A team of surgeons

                                                                                                                                                                                                                                               

The mucoepidermoid carcinoma of the bronchus

 

The mucoepidermoid carcinoma of the bronchus

Presented by Dr Nicodeme Lavaud, du Centre Chirurgical Des Facultés  &  Dr Devendra Parikh, from the HCG Cancer center, Robotic cancer surgeon

 

Introduction

   unappreciated  of the surgical world because of its rarity, some pathologies deserve researches and periodic publications in order to disclose them.  We are not all researchers, it is a first person who finds the disease and divulges it so that everyone can understand it. The mucoepidermoid carcinoma   of the bronchus is one of those pathologies. What is the mucoepidermoid carcinoma of the bronchus? The presentation of a patient who had this condition and his surgical procedure will help us to contribute to its disclosure.

 

Anatomic reminder

 

The bronchus

  The trachea gives two bronchus at D5 level. They are moving to the hilium of the corresponding lung where they give ramifications within the pulmonary  parenchyma (bronchial tree). The length of the right bronchus is 2 cm, and 5 cm for the left bronchus.

 

The arteries of the extra pulmonary bronchus come from the bronchic arteries. The veins flow into the bronchic vein. The lymph nodes drains into the near tracheobronchial  lymph nodes.

 

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Picture 1: the trachea and the bronchus

 

 

 

The presentation of the clinic case.

 

 

  A 58 years old men presented himself in consultation for respiratory symptoms. The diagnosis was that of a mucoepidermoid carcinoma of the left bronchus. Arriving in the operating room, he underwent resection of the tumor and a sleeve bronchoplasty (end-to-end anastomosis of the left bronchus).

 

The main steps of the intervention

  • A left posterolateral thoracotomy.
  • The dissection of the lymph nodes of the window in an anteroposterior plane.
  • The transaction of the Botallo's ligament, retracting the aorta posteriorly.
  • The right lymph nodes are spared.
  • The dissection of the subcarinal's lymph nodes.
  • A bronchoscopic visualisation of the tumor.
  • The transaction of the left bronchus toward the Carina.
  • The transaction of the left bronchus toward the lung.
  • A frozen confirmation of the margin.
  • An end to end anastomosis of the left bronchus.
  • An intercostal muscle flap to protect the anastomosis.

 

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Picture 2: The left bronchus ready for the anastomosis after the transaction

 

 

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Picture 3: Dissecting of the intra-thoracic structures

 

 

The patient was dicharged on the 8th postoperative day

 

 

Discussions

 

The age

   It occurs more frequently in the children 3:1. according to: “ the journal of Bronchology & Interventional Pulmonology” January 2009 - Volume 16 - Issue 1 - p 39-40. However, the patient in our presentation have had 58 years old, what is acceptable because the pathology can occur between 3 and 78 years old according to the same review.

According to a series of 56 cases published by Yousem et al., more than 50% of the sufferers were under the 30 years, while in that of Li et al., the mean age was 34 years. It seems that high grade MEC occurs more frequently in older patients.

 

The seat of the tumor

These neoplasms mainly involve the lobular or segmental bronchi, often causing complete or partial atelectasis of the corresponding distal parenchyma. In that presentation, the tumor was located in the left bronchus.

 

 

The diagnostic 

   According to the journal of Bronchology & Interventional Pulmonology” January 2009 - Volume 16 - Issue 1 - p 39-40, the conventional chest radiography and CT generally are not useful in establishing the diagnosis of mucoepidermoid carcinoma of the bronchus because of the small size of the neoplasm, especially during the early phase, and the endobronchial location combined with interference of associated pneumonia or atelectasis. In a study of patients with suspected mucoepidermoid carcinoma, Colletti et al, however, found that the sensitivity of high-resolution CT scanners for tumor detection was 80%. Flexible bronchoscopy remains an excellent diagnostic modality, with the capability of visualizing the lesion directly and obtaining tissue for histopathologic diagnosis.

In that present case the tools used was the bronchoscopy. The extemporaneous exam have been realized after to determine the margin of transaction.

 

 

The surgical procedure

  According to most of the sturdies the treatment of MECs is usually surgical by the  traditional or sleeve lobectomy, performed with an open ( anterolateral thoracotomie)or video-assisted technique, followed by a mediastinal lymphadenectomy if necessary, but patients in the  high-grade group have a poor prognosis because of metastasis.

Here, the open technique have been used and the lymph nodes have been removed at the beginning of the intervention.

 

 

Conclusion 

   The mucoepidermoid carcinoma arise from the tracheobronchial glands, are rarely seen, and have a malignant potential, although, the tumors are usually low-grade. It occurs mainly before 30 years. The treatment is surgical, like this of our our presentation. It is made of a traditional or sleeve lobectomy, performed with an open or video-assisted technique, followed by a mediastinal lymphadenectomy if necessary.

We should always think about the mucoepidermoid carcinoma of the bronchus when there is respiratory symptoms.

 

 

References

edme1609@yahoo.fr

tlmq15@yahoo.com

infochir@gmail.com    http://infochir.wordpress.com/contact/

emiledams@yahoo.com

Schwartz's principles of surgery 10th     https://www.linkedin.com/in/gary-schwartz-md-68179212

lavaudnicodeme@yahoo.fr    https://www.linkedin.com/in/nicodeme-lavaud-391104167

drdevendragp@gmail.com    https://www.linkedin.com/in/devendra-parikh-17479b1a/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288321/#!po=16.0714

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6100671/#!po=8.33333

https://journals.lww.com/bronchology/Fulltext/2015/01000/Cryotechnology_in_Diagnosing_and_Treating_Lung.16.aspx

 

 

 

 

 

 

 

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Date de dernière mise à jour : 11/07/2021