Scientific letter
Incomplete Surgery for Bronchial Cystic Adenoid Carcinoma: A Therapeutic Alternative
Cirugía incompleta del carcinoma adenoide quístico bronquial: una alternativa terapéutica
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class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Incomplete Surgery for Bronchial Cystic Adenoid Carcinoma: A Therapeutic Alternative" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "606" "paginaFinal" => "607" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Santiago Figueroa Almánzar, Antonio Arnau Obrer, Eva García del Olmo, Enrique Pastor Martínez, Ricardo Guijarro Jorge" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Santiago" "apellidos" => "Figueroa Almánzar" "email" => array:1 [ 0 => "santiago.figueroa@me.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonio" "apellidos" => "Arnau Obrer" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Eva" "apellidos" => "García del Olmo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Enrique" "apellidos" => "Pastor Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Guijarro Jorge" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Cirugía, Universidad de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cirugía incompleta del carcinoma adenoide quístico bronquial: una alternativa terapéutica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 906 "Ancho" => 975 "Tamanyo" => 144560 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal reconstruction of the thoracic CT scan showing a well-defined mass encompassing the left main bronchus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchial adenoid cystic carcinoma (ACC) is a rare infiltrative neoplasm that has a tendency for local recurrence and the ability to metastasis. Surgery is usually the best therapeutic option and there may be an indication for adjuvant radiotherapy, as in the cases that we present below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 19-year-old male with a history of pneumonia in the left lung and, since then, dyspnoea and bronchial hyperreactivity, which led to the diagnosis of asthma. Computed tomography (done after the appearance of pleuritic pain) identified a well-defined mass in the left pulmonary hilum (35<span class="elsevierStyleHsp" style=""></span>mm×23<span class="elsevierStyleHsp" style=""></span>mm×30<span class="elsevierStyleHsp" style=""></span>mm), that encompassed the main bronchus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Bronchoscopy showed a near total obstruction of the primary bronchus by a mammillated mass that extended 3–4<span class="elsevierStyleHsp" style=""></span>cm into the lumen and reached the carina. Bronchial biopsy determined it was an ACC.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Surgical treatment involved initial bronchotomy in the carina; tumour infiltration was thus confirmed in both lobar bronchia, superior and inferior. Left pneumonectomy was then performed, and no tumour remains were observed. The pathology study reported a mass measuring 6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm that infiltrated the entire bronchial wall, reaching the adjacent fat. The subcarinal and hilar lymph nodes were negative, but the bronchial resection edge was infiltrated by tumour.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We opted for adjuvant radiotherapy on the left bronchial bud, carina, distal trachea and right bronchial tree, with a total dose of 5940<span class="elsevierStyleHsp" style=""></span>cGy. After 6 years of follow-up, the patient has presented no signs of recurrence.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 2</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 29-year-old male with symptoms of persistent cough and dyspnoea with wheezing was diagnosed with bronchial asthma. Chest CT scan detected a tumour in the left pulmonary hilum that compressed the superior pulmonary vein and main bronchus, which was partially surrounded.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Bronchoscopy showed concentric stenosis of the primary bronchus 2<span class="elsevierStyleHsp" style=""></span>cm from the tracheal carina, with submucosal growth to the interlobar carina. Biopsy revealed ACC.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgery was indicated, during which we observed infiltration of both lobar bronchi that required left pneumonectomy. The pathology report described a tumour measuring 4<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm that infiltrated the bronchial wall and extended through the lumen to the resection edge, with lymphatic embolisation and perineural infiltration. Hilar and mediastinal lymphadenopathies did not present tumour.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient received adjuvant radiotherapy with a total dose of 5940<span class="elsevierStyleHsp" style=""></span>cGy. Follow-up CT scan 5 years after surgery showed no signs of recurrence.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Bronchial adenoid cystic carcinomas represent 0.2% of lung cancers.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Their nature seems more aggressive than tracheal ACC and, therefore, prognosis is worse.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Their relationship with smoking is uncertain. There seems to be a similar distribution in both sexes, and the most typical age at presentation is the fifth decade of life, although our patients were younger. These tumours are usually located in the proximal airway and direct transluminal extension is the most frequent, although there may be submucosal/perineural infiltration at a considerable distance from the main tumour mass.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Lymph node metastases are associated in up to 55% of cases in some series; distant metastases are less common.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Three histological subtypes have been identified: cribriform, tubular and solid. Their correlation with prognosis is controversial.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Symptoms are usually latent and nonspecific, which results in important delays in diagnosis. This happened in our two cases, which were initially managed as bronchial asthma.</p><p id="par0060" class="elsevierStylePara elsevierViewall">As for therapeutic alternatives, chemotherapy is not useful and endoscopic options do not guarantee complete resection: their role is fundamentally palliative or temporary prior to a definitive therapy.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Complete surgical resection is the treatment of choice. In bronchial tumours, pneumonectomy is usually necessary, although bronchoplasty can be an option.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Macroscopically, if the tumour involves the tracheal carina, other non-surgical options should be considered, given the difficulty to obtain adequate resection margins and the elevated perioperative morbidity and mortality associated with “sleeve” pneumonectomy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In some studies, however, proximal extension of the tumour to the carina is observed in the microscopic study of the bronchial resection edges, as its tendency to infiltrate the submucosa can impede a precise diagnosis in the preoperative bronchoscopy, which occurred in our two patients. In these circumstances, prolonged survivals have been reported in spite of the microscopic involvement of the resection margins.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4,9,10</span></a> The incidence of local recurrence in these cases can reach 50% if not associated with another treatment, so some authors currently consider adjuvant radiotherapy as standard.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The 5-year survival of this disease is estimated at around 82% for complete resection and 77% for incomplete resections.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The possibility of recurrence years after surgical exeresis should be taken into account.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion, we believe that incomplete surgery of bronchial adenoid cystic carcinoma associated with adjuvant radiotherapy is a valid therapeutic option in selected cases. Any future endobronchial recurrences can be treated by interventional bronchoscopy.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Figueroa Almánzar S, Arnau Obrer A, García del Olmo E, Pastor Martínez E, Guijarro Jorge R. Cirugía incompleta del carcinoma adenoide quístico bronquial: una alternativa terapéutica. Cir Esp. 2015;93:606–607.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 906 "Ancho" => 975 "Tamanyo" => 144560 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal reconstruction of the thoracic CT scan showing a well-defined mass encompassing the left main bronchus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenoid cystic carcinoma of the lung" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 21 | 2 | 23 |
| 2024 September | 57 | 1 | 58 |
| 2024 August | 40 | 13 | 53 |
| 2024 July | 48 | 4 | 52 |
| 2024 June | 33 | 6 | 39 |
| 2024 May | 32 | 2 | 34 |
| 2024 April | 25 | 6 | 31 |
| 2024 March | 25 | 2 | 27 |
| 2024 February | 24 | 2 | 26 |
| 2024 January | 57 | 4 | 61 |
| 2023 December | 46 | 4 | 50 |
| 2023 November | 33 | 3 | 36 |
| 2023 October | 30 | 2 | 32 |
| 2023 September | 21 | 1 | 22 |
| 2023 August | 16 | 1 | 17 |
| 2023 July | 12 | 4 | 16 |
| 2023 June | 10 | 2 | 12 |
| 2023 May | 16 | 2 | 18 |
| 2023 April | 12 | 0 | 12 |
| 2023 March | 13 | 4 | 17 |
| 2023 February | 8 | 4 | 12 |
| 2023 January | 18 | 5 | 23 |
| 2022 December | 15 | 4 | 19 |
| 2022 November | 26 | 10 | 36 |
| 2022 October | 19 | 10 | 29 |
| 2022 September | 23 | 8 | 31 |
| 2022 August | 28 | 13 | 41 |
| 2022 July | 23 | 6 | 29 |
| 2022 June | 32 | 20 | 52 |
| 2022 May | 35 | 5 | 40 |
| 2022 April | 20 | 6 | 26 |
| 2022 March | 26 | 8 | 34 |
| 2022 February | 32 | 5 | 37 |
| 2022 January | 38 | 7 | 45 |
| 2021 December | 20 | 11 | 31 |
| 2021 November | 21 | 6 | 27 |
| 2021 October | 23 | 15 | 38 |
| 2021 September | 16 | 9 | 25 |
| 2021 August | 19 | 8 | 27 |
| 2021 July | 45 | 8 | 53 |
| 2021 June | 18 | 11 | 29 |
| 2021 May | 24 | 9 | 33 |
| 2021 April | 101 | 11 | 112 |
| 2021 March | 47 | 19 | 66 |
| 2021 February | 17 | 9 | 26 |
| 2021 January | 26 | 9 | 35 |
| 2020 December | 22 | 9 | 31 |
| 2020 November | 21 | 7 | 28 |
| 2020 October | 19 | 3 | 22 |
| 2020 September | 27 | 31 | 58 |
| 2020 August | 21 | 32 | 53 |
| 2020 July | 19 | 10 | 29 |
| 2020 June | 27 | 16 | 43 |
| 2020 May | 29 | 10 | 39 |
| 2020 April | 26 | 11 | 37 |
| 2020 March | 27 | 9 | 36 |
| 2020 February | 30 | 6 | 36 |
| 2020 January | 22 | 8 | 30 |
| 2019 December | 21 | 18 | 39 |
| 2019 November | 14 | 8 | 22 |
| 2019 October | 14 | 3 | 17 |
| 2019 September | 20 | 5 | 25 |
| 2019 August | 15 | 3 | 18 |
| 2019 July | 26 | 9 | 35 |
| 2019 June | 37 | 14 | 51 |
| 2019 May | 90 | 53 | 143 |
| 2019 April | 40 | 1 | 41 |
| 2019 March | 12 | 11 | 23 |
| 2019 February | 14 | 4 | 18 |
| 2019 January | 15 | 4 | 19 |
| 2018 December | 15 | 2 | 17 |
| 2018 November | 27 | 9 | 36 |
| 2018 October | 15 | 4 | 19 |
| 2018 September | 21 | 6 | 27 |
| 2018 August | 13 | 1 | 14 |
| 2018 July | 7 | 1 | 8 |
| 2018 June | 3 | 0 | 3 |
| 2018 May | 8 | 3 | 11 |
| 2018 April | 2 | 0 | 2 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 12 | 2 | 14 |
| 2018 January | 6 | 0 | 6 |
| 2017 December | 9 | 4 | 13 |
| 2017 November | 8 | 0 | 8 |
| 2017 October | 13 | 2 | 15 |
| 2017 September | 11 | 2 | 13 |
| 2017 August | 10 | 3 | 13 |
| 2017 July | 16 | 4 | 20 |
| 2017 June | 21 | 5 | 26 |
| 2017 May | 14 | 2 | 16 |
| 2017 April | 15 | 3 | 18 |
| 2017 March | 13 | 46 | 59 |
| 2017 February | 11 | 4 | 15 |
| 2017 January | 9 | 2 | 11 |
| 2016 December | 11 | 9 | 20 |
| 2016 November | 5 | 2 | 7 |
| 2016 October | 9 | 8 | 17 |
| 2016 September | 17 | 5 | 22 |
| 2016 August | 16 | 2 | 18 |
| 2016 July | 9 | 3 | 12 |
| 2016 June | 18 | 16 | 34 |
| 2016 May | 13 | 9 | 22 |
| 2016 April | 11 | 8 | 19 |
| 2016 March | 18 | 17 | 35 |
| 2016 February | 10 | 4 | 14 |
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