Bronchial adenoma and hamartoma

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The term ‘adenoma‘ covers a variety of tumours, approximately 90% of which are carcinoid tumours arising fromcells of the APUD series. The diagnosis is often made inyoung adults and the sexes are equally affected. Thesetumours are usually endobronchial, arising in larger airways,and causing airway narrowing, volume loss, collapseand distal infection. Common clinical features are cough,haemoptysis, breathlessness, unilateral wheeze and recurrentinfections. Most tumours are of low-grade malignancyand symptoms may be present for a long time before adiagnosis is made. Wheezing and dyspnoea may lead to amistaken diagnosis of asthma. Some tumours becomemalignant and occasionally (2% of cases) the patientsdevelop the carcinoid syndrome . It is important tonote that tumour is not usually visible on the chest X-rayand the most common radiological abnormality is volumeloss or lobar collapse. Diagnosis is frequently made atbronchoscopy, where 90% of these tumours are visible. The tumour is vascular and bleeds easily and profusely. Rigid bronchoscopy for biopsy is sensible if at fibreoptic bronchoscopythe appearances suggest an adenoma. The besttreatment whenever possible is surgical resection, and theprognosis for these tumours is good unless there has beenmalignant change.

HAMARTOMA

Hamartomas are tumour-like malformations of disorganizedtissue; in some the predominant tissue is cartilage,and in others smooth muscle. Unlike carcinoid tumours,hamartomas usually present over the age of 50. Malesare three times more likely to be affected than females.Hamartomas are usually peripheral within the lungparenchyma and seldom within the bronchus. They growslowly and are benign. Most are asymptomatic and areincidental findings on chest X-ray. The mass of the hamartomais usually small, less than 4cm in diameter, rounded,well defined and sometimes calcified. Cavitation is rare.In most cases in the absence of typical calcification, andwithout the benefit of past chest X-rays, a malignantbronchial carcinoma will be part of the differential diagnosisand the correct treatment will be surgical excision. Atsurgery the hamartoma is felt to be hard, can be removedwithout resecting lung, and the prognosis is excellent.

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