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Minimally Invasive Treatment of Bronchial Mucous Gland Adenoma: An Unusual Approach to an Unusual Problem
October 2015, Vol 148, No. 4_MeetingAbstracts
Pulmonary Procedures | October 2015
Minimally Invasive Treatment of Bronchial Mucous Gland Adenoma: An Unusual Approach to an Unusual Problem Benjamin Seides, MD; Sara Greenhill, MD; Kevin Kovitz, MD; Neeraj Desai, MD Chicago Chest Center, Elk Grove Village, IL Chest. 2015;148(4_MeetingAbstracts):828A. doi:10.1378/chest.2216721
Abstract SESSION TITLE: Procedures Case Report Posters SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Bronchial mucous gland adenoma (MGA) is a rare benign neoplasm of the lung. It is derived from salivary gland epithelium, and comprised of mature acini of mucous secreting cells. [1-3] We report the first case of MGA treated with complete endoscopic resection via rigid bronchoscopy and laser ablation. CASE PRESENTATION: 53 year-old male former smoker presented with a long history of asthma symptoms and recurrent pneumonias, unresponsive to usual therapies. CT of the chest revealed an obstructing lesion at the distal left mainstem bronchus (fig.1). PET-CT of the mass indicated a standard uptake value (SUV) of 2.2 without hypermetabolism elsewhere. With clinical suspicion for carcinoid, we took the patient to the operating room for diagnostic and therapeutic bronchoscopy. The lesion was fleshy, smoothly marginated, spherical, and completely occluding the airway in a ball-valve fashion (fig. 2). It was hypovascular by endobronchial ultrasound. Using a rigid bronchoscope, we cored out the lesion, removing residual tissue with rigid forceps. The base of the lesion was then ablated using a 980 nm diode laser. 100% patency to the left mainstem was restored with immediate remission of symptoms. The patient was sent home that day. Pathology of the lesion revealed it to be a bronchial MGA. The patient remains asymptomatic.
DISCUSSION: Bronchial MGA is a rare benign neoplasm of the lung. It exerts symptoms via obstruction, thus treatment by removal is curative. Prior to diagnosis, many patients present with years of unexplained respiratory symptoms, unresponsive to usual therapies, as in our patient. [1, 2] Virtually all published cases have described treatment of MGA by major surgery including surgical resection and bronchoplastic reconstruction.[1-3] We highlight the successful management of MGA via a less invasive, outpatient-based approach. Though there remains a theoretical concern for local recurrence, the indolent and benign nature of the tumor makes this entity easily manageable with surveillance and additional bronchoscopy, if needed.
CONCLUSIONS: Bronchial MGA is a rare neoplasm of the lung, which is successfully treatable via a minimally invasive approach.
Reference #1: Milenkovic, B., et al. J Asthma, 2007. 44(9): p. 789-93. Reference #2: Badyal, R.K., et al. Lung India, 2014. 31(3): p. 274-6. Reference #3: Ferguson, C.J. et al. J Thorac Cardiovasc Surg, 1988. 95(2): p. 347-50. DISCLOSURE: The following authors have nothing to disclose: Benjamin Seides, Sara Greenhill, Kevin Kovitz, Neeraj Desai
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Pulmonary Procedures | October 2015
Minimally Invasive Treatment of Bronchial Mucous Gland Adenoma: An Unusual Approach to an Unusual Problem Benjamin Seides, MD; Sara Greenhill, MD; Kevin Kovitz, MD; Neeraj Desai, MD Chicago Chest Center, Elk Grove Village, IL Chest. 2015;148(4_MeetingAbstracts):828A. doi:10.1378/chest.2216721
Abstract SESSION TITLE: Procedures Case Report Posters SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Bronchial mucous gland adenoma (MGA) is a rare benign neoplasm of the lung. It is derived from salivary gland epithelium, and comprised of mature acini of mucous secreting cells. [1-3] We report the first case of MGA treated with complete endoscopic resection via rigid bronchoscopy and laser ablation. CASE PRESENTATION: 53 year-old male former smoker presented with a long history of asthma symptoms and recurrent pneumonias, unresponsive to usual therapies. CT of the chest revealed an obstructing lesion at the distal left mainstem bronchus (fig.1). PET-CT of the mass indicated a standard uptake value (SUV) of 2.2 without hypermetabolism elsewhere. With clinical suspicion for carcinoid, we took the patient to the operating room for diagnostic and therapeutic bronchoscopy. The lesion was fleshy, smoothly marginated, spherical, and completely occluding the airway in a ball-valve fashion (fig. 2). It was hypovascular by endobronchial ultrasound. Using a rigid bronchoscope, we cored out the lesion, removing residual tissue with rigid forceps. The base of the lesion was then ablated using a 980 nm diode laser. 100% patency to the left mainstem was restored with immediate remission of symptoms. The patient was sent home that day. Pathology of the lesion revealed it to be a bronchial MGA. The patient remains asymptomatic.
DISCUSSION: Bronchial MGA is a rare benign neoplasm of the lung. It exerts symptoms via obstruction, thus treatment by removal is curative. Prior to diagnosis, many patients present with years of unexplained respiratory symptoms, unresponsive to usual therapies, as in our patient. [1, 2] Virtually all published cases have described treatment of MGA by major surgery including surgical resection and bronchoplastic reconstruction.[1-3] We highlight the successful management of MGA via a less invasive, outpatient-based approach. Though there remains a theoretical concern for local recurrence, the indolent and benign nature of the tumor makes this entity easily manageable with surveillance and additional bronchoscopy, if needed.
CONCLUSIONS: Bronchial MGA is a rare neoplasm of the lung, which is successfully treatable via a minimally invasive approach.
Reference #1: Milenkovic, B., et al. J Asthma, 2007. 44(9): p. 789-93. Reference #2: Badyal, R.K., et al. Lung India, 2014. 31(3): p. 274-6. Reference #3: Ferguson, C.J. et al. J Thorac Cardiovasc Surg, 1988. 95(2): p. 347-50. DISCLOSURE: The following authors have nothing to disclose: Benjamin Seides, Sara Greenhill, Kevin Kovitz, Neeraj Desai
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