Successful complete tumor resection for pulmonary mucoepidermoid carcinoma by thoracoscopic right upper lobectomy with intraoperative bronchoscopy: A pediatric case report. (April 2023)

• Record Type: Journal Article
• Authors: Nishida, Nanako; Onishi, Shun; Murakami, Masakazu; Kawano, Takafumi; Muto, Mitsuru; Ieiri, Satoshi
• Is Part Of: International journal of surgery case reports. Volume 105(2023)
• Publication Date: 2023-04
• Subjects: Intraoperative bronchoscopy -- Lung tumor -- Pulmonary mucoepidermoid carcinoma -- Thoracoscopic lobectomy -- Pediatric; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2023.108119
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Mucoepidermoid carcinoma presents as an exophytic endobronchial mass that induces obstructive symptoms often followed by distal collapse atelectasis of the lung parenchyma. Case presentation: A six-year-old girl had recurrent bacterial pneumonia and atelectasis of the right upper lobe. Computed tomography revealed a 30-mm mass in the anterior segment of the right upper lobe with an obstructed trachea and peripheral atelectasis. A minor salivary gland tumor was suspected, so thoracoscopic right upper lobectomy (RUL) was performed. Intraoperative bronchoscopy showed no protrusion of the tumor into the tracheal lumen. We confirmed that there was no injury to the middle lobe branch and no residual tumor via bronchoscopy before transection of the trachel bronchus of the right upper lobe. The histological type was low-grade mucoepidermoid carcinoma. The postoperative course was uneventful, and no recurrence was evident after one year. Clinical discussion: Primary pulmonary cancers in children are extremely rare. Mucoepidermoid carcinoma is the most common disease in pediatric primary lung tumors but remains relatively rare. Mucoepidermoid carcinoma of the tracheobronchial tree sometimes requires sleeve resection. Intraoperative bronchoscopy helped determine the exact position of the tumor. The value of intraoperative bronchoscopy for sparing the lung parenchyma and preserving as much of the respiratory function as possible. Intraoperative bronchoscopy should be actively performed in cases of pediatric lobectomy, especially those involving tracheobronchial tumors. Conclusion: Intraoperative bronchoscopy allowed for complete RUL without residual tumor or injury of the middle lobe bronchus. Highlights: MEC is the most common disease in pediatric primary lung tumors but remains relatively rare. There have been no previous reports on thoracoscopic lobectomy for pediatric MEC cases. We performed complete tumor resection for pulmonary MEC by thoracoscopic right upper lobectomy with intraoperative bronchoscopy.