Bronchial Adenoma Clinical Presentation

  • Author: Charles W Van Way III, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Oct 22, 2010
 

History

Up to 60% of patients have no symptoms. This is more likely if the adenoma is located peripherally as opposed to proximally. When present, symptoms are related to the presence and degree of endobronchial occlusion and the vascularity of the tumor. Hemoptysis occurs in 18%, recurrent infection or cough in 17%, dyspnea or wheezing in 2%, and carcinoid syndrome in 1%.

Endobronchial symptoms

  • Classic triad of cough, hemoptysis, and recurrent infection
  • Dyspnea
  • Wheezing and stridor
  • Sputum production
  • Pneumonia

Mediastinal involvement

  • Hoarseness due to recurrent laryngeal nerve involvement
  • Chylothorax due to thoracic duct involvement
  • Chest pain

Systemic

  • Endocrinopathies
  • Unexplained weight loss
  • Low-grade temperature elevation

Classic triad of symptoms

  • Cough
  • Hemoptysis
  • Recurrent infection
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Physical

Physical examination generally is unrevealing, but subtle findings may provide clues. In addition, the physical examination may help in finding other confounding disease processes.

Upper airway obstruction - Stridor/wheezing

  • Lower airway obstruction
  • Asymmetric breath sounds
  • Postobstructive processes

Respiratory insufficiency

  • Dyspnea
  • Increased work of breathing
  • Retractions
  • Orthopnea
  • Cyanosis

Extrapulmonary manifestations

These are rare, but may include mechanical compressive and obstructive syndromes such as those seen in other thoracic malignancies.

  • Pancoast tumor - Superior sulcus tumor causing pain (eg, shoulder, forearm, arm, scapula), Horner syndrome, and atrophy of upper extremity musculature
  • Acute spinal cord compression – Paraplegia, sensory deficits, urinary retention/incontinence, and vertebral pain
  • Superior vena cava syndrome – Head congestion/fullness; headache; nasal congestion; dyspnea; cough; orthopnea; dilated veins in the upper extremity, neck, and face; upper extremity and facial edema; papilledema; facial cyanosis; and mental status changes
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Causes

Bronchial carcinoids are thought to arise from Kulchitsky cells. These neuroendocrine cells, formerly classified as amine precursor uptake and decarboxylation cells, produce and store biogenic amines and peptides. Typical carcinoids originate as clusters of monotonous polyhedral cells in a fibrovascular stroma. Ultrastructurally and immunoreactively, carcinoids share characteristics with small cell neuroendocrine carcinoma of the lung.

Adenoid cystic carcinoma originates from salivary gland tissue. Occasionally, some tumor cells in this variant are of myoepithelial origin. These tumors have several other names, including cylindromas, adenoid cystic basal cell carcinomas, adenomyoepitheliomas, and pseudoadenomatous basal cell carcinomas.

Mucoepidermoid carcinomas originate from tracheal and proximal bronchi. These tumors are of squamous and intermediate elements, with intercellular bridges. They have the same microscopic appearance as mucoepidermoid carcinoma of the salivary glands, arise in glandular submucosa, and manifest as submucosal lesions.

Mucous gland adenomas (ie, bronchial cysts, papillary cystadenomas) are rare submucosal tumors arising from mucous glands and truly are benign tumors.

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Contributor Information and Disclosures
Author

Charles W Van Way III, MD  Professor, Department of Surgery, Sosland/Missouri Endowed Chair of Trauma Services, Director, Shock/Trauma Research Center, University of Missouri Kansas City School of Medicine

Charles W Van Way III, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Critical Care Medicine, American College of Physician Executives, American College of Surgeons, American Medical Association, American Medical Informatics Association, American Society for Clinical Nutrition, American Society for Nutritional Sciences, American Society for Parenteral and Enteral Nutrition, American Surgical Association, Association of Military Surgeons of the US, Central Surgical Association, Missouri State Medical Association, Shock Society, and Southwestern Surgical Congress

Disclosure: Baxter, Inc Consulting fee Consulting

Coauthor(s)

Gerald L Early, MD, MA, FACS, FCCP  Associate Professor, Department of Surgery, University of Missouri-Kansas City

Gerald L Early, MD, MA, FACS, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, American Medical Association, Society of Critical Care Medicine, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Peterson, MD  Chief of Medicine, Vice-Chair of Medicine, University of California at San Francisco; Endowed Professor of Medicine, University of California at San Francisco-Fresno

Michael Peterson, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Daniel R Ouellette, MD, FCCP  Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System

Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society

Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Astra Zeneca Honoraria Speaking and teaching

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors acknowledge the contributions of Ellis Salloum, MD, who was a coauthor on the original version of this article.

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