PMC6280630_01
A, B. Chest scans showing volume loss of the right lung with endobronchial lesion. C. Endoscopic image of the suture of the left main bronchus to the trachea after resection D. Follow-up X-ray showing the thoracic plasty, the displacement of the mediastinum after pneumonectomy and recurrent lesions in the left lung several years after of the initial surgery.
gr1.jpg
PMC6280630_01_gr1.jpg
fig1
In Fig. 1C, the endoscopic aspect of the bronchial anastomosis to the trachea is observed. Fig. 1D shows the radiography after thoracoplasty.
A, B Hematoxylin and eosin staining (H & E). Adenoid cystic carcinoma with cribiform pattern. C. Immunohistochemistry (IHC) technique, expression of cytokeratin CK5/6. D. Expression of p63 gene that confirms the morphological diagnosis.
gr2.jpg
PMC6280630_01_gr2.jpg
fig2
The pathological study reported a lesion of basal cells that formed cystic structures with mucoid material in their lumens, identified as adenoid cystic carcinoma with cribiform pattern (Fig. 2 A, B, C, D).
PMC6280630_02
A, B. Chest scans showing loss of volume of the left lung with endobronchial lesion. C, D. Endoscopic image of the lesion of the left main bronchus reaching the carina with mamelons that line the mucosa of the left main bronchus.
gr3.jpg
PMC6280630_02_gr3.jpg
fig3
A chest CT showed displacement of the trachea to the left with complete atelectasis of the left lung and image of an inferior endotracheal mass in addition to mediastinal adenomegalies (Fig. 3 A, B). A partial resection of the lesion that obstructed the left main bronchus (Fig. 3C and D) was performed through flexible fibrobronchoscopy using cryoprobe.
A, B. Hematoxylin and eosin staining (H & E), adenoid cystic carcinoma with cribiform pattern, positive immunohistochemical study (IHC) for the expression of p63 and p40. C. Benign epithelial inclusions within the lymph node, negative for malignancy. D. Expression of cytokeratin CK7 in the lymph node, confirming a benign epithelial inclusion.
gr4.jpg
PMC6280630_02_gr4.jpg
fig4
Pathology reported a lesion of basal cells that form cystic structures with mucoid material in their lumens, identified as adenoid cystic carcinoma with cribiform pattern (Fig. 4 A, B, C, D).
A, B Trachea in the upper part, right bronchus to the right and left bronchus to the left with repair threads. C. Two tubes, one for each main bronchus, in the upper part the open carina with the balloon of the exposed orotracheal tube. D. Tube in the left bronchus and finished right tracheo-bronchial anastomosis. Trachea (1), right bronchus (2), left bronchus (3), tracheo-bronchial anastomosis (4).
gr5.jpg
PMC6280630_02_gr5.jpg
fig5
Fig. 5 shows the different moments of the surgical procedure (Fig. 5 A, B, C, D).
PA and lateral chest X-ray showing loss of volume of the left hemitorax post-pneumonectomy and the displacement of the mediastinum to the left, right lung with adequate expansion and without abnormal infiltrates.
gr6.jpg
PMC6280630_02_gr6.jpg
fig6
In her last radiological control, a normal evolution after pneumonectomy was appreciated, with a single right lung expanded without lesions and displacement of the mediastinum to the left (Fig. 6).