Makindo Medical Notes

🌬️ Bronchial adenoma is a historic term once used for rare airway tumours. Although the word “adenoma” suggests benign behaviour, these tumours can be benign or malignant. Today, it refers mainly to specific tumour types: carcinoid tumours, adenoid cystic carcinoma, and mucoepidermoid carcinoma.

📖 About

• Rare tumours, often slow-growing but locally invasive ⚠️
• Can occur at any age, but more common in middle adulthood

🗂️ Types

• Carcinoid Tumours: Most common.
  • Typical carcinoid → slow, less aggressive ✅
  • Atypical carcinoid → more aggressive, higher recurrence risk ⚠️
• Adenoid Cystic Carcinoma: Rare, indolent but infiltrative.
• Mucoepidermoid Carcinoma: Variable behaviour (low- vs high-grade forms).

🧬 Risk Factors

• 📆 Age: Middle-aged adults most affected.
• 🚬 Smoking: Not as strongly linked as lung cancer, but a risk especially for mucoepidermoid carcinoma.
• 🧪 Genetics: Familial predisposition in some cases.

🔎 Symptoms

• 💨 Cough: Persistent, may include haemoptysis.
• 🎵 Wheezing: Often localised, may mimic asthma.
• 😮‍💨 Dyspnoea: From airway obstruction.
• ♻️ Recurrent infections: Same lobe pneumonia → obstruction clue.
• ⚡ Chest pain: If invasive.

🧾 Differentials

• 🦠 Tuberculosis (TB)
• 🫁 Primary lung carcinoma
• 🌿 Sarcoidosis

🧪 Investigations

• 🩻 Chest X-ray: May show a hilar/airway mass or collapse.
• 🖼️ CT Scan: Defines location, extent, invasion.
• 📡 Bronchoscopy: Direct visualisation + biopsy.
• 🔬 Histology: Confirms type (carcinoid, ACC, mucoepidermoid).

🛠️ Management

• 🔪 Surgery: Mainstay if resectable (bronchoscopic excision → lobectomy if extensive).
• ☢️ Radiotherapy: For unresectable/infiltrative tumours.
• 💊 Chemotherapy: For aggressive subtypes (e.g. atypical carcinoid, high-grade mucoepidermoid).
• 🎯 Targeted therapy: Selected cases with molecular drivers.

📚 Case Example

👨 A 45-year-old non-smoker presents with a 6-month history of recurrent pneumonia affecting the right middle lobe. He has persistent cough, occasional haemoptysis, and a localised wheeze not improving with inhalers. 🩻 Chest X-ray: Right hilar opacity. 📡 Bronchoscopy: Endobronchial mass. 🔬 Biopsy: Typical carcinoid tumour. ✅ Management: Surgical resection.