Tracheobronchial Mucoepidermoid Carcinoma in a 17-year-old Girl: A Case Report and Review of the Literature

發生在17歲女孩的氣管支氣管惡性黏液類上皮癌－病例報告

10.29806/TM.200608.0008

李建德(Chien-Te Li)；林慶雄(Ching-Hsiung Lin)；何上芸(Shang-Yun Ho)；張惠媚(Huei-Mei Chang)；鄭清源(Ching-Yuan Cheng)

惡性黏液類上皮癌 ； 氣管支氣管 ； mucoepidermoid carcinoma ； tracheobronchial tree

胸腔醫學

21卷4期（2006 / 08 / 01）

355 - 361

英文

發生在氣管、支氣管惡性黏液類上皮癌相當罕見，被歸類為唾液腺型態腫瘤，佔原發性肺癌的0.1~0.2%，其中又分為低度及高度惡性程度。低惡性度生長緩慢，好發於任何年齡層，可以全切除治癒。高惡性度生長較快，可浸潤於唾液腺內並且淋巴或遠處轉移。惡性黏液上皮癌佔腮腺惡性腫瘤的21%，為最常見的腮腺惡性腫瘤，佔舌下腺惡性腫瘤的10%。 我們報告一位17歲健康的高中女生，因斷續乾咳8個月，在診所當感冒治療無法治癒，接著因有胸悶及活動性呼吸困難的症狀求診，胸部X光顯示不明原因左肺完全塌陷，進一步胸部電腦斷層掃瞄檢查顯示左支氣管內有一不規則腫瘤。經軟式支氣管鏡檢查病理切片仍無法診斷出病因，因而會診外科至手術室接受硬式支氣管鏡檢查，冷凍病理切片證實為低度惡性黏液類上皮癌，最後接受左肺完全切除及淋巴節擴清手術。 手術後病患身體恢復良好，並且持續追蹤至今一年，沒有復發或轉移的現象，我們在此回顧以前的病例報告，顯示低度惡性黏液類上皮癌可以因完全手術切除而治癒。

Tracheobronchial mucoepidermoid carcinoma is rare. It is classified as a carcinoma of the salivary gland type in lung cancer, and comprises only 0.1-0.2% of primary lung cancers. The tumor is classified as either a low- or high-grade malignancy. The low-grade growth can slowly appear in any age group, and is readily cured by excision. The high-grade tumor behaves aggressively, infiltrates widely in the salivary gland, and produces lymph node and distant metastases. Mucoepidermoid carcinomas account for about 21% of the malignant tumors of the parotid gland and 10% of those of the sublingual gland. They are the most common malignant tumor of the parotid. We report the case of a 17-year-old girl, a high school student previously in good health and without systemic disease, who suffered from non-productive cough off and on for 8 months. Initially, she was treated at a local clinic as having a common cold, until chest tightness and dyspnea on exertion developed, and then she visited our OPD. The chest radiograph revealed a total collapse of the left lung parenchyma. The chest computer tomography examination demonstrated a contrast medium-enhanced and hypervascular irregular tumor obstructing the left main bronchus. Fibroflexible bronchoscopy revealed a tumor near the carina, coated with whitish debris, and protruding from the left main bronchus with lumen total occlusion. Several transbronchial biopsies were performed, but yielded no definite diagnosis. We consulted the chest surgeon, and a rigid bronchoscopy was performed; the frozen tissue of the excised biopsy taken during the operation revealed only a suspected endocrine tumor, possibly a carcinoid tumor. Finally, a left pneumonectomy, including lymph node dissection was done, and the pathology reported mucoepidermoid carcinoma, low grade. A literature review revealed that low-grade tracheobronchial carcinoma can be cured by surgical excision. No other metastasis was detected in this patient, and she recovered well with no symptoms after surgical treatment. At the end of a 1-year follow up and short-term pulmonary rehabilitation, she was well and without residual symptoms.