastatic, small, blue cell tumors of childhood. Of the primary pulmonary neoplasms, most are malignant with mucoepidermoid carcinoma representing about 10% of these malignant tumors. We present an 8-year-old Hispanic male with hemoptysis and several episodes of pneumonia which initially was thought to be infectious upon biopsy during bronchoscopy, but proved to be mucoepidermoid carcinoma of the tracheobronchial tree by microscopic examination during an open lung biopsy. This rare tumor is more common in adults than in children, and infrequently presents with hemoptysis. Mucoepidermoid tumors of the tracheobronchial tree carry a more favorable prognosis in children than adults. In the adult population, the overall mortality is slightly less than 30%. In contrast, of the 31 reported cases of tracheobronchial mucoepidermoid carcinoma in pediatrics, all children are free of tumor involvement with a mean follow-up period of 5.8 years (range, 0.7-21 years). Based upon the available clinical outcome and survival data, it would appear that tracheobronchial mucoepidermoid carcinoma may be successfully managed by surgical intervention alone in children and adolescents.