Adenoma of a bronchial tube is the new growth proceeding from an epithelium of channels and mucous glands of a bronchial wall. Clinically adenoma of a bronchial tube is shown by short wind, stridorozny breath, cough, a blood spitting, signs of an inflammation of airways. The Adenomatozny tumor of a bronchial tube comes to light according to a X-ray analysis, a tomography, a bronkhoskopiya and a bronchography, an endoscopic biopsy. A new growth are subject to surgical removal; depending on a clinical situation endoscopic removal of a tumor, a circular or okonchaty resection of a bronchial tube, different types of a resection of lungs, a pnevmonektomiya can be carried out.
Bronchial tube adenoma
The tumors developing in bronchial tubes can be both good-quality, and malignant. Carry bronkhogenny lung cancer to number of malignant tumors. Benign tumors of bronchial tubes, are generally presented by adenomas. In general, good-quality new growths of bronchial tubes meet much less often malignant, approximately in 5-10% of cases in the general structure of tumoral damages of airways. Meanwhile, among benign tumors, adenomas make about 60-65%. Bronchial adenomas belong to the tumors of epitelialny type developing mainly from glands of a mucous membrane of a bronchial tree. In pulmonology adenoma of a bronchial tube is considered as a benign tumor with a high potential of a zlokachestvennost since different types of adenomas are inclined to a retsidivirovaniye and a malignization. Adenoma of a bronchial tube is more often diagnosed for women at the age of 35-50 years.
The reliable causes of adenomas of a bronchial tube are unknown. It is supposed that in their development can play a role smoking (active and passive), professional factors (work with arsenic, nickel, asbestos, etc.), ecological trouble. Pathogenetic communication of adenoma of a bronchial tube with other bronchopulmonary pathology is not excluded: HOBL, bronchial asthma, chronic bronchitis, recurrent and long pneumonia, etc. Considering that adenomas of any localizations (adenoma of a prostate, a mammary gland, a thyroid gland, salivary glands, a GIT, a bronchial tube) arise from a ferruterous epithelium, participation of endocrine mechanisms in their emergence is probable.
In the morphological plan "bronchial tube adenoma" – the collective concept including tumors various on a structure and cellular structure. Taking into account patogistologichesky structure distinguish several types of adenomas of a bronchial tube: kartsinoidny, mukoepidermoidny, tsilindromatozny and mixed.
More than in 80% in clinical practice adenomas of kartsinoidny type (a bronchial tube kartsinoida) meet. On the microscopic structure they it is presented by the proliferating cages proceeding from a ciliary epithelium or bronchial glands. Presence at cages of considerable number argentaffinny (painted by silver salts) structures is characteristic that allows to rank this type of adenoma of a bronchial tube as typical kartsinoida. In the place of growth of a kartsinoid there is a large number of vessels that explains bent of a tumor to gemorragiya. Adenoma is usually strongly connected with a wall of a bronchial tube and in some cases gets deeply into its thickness. It is supposed that kartsinoida of bronchial tubes, as well as kartsinoidam of a digestive tract, sekretirutsya serotonin and adrenaline therefore this kind of adenoma of bronchial tubes can cause vegetative violations: feeling of heat, dizziness, bronchospasm attacks, allergic dermatosis, etc.
Among kartsinoidny adenomas of a bronchial tube distinguish typical vysokodiffrentsirovanny , atypical moderately differentiated and anaplazirovanny low-differentiated . Malignization of kartsinoidny adenomas of a bronchial tube occurs in 5–10% of cases. Infiltrative growth and ability to hematogenic and limfogenny metastasis in the remote bodies - other lung, a brain, a liver, bones, kidneys, a pancreas is characteristic of a malignant kartsinoid. Unlike bronkhogenny cancer, malignant adenoma of a bronchial tube differs in the slow growth and late metastasis, and its radical removal yields the good remote results.
The second place on the detectability frequency (about 10%) is taken by adenomas of a bronchial tube of tsilindromatozny type (tsilindroma). Microscopically they consist of a cylindrical or prismatic epithelium. Much less often (less than 1%) the adenomas of a bronchial tube of mukoepidermoidny type (mukoepidermoida) presented by the ferruterous and cystous educations filled with mucous weight meet. Adenomas of a bronchial tube of the mixed type combine a structure the cylinder and kartsinoid. On localization distinguish the central and peripheral adenomas of a bronchial tube.
Among bronchial tube adenomas the least malignant current is peculiar to kartsinoidny tumors. Bronchial tube adenomas usually reach the sizes of 2-3 cm in the diameter, have gladyoky, sometimes a lobular surface of pinkish-red color. Adenomas can have endobronchial, the extra bronchial (ekstrabronkhialny) and mixed growth. Endobronchial adenoma grows in a bronchial tube gleam, raising a mucous membrane, causing its atrophic changes and an ulceration. Endobronchial growth is followed by increase of bronchial obstruction, up to fake closing of a gleam of a bronchial tube. In process of growth of a tumor can arise a lung, develop chronic pneumonia with frequent aggravations, a pneumosclerosis, bronkhoektaza.
Extra bronchial growth of adenoma of a bronchial tube is characterized by spread of a tumor to thickness of a bronchial wall or external localization. At the mixed nature of growth adenoma of a bronchial tube has an appearance of hourglasses, dumbbells or an aysyoberg; at the same time endobronchial and vnebronyokhialny parts of a tumor are divided by a peretyazhyoka between the moved apart and destroyed bronchial tube cartilages. In 60% of cases of adenoma affect share or segmentary bronchial tubes; in 20% - the main bronchial tubes; in 20% - bronchioles.
Bronchial tube adenoma symptoms
Expressiveness of symptoms depends on localization of a tumor, extent of bronchial obstruction, development of complications. In the clinical course of the central adenoma of a bronchial tube allocate three periods. In the first period adenoma does not cause gross violation of bronchial passability. Clinical manifestations include dry cough, a general malaise, a blood spitting. In the second period connected with sharp violation of passability of a bronchial tube pathological changes in pulmonary fabric and a pleura (repeated bronchial pneumonia, atelektaza, pleurisy), short wind, the stridorozny or whistling breath, cough with a phlegm, temperature increase, pulmonary bleedings develop.
The third period is characterized by a full obturation of a gleam of a bronchial tube adenoma that is followed by development of a resistant atelektaz of a lung with a poststenotichesky bronkhoektaziya and accession of a purulent infection. The clinical picture of this period decides by temperature increase of a body to 38-39 °C, cough on plentiful office of a purulent phlegm, a blood spitting, thorax pains, symptoms of intoxication, the general weakness, weight loss, anemia. Development of pulmonary heart failure is possible.
Persons with peripheral defeats have a course of adenoma of a bronchial tube usually asymptomatic. Kartsinoida of a bronchial tube in 2-4% of cases are followed by development of a kartsinoidny syndrome. In this case periodically there are rushes of blood to the head and the top extremities, feeling of heat, rozoyovato-red spots on face skin, a bronchospasm, fluctuations HELL, pristupoobrazny belly-aches, diarrhea. Weight and frequency of attacks increases at a malignization of adenoma of a bronchial tube of kartsinoidny type.
Bronchial tube adenoma not always in due time is found at preventive fluorography. Even on roentgenograms, at localization of adenoma in the main and share bronchial tubes, pathological changes are, as a rule, invisible; only on tomograms defects of a bronchial wall can be defined. The radiological picture at adenoma of a bronchial tube depends on extent of bronchial obstruction, caliber of the affected bronchial tube, duration of a course of process. At a full obturation of a bronchial tube the X-ray analysis of lungs reveals partial or full a lung; in case of partial impassability hypoventilation signs are defined. The most convincing data for adenoma of a bronchial tube are obtained at KT and MPT of lungs, a stsintigrafiya of lungs. The X-ray contrast research - a bronkhoyografiya allows to specify character of a new growth and its relationship with a wall of a bronchial tube.
In most cases final diagnosis of adenoma of a bronchial tube is promoted by carrying out a diagnostic bronkhoskopiya with a biopsy. In case of endobronchial growth it is possible to visualize the okyorugly formation of pink color with a brilliant smooth or melkobugristy surface which is easily bleeding at contact. The bronchial tube adenoma having a leg has high mobility; if the tumor grows in that case on the wide basis or has an appearance of "iceberg" it is not possible to displace it at a bronkhoskopiya. Carrying out an endoscopic biopsy with the subsequent histologic research allows to specify type of adenoma of a bronchial tube and degree of its high quality.
For the purpose of assessment of weight of obstructive and restrictive violations the spirometry is carried out. For an exception of adenomas of other localization carrying out TRUZI (at men), ultrasonography of mammary glands (at women) is expedient, EGDS, kolonoskopiya, ultrasonography of a thyroid gland, kidneys and adrenal glands, salivary glands.
Treatment of adenoma of a bronchial tube
In view of danger of complications (nagnoitelny process, bleeding, a malignization), adenomas of bronchial tubes are subject to surgical removal in the earliest terms. Character and volume of intervention is defined by localization, the sizes, features of growth, histologic structure of adenoma of a bronchial tube, development of secondary changes of pulmonary fabric. In the early period, at obviously benign adenoma of a bronchial tube of the central localization with endobronchial growth having a thin leg endoscopic removal of a tumor can be made. However endobronchial intervention is accompanied by probability of insufficient radicalism of operation, high risk of bleeding, need of repeated endoscopic control and a biopsy of a bronchial tube.
In most cases removal of adenoma of a bronchial tube on a narrow leg is made by a bronkhotomiya or an okonchaty resection of a bronchial tube. At the adenomas having the wide basis the circular resection of a bronchial tube with imposing of an interbronchial anastomoz is shown. These types of operations which are limited to an economical resection of a bronchial tube can be executed only at histologically the confirmed good-quality educations and functionally full-fledged pulmonary fabric. In case of limited irreversible changes of pulmonary fabric distalny bronchial tube obturation the tumor (bronkhoektaz, poststenotichesky abscesses of a lung, fibrosis), makes a regional resection, a segmentektomiya, lobectomy or a bilobektomiya. At pathological changes in all lung the unique intervention is the pnevmonektomiya.
Untimely diagnosis of adenoma of a bronchial tube excludes a possibility of carrying out the sparing operations and dictates need of performance of large-scale resections of a lung. After a radical resection of adenoma of a bronchial tube 5-year survival makes 96%. A local recurrence, a malignization of a tumor and the remote metastasis of adenoma of a bronchial tube are in some cases possible. The patients who transferred removal of adenoma of a bronchial tube have to be under observation of the pulmonologist (the thoracic surgeon), to undergo regular radiological and endoscopic control.