Makindo Medical Notes

A Bronchial adenoma is a term historically used to describe a group of rare tumours that originate from the mucous glands and ducts of the trachea and bronchi. However, the term "bronchial adenoma" is somewhat misleading as it implies a benign tumour, whereas these tumours can be either benign or malignant. The term is now more accurately used to describe specific types of tumours, such as carcinoid tumours, adenoid cystic carcinoma, and mucoepidermoid carcinoma.

About

• Rare, usually benign but locally invasive

Types

• Carcinoid Tumours: The most common type of bronchial adenoma, typically slow-growing and considered low-grade malignancies. These can be further classified as typical carcinoid (less aggressive) or atypical carcinoid (more aggressive).
• Adenoid Cystic Carcinoma: A rare type of cancer that tends to grow slowly but can be more invasive and difficult to treat.
• Mucoepidermoid Carcinoma: A rare tumour that can vary in behavior from low-grade, less aggressive forms to more aggressive high-grade forms.

Risk Factors

• Age: Bronchial adenomas can occur at any age but are more commonly diagnosed in middle-aged adults.
• Smoking: While less strongly associated with smoking than other types of lung cancer, smoking may still increase the risk, particularly for certain subtypes like mucoepidermoid carcinoma.
• Genetic Factors: Family history and genetic predispositions can play a role in the development of these tumours.

Symptoms

• Cough: Persistent cough is a common symptom, sometimes accompanied by blood (haemoptysis).
• Wheezing: Wheezing can occur, often mistaken for asthma or bronchitis.
• Dyspnoea (Shortness of Breath): Due to obstruction of the airway by the tumour.
• Recurrent Respiratory Infections: Such as pneumonia, due to obstruction and impaired clearance of mucus.
• Chest Pain: May be present, particularly if the tumour is invasive.

Differentials

• Lung tumour , TB, Sarcoid

Investigations

• Chest X-ray: Often the first imaging test performed; it may reveal a mass or obstructed airway.
• CT Scan: Provides detailed imaging of the lungs and helps in assessing the size, location, and extent of the tumour.
• Bronchoscopy: A procedure that allows direct visualization of the airways and enables biopsy of the tumour for histological examination.
• Biopsy: The definitive diagnosis is made by examining tissue samples under a microscope to determine the type of tumour.

Management

• Surgery: The primary treatment for bronchial adenomas, particularly for localized tumours. The type of surgery depends on the tumour's size and location and may range from bronchoscopic resection to more extensive procedures like lobectomy.
• Radiation Therapy: May be used in cases where the tumour cannot be completely removed surgically or as an adjunct to surgery.
• Chemotherapy: Generally reserved for more aggressive or advanced cases, particularly for atypical carcinoid tumours or high-grade mucoepidermoid carcinoma.
• Targeted Therapy: In some cases, targeted therapies may be considered, especially for tumours with specific genetic mutations.