Benign tumors of lungs are a large number of new growths, various by origin, to a histologic structure, localization and features of clinical manifestation. Can proceed asymptomatically or with clinical manifestations: cough, short wind, blood spitting. Bronkhoskopiya, torakoskopiya are diagnosed by means of radiological methods. Treatment is almost always surgical. The volume of intervention depends on kliniko-radiological data and varies from an enukletion of a tumor and economical resections to anatomic resections and a pulmonektomiya.
Benign tumors of lungs
Tumors of lungs make big group of the new growths which are characterized by excess pathological growth of tissues of lung, bronchial tubes and pleurae and consisting of qualitatively changed cages with violations of processes of a differentiation. Depending on degree of a differentiation of cages distinguish benign and malignant tumors of lungs. Also metastatic tumors of lungs (eliminations of the tumors which are initially arising in other bodies) which on the type always are malignant meet. Benign tumors of lungs make 7-10% of total number of new growths of this localization, developing with an identical frequency at women and men. Benign tumors of lungs usually are registered at young patients aged up to 35 years.
The reasons leading to development of benign tumors of a lung up to the end are not studied. However, assume that this process is promoted by genetic predisposition, gene anomalies (mutations), viruses, influence of tobacco smoke and various chemical and radioactive materials polluting the soil, water, atmospheric air (formaldehyde, benzanthracene, vinyl chloride, radioactive isotopes, UF-radiation, etc.). As risk factor of development of benign tumors of lungs serve the bronchopulmonary processes proceeding with decrease in local and general immunity: HOBL, bronchial asthma, chronic bronchitis, long and frequent pneumonia, tuberculosis etc.).
Benign tumors of lungs develop from the high-differentiated cages similar in a structure and functions to healthy cells. Benign tumors of lungs differ in rather slow growth, do not infiltrirut and do not destroy fabric, do not spread. The fabrics located around a tumor atrophy and form the soyedinitelnotkanny capsule (pseudo-capsule) surrounding a new growth. A number of benign tumors of a lung has tendency to a malignization.
On localization distinguish the central, peripheral and mixed benign tumors of lungs. Tumors with the central growth proceed from large (segmentary, share, main) bronchial tubes. Their growth in relation to a gleam of a bronchial tube can be endobronchial (ekzofitny, in a bronchial tube) and peribronkhialny (in surrounding tissue of a lung). Peripheral tumors of lungs proceed from walls of small bronchial tubes or surrounding fabrics. Peripheral tumors can grow subplevralno (superficially) or vnutrilegochno (deeply).
Benign tumors of lungs of peripheral localization meet more often than central. In the right and left lung peripheral tumors are observed with an identical frequency. The central benign tumors settle down in the right lung more often. Benign tumors of lungs develop from share and main bronchial tubes more often, but not from segmentary as lung cancer.
Benign tumors of lungs can develop from:
- epitelialny tissue of bronchial tubes (polyps, adenomas, papillomas, , tsilindroma);
- neyroektodermalny structures (nevrinoma (shvannoma), neurofibroma);
- mesodermal fabrics (hondroma, fibroma, gemangioma, leyomioma, limfangioma);
- from germinal fabrics (a teratom, a gamartom - congenital tumors of lungs).
Among benign tumors of lungs gamartoma and adenomas of bronchial tubes meet more often (in 70% of cases).
- Bronchial tube adenoma – the ferruterous tumor developing from an epithelium of a mucous membrane of bronchial tubes. In 80-90% has the central ekzofitny growth, in large bronchial tubes and breaking bronchial passability. Usually the sizes of adenoma make up to 2-3 cm. Growth of adenoma causes an atrophy over time, and sometimes an ulceration of a mucous membrane of a bronchial tube. Adenomas have tendency to a malignization. Histologically the following kinds of adenomas of bronchial tubes differ: , carcinoma, tsilindroma, adenoide. Most often occurs among adenomas of a bronchial tube (81-86%): vysokodiffrentsirovanny, umerennodifferentsirovanny and low-differentiated. At 5-10% of patients the malignization of a kartsinoid develops. Adenomas of other types meet less often.
- Gamartoma - (a hondroadenoma, a hondroma, a gamartokhondroma, a lipokhondroadenoma) – the new growth of an embryonic origin consisting of elements of germinal fabric (a cartilage, layers of fat, connecting fabric, glands, thin-walled vessels, it is smooth - muscle fibers, a congestion of lymphoid fabric). Gamartoma – the most frequent peripheral benign tumors of lungs (60-65%) with localization in forward segments. Gamartoma or vnutrilegochno (in thickness of pulmonary fabric), or subplevralno, superficially grow. Usually gamartoma have rounded shape with a smooth surface, are accurately delimited from surrounding fabrics, have no capsule. Gamartoma differ in the slow growth and an asymptomatic current, extremely seldom regenerating in a malignant new growth – gamartoblasty.
- Papilloma (or a fibroepitelioma) – the tumor consisting of a soyedinitelnotkanny stroma with the multiple sosochkovidny outgrowths outside covered with a metaplazirovanny or cubic epithelium. Papillomas develop mainly in large bronchial tubes, grow endobronkhialno, sometimes a bronchial tube gleam entirely. Quite often papillomas of bronchial tubes meet together with papillomas of a throat and trachea and can be exposed to an ozlokachestvleniye. Appearance of papilloma reminds a cauliflower, a cock crest or berry of raspberry. Macroscopically papilloma represents education on the wide basis or a leg, with a lobular surface, pink or dark red color, myagkoelastichny, is more rare than a tverdoelastichny consistence.
- Fibroma of lungs – d tumor – 2-3 cm, proceeding from connecting fabric. Makes from 1 to 7,5% of benign tumors of lungs. Fibromas of lungs equally often affect both lungs and can reach the huge size in a half of a thorax. Fibromas can be localized is central (in large bronchial tubes) and on peripheral sites of a lung. Macroscopically fibromatous knot dense, with a plain surface whitish or reddish and well created capsule. Fibromas of lungs are not inclined to a malignization.
- Lipoma — the new growth consisting of fatty tissue. In lungs of a lipoma come to light quite seldom and are casual radiological finds. Are localized mainly in the main or share bronchial tubes, is more rare on the periphery. The lipomas proceeding from a sredosteniye (abdomino-mediastinalny lipomas) meet more often. Growth of a tumor slow, the malignization is not characteristic. Macroscopically a lipoma of rounded shape, a plotnoelastichny consistence, with accurately expressed capsule, yellowish color. Microscopically the tumor consists of the fatty cages divided by soyedinitelnotkanny partitions.
- Leyomioma is seldom found benign tumor of lungs developing from smooth muscle fibers of vessels or walls of bronchial tubes. It is more often observed at women. Leyomioma happen the central and peripheral localization in the form of polyps on the basis or a leg, or multiple small knots. The leyomioma slowly grows, sometimes reaching the huge sizes, has a softish consistence and well expressed capsule.
- Vascular tumors of lungs (a gemangioendotelioma, a gemangioperitsitoma, capillary and kavernozny gemangioma of lungs, a limfangioma) make 2,5-3,5% of all good-quality formations of this localization. Vascular tumors of lungs can have peripheral or central localization. All of them macroscopically rounded shape, a dense or plotnoelastichny consistence, are surrounded with the soyedinitelnotkanny capsule. Color of a tumor varies from pinkish to dark red, the sizes – from several millimeters to 20 centimeters and more. Localization of vascular tumors in large bronchial tubes causes a blood spitting or pulmonary bleeding.
- Gemangioperitsitoma and gemangioendotelioma are considered as conditionally benign tumors of lungs since have tendency to rapid, infiltrative growth and a malignization. On the contrary, kavernozny and capillary gemangioma, grow slowly and is delimited from surrounding fabrics, do not ozlokachestvlyatsya.
- Dermoidny cyst (teratom, dermoid, embrioma, difficult tumor) – the disembrionalny opukholevidny or cystous new growth consisting of different type of fabrics (grease masses, hair, teeth, bones, cartilages, sweat glands etc.). Macroscopically has an appearance of a dense tumor or cyst with the accurate capsule. Makes 1,5–2,5% of benign tumors of lungs, mainly meets at young age. Growth teraty slow, suppuration of a cystous cavity or ozlokachestvleny tumors (teratoblastoma) is possible. At break of contents of a cyst the picture of abscess or an empiyema of a pleura develops in a cavity of a pleura or a gleam of a bronchial tube. Localization teraty always peripheral, is more often in the top share of the left lung.
- Nevrogenny tumors of lungs (nevrinoma (shvannoma), neurofibromas, hemodektoma) develop from nervous tissues and make about 2% among good-quality blasty lungs. More often tumors of lungs of a nevrogenny origin are located peripheral, can be found in both lungs at once. Macroscopically have an appearance of roundish dense knots with the accurate capsule, grayish-yellow color. The question of a malignization of tumors of lungs of a nevrogenny origin is disputable.
Fibrous gistiotsitoma (tumor of inflammatory genesis), ksantoma (soyedinitelnotkanny or epitelialny educations, the containing neutral fats, holesterinester, ferriferous pigments), a plazmotsitoma (a plazmotsitarny granuloma, the tumor arising owing to disorder of proteinaceous exchange) belong to rare benign tumors of lungs. Tuberkuloma – the educations which are a clinical form of tuberculosis of lungs and formed by the kazeozny masses, elements of an inflammation and sites of fibrosis also occur among benign tumors of a lung.
Clinical displays of benign tumors of lungs depend on localization of a new growth, its size, the direction of growth, hormonal activity, degree of an obturation of a bronchial tube, the caused complications. Benign (especially peripheral) tumors of lungs it is long can not to give any symptoms. In development of benign tumors of lungs are allocated:
- asymptomatic (or preclinical) stage
- stage of initial clinical symptomatology
- stage of the expressed clinical symptomatology caused by complications (bleeding, , a pneumosclerosis, abstsediruyushchy pneumonia, an ozlokachestvleniye and metastasis).
Peripheral tumors of lungs
At peripheral localization in an asymptomatic stage benign tumors of lungs prove nothing. In a stage of the initial and expressed clinical symptomatology the picture depends on the sizes of a tumor, depth of its arrangement in pulmonary fabric, the relations to adjacent bronchial tubes, vessels, nerves, bodies. Tumors of the easy big sizes can reach a diaphragm or a chest wall, causing breast pains or areas of heart, short wind. In case of an erosion of vessels the tumor observes a blood spitting and pulmonary bleeding. Sdavleniye a tumor of large bronchial tubes causes violation of bronchial passability.
Central tumors of lungs
Clinical displays of benign tumors of lungs of the central localization are defined by expressiveness of violations of bronchial passability in which allocate the III degrees. According to each extent of violation of bronchial passability the clinical periods of a disease differ.
- The I degree — a partial bronchial stenosis
During the 1st clinical period corresponding to a partial bronchial stenosis, a gleam of a bronchial tube it is narrowed slightly therefore the current is more often than it asymptomatic. Are sometimes noted cough, with a small amount of a phlegm, more rare with blood impurity. The general health does not suffer. Radiological the lung tumor in this period is not found, and can be revealed at a bronchography, a bronkhoskopiya, a linear or computer tomography.
- The II degree — a valvate or valve bronchial stenosis
In the 2nd clinical period the valvate or valve stenosis of a bronchial tube connected with an obturatsiy tumor of the most part of a gleam of a bronchial tube develops. At a valve stenosis the bronchial tube gleam partially opens on a breath and is closed on an exhalation. Regarding a lung, ventilated by the narrowed bronchial tube, expiratory emphysema develops. There can be a full closing of a bronchial tube owing to hypostasis, a congestion of blood and a phlegm. In the tissue of a lung located on the periphery of a tumor inflammatory reaction develops: at the patient body temperature increases, cough with a phlegm, short wind, sometimes a blood spitting, breast pains, fatigue and weakness develops. Clinical displays of the central tumors of lungs in the 2nd period have the alternating character. Anti-inflammatory therapy removes hypostasis and an inflammation, leads to restoration of pulmonary ventilation and disappearance of symptoms for a certain period.
- The III degree — bronchial tube occlusions
The current of the 3rd clinical period is connected with the phenomena of full occlusion of a bronchial tube a tumor, suppuration of a zone of an atelektaz, irreversible changes of the site of pulmonary fabric and his death. Weight of symptomatology is defined by caliber obturirovanny a tumor of a bronchial tube and volume of an affected area of pulmonary fabric. Permanent temperature increase, the expressed breast pains, weakness, short wind (sometimes suffocation attacks), feeling sick, cough with a purulent phlegm and impurity of blood, sometimes – pulmonary bleeding is noted. Radiological picture of a partial or full atelektaz of a segment, share or all lung, inflammatory and destructive changes. On a linear tomography the characteristic picture, a so-called "stump of a bronchial tube" is found - the break of the bronchial drawing is lower than an obturation zone.
Speed and expressiveness of violations of passability of bronchial tubes depends on character and intensity of growth of a tumor of a lung. With a peribronkhialny growth of benign tumors of lungs the clinical manifestations which were less expressed full occlusion of a bronchial tube develops seldom.
At the complicated course of benign tumors of a lung can develop pneumofibrosis, , abstsediruyushchy pneumonia, bronkhoektaza, pulmonary bleeding, a syndrome of a sdavleniye of bodies and vessels, a new growth malignization. At the carcinoma which is gormonalno an active tumor of lungs at 2–4% of patients the kartsinoidny syndrome which is shown periodic attacks of heat, inflows to the top half of a trunk, a bronchospasm, a dermatosis, diarrhea, mental disorders owing to sharp increase in blood of level of serotonin and its metabolites develops.
Often benign tumors of lungs are the casual radiological finds found at fluorography. At a X-ray analysis of lungs benign tumors of lungs decide as roundish shadows on accurate contours of various size. Their structure more often uniform, sometimes, however, with dense inclusions: glybchaty calcifications (gamartoma, tuberkuloma), bone fragments (teratoma).
In details the computer tomography (KT of lungs) defining not only dense inclusions, but also availability of the fatty tissue peculiar to lipomas, liquid — in tumors of a vascular origin, dermoidny cysts allows to estimate structure of benign tumors of lungs. The method of a computer tomography with contrast bolyusny strengthening allows to differentiate benign tumors of lungs from tuberkuloma, peripheral cancer, metastasises etc.
In diagnosis of tumors of a lung the bronkhoskopiya allowing not only to examine a new growth, but also to carry out its biopsy (at the central tumors) and to receive material for a cytologic research is applied. At a peripheral arrangement of a tumor of a lung the bronkhoskopiya allows to reveal indirect signs of blastomatozny process: bronchial tube sdavleniye outside and narrowing of its gleam, shift of branches of a bronchial tree and change of their corner.
At peripheral tumors of lungs the transthoracic aspiration or punktsionny biopsy of a lung under X-ray - or ultrasonography control is carried out. By means of an angiopulmonografiya vascular tumors of lungs are diagnosed.
In a stage of clinical symptomatology obtusion of a perkutorny sound over a zone of an atelektaz (abscess, pneumonia), easing or lack of voice trembling and breath, dry or damp rattles are fizikalno defined. At patients with an obturation of the main bronchial tube the thorax is asymmetric, intercostal intervals are maleficiated, corresponding half of a thorax lags behind during commission of respiratory movements. At a lack of diagnostic data from carrying out special methods of a research, resort to performance of a torakoskopiya or torakotomiya with a biopsy.
Treatment of benign tumors of lungs
All benign tumors of lungs, irrespective of risk of their malignization are subject to expeditious removal (in the absence of contraindications to surgical treatment). Operations are carried out by thoracic surgeons. What earlier diagnosed a tumor of a lung and removal is carried out it, the volume and a trauma from surgery, danger of complications and development of irreversible processes in lungs, including malignization of a tumor and it and metastasis are less.
The central tumors of lungs usually are removed by method economical (without pulmonary fabric) bronchial tube resections. Tumors on the narrow basis are removed by an okonchaty resection of a wall of a bronchial tube with the subsequent ushivaniye of defect or a bronkhotomiya. Tumors of lungs on the wide basis delete by means of a circular resection of a bronchial tube and imposing of an interbronchial anastomoz.
At already developed complications in a lung (bronkhoektaza, abscesses, fibrosis) resort to removal of one or two shares of a lung (lobectomy or a bilobektomiya). At development of irreversible changes in general easy make its removal – a pnevmonektomiya. The peripheral tumors of lungs located in pulmonary fabric delete with method of an enukleation (vylushchivaniye), a segmentary or regional resection of a lung, at the big sizes of a tumor or the complicated current resort to lobectomy.
Expeditious treatment of benign tumors of lungs is usually made by method of a torakoskopiya or a torakotomiya. The benign tumors of a lung of the central localization growing on a thin leg can be removed in the endoscopic way. However, this method is accompanied by danger of development of bleeding, insufficiently radical removal, need of carrying out repeated bronkhologichesky control and a biopsy of a wall of a bronchial tube in the place of localization of a leg of a tumor.
At suspicion of a malignizirovanny tumor of lungs, during operation resort to an urgent histologic research of fabrics of a new growth. At morphological confirmation of a zlokachestvennost of a tumor the volume of surgery is carried out as at lung cancer.
Forecast and prevention
At timely medical and diagnostic actions remote results favorable. A recurrence during radical removal of benign tumors of lungs is observed seldom. The forecast at kartsinoida of lungs is less favorable. Taking into account morphological structure of a kartsinoid five-year survival at the high-differentiated type of a kartsinoid makes 100%, at moderately differentiated type of-90%, at low-differentiated — 37,9%. Specific prevention is not developed. Timely treatment of infectious and inflammatory diseases of lungs, an exception of smoking and contact with harmful substances-pollyutantami allows to minimize risks of emergence of a new growth.