Malignant change in bronchiectasis

An Underrated Potential Risk of Bronchiectasis: Lymph Node Metastasis of a Pulmonary Tumorlet

Pulmonary tumorlets occur as the result of extensive scar caused by bronchiectasis or other inflammatory processes. They are minute lesions found in close association with the bronchioles and may rarely metastasize to lymph nodes. We present a 35-year-old male patient who underwent bilobectomy inferior with a diagnosis of bronchiectasis of 20 years duration. Histologic examination showed cystic bronchiectasis with areas of multiple neuro-endocrine tumor-lets in addition to metastatic peribronchial lymph nodes. We emphasize the significance of early surgical treatment of bronchiectasis showing little to no response to medical therapy as well as peribronchial lymph node dissection.

Pulmonary and Peribronchial Lymph Node Tumorlets: Report of a Case and Review of the Literature

A 38-year-old man underwent a left lower lobectomy and lingulectomy for bronchiectasis. On macroscopic examination the lungs were bronchiectatic. Microscopically, multiple tumorlets were detected in the lung parenchyma. One peribronchial lymph node contained a tumorlet. We discuss the case and review the literature on this rare entity.

Sclerosing haemangiomas of the lung

A series of 29 pulmonary sclerosing haemangiomas is analysed. Included is one case with multiple tumours and another with metastatic growth in a hilar lymph node. Histochemical and electron microscopic studies show that type 2 pneumocytes are an important constituent cell type though bronchial structures, tumorlets and angiomas also occur within these tumours. They are considered to be pulmonary hamartomas formed from distal lung structures. They are of slow growth and have been confused in the past with pulmonary histiocytomas and plasma cell granulomas.

Carcinoid tumorlets of the lung with metastasis to a peribronchial lymph node. Report of a case and review of the literature

A case of a rare entity, pulmonary tumorlets that metastasized to a peribronchial lymph node, is reported. The patient, a 38-year-old man, underwent a right pneumonectomy for end-stage lung disease caused by bronchiectasis, chronic bronchitis, and pulmonary fibrosis. No tumors were detected on radiologic or on gross examination of the lung. Microscopically, multiple tumorlets were identified in the fibrotic pulmonary parenchyma. Five peribronchial lymph nodes were found and appeared grossly normal. A microscopic focus of metastatic tumor, histologically identical to the pulmonary tumorlets, was discovered in one of these nodes. This metastasis was identified only because a diligent search for peribronchial lymph nodes was undertaken, and because sections of each node were obtained. Pathologists usually do not extensively examine peribronchial lymph nodes in cases of chronic inflammatory disease of the lung, even when small tumorlets are discovered as incidental findings, because it is presumed that the tumorlets have not metastasized. As shown by our case, this presumption is not always correct. Pulmonary tumorlets may metastasize to peribronchial lymph nodes more frequently than has been previously recognized.

The histogenesis and development of pulmonary tumorlets

A lung, which was surgically removed from a patient who had oat cell carcinoma, contained multiple tumorlets and showed extensive Kultschitsky-type cell proliferation of bronchial and bronchiolar mucosa. On the basis of light and electron microscopic observations, it is shown that pulmonary tumorlets arise from focal areas of bronchial and bronchiolar Kultschitsky cell proliferation which may advance to luminal obliteration. Involvement of the pulmonary parenchyma takes place by extension of these newly proliferated cells along the terminal branches of the bronchiolar tree or by penetration of the bronchial or bronchiolar wall; the latter process evokes a striking proliferation of connective tissue which forms the matrix in which the cells of some fully developed tumorlets are embedded. Because of striking morphologic similarities between tumorlets and spindle cell carcinoid tumors, and the proven origin of tumorlets from pulmonary Kultschitsky-type cells, it is suggested that the more complete and histogenetically acceptable term "carcinoid tumor-let" be used to distinguish this lesion from other forms of epithelial proliferations in the lung.

On the origin of the so-called tumorlets of the lung

A light and electron microscopic study of multiple tumorlets in a 66 year old female is presented. Clinically the patient had had chronic obstructive lung disease with bronchiectasis of the right upper lobe. Aside from severe bronchiectatic alterations, the resected lobe showed typical tumorlets. On electron microscopic study, these were shown to consist of cells containing large numbers of a neurosecretory type of granule, which was identical to those present in the bronchial counterpart of the intestinal argentaffin (Kulchitsky) cell, as well as in pulmonary carcinoid and oat cell carcinoma cells. Our studies suggest the possibility of a histogenetic relationship between tumorlets, bronchial carcinoid tumors, and oat cell carcinoma, the cell of origin in each case being the bronchial counterpart of the intestinal argentaffin cell.

Pulmonary tumorlet. A form of peripheral carcinoid

Twenty cases of pulmonary tumorlet are presented. Approximately one-third of the tumors occurred in lungs severely scarred by bronchiectasis or other inflammatory processes; the other two-thirds were found in lungs with little to no scarring. In the former instances, tumorlets were found in large scars in which identifying architectural features had been destroyed. In the latter, the tumorlets were seen in minute fibrous nodules, surrounding or obliterating small bronchi or bronchioles. Argyrophilic granules were demonstrated in 14 of 15 cases; in the electron microscope these were consistent with neurosecretory granules. Their location, silver staining properties, and ultrastructure suggest that pulmonary tumorlets are minute peripheral carcinoid tumors.

Histopathological studies on the tumourlet of the lung with special reference to the cytogenesis of proliferating cells

Eight foci of tumourlets of the lung and one allied lesion obtained from autopsy cases were histologically examined. The tumourlet of the lung consisted of epithelial cells and was considered to be a benign lesion. Small sized-lesion, uniformity of proliferating cells with very few mitosis and existence of associated lung lesions were documented as characteristic findings. However, the histopathogenesis of the tumourlet was not fully clarified. It was found that proliferating cells of tumourlets often show argyrophilia and contain numerous neurosecretory-like granules in their cytoplasm. These characteristics are very similar to Kultschitzky-like cells of the lung.

The problem of cancer of the lung in the industrial area of Liège during recent years

Images

The Frequency of Tumour-like Formations in Bronchiectatic Lungs

Images