Clinical characteristics of children with primary tracheobronchial tumors and SVM model in mucoepidermoid carcinoma Prediction

Objective To determine the clinical characteristics, treatment, and prognosis of primary tracheobronchial tumors (PTT) in children. Methods The medical records of children with PTT who were hospitalized at the Children's Hospital of Chongqing Medical University from January 1995 through January 2020 were reviewed retrospectively. The clinical features, imaging, and bronchoscopic manifestations, treatment, and outcomes of these patients were summarized. Results Sixteen children were hospitalized with PTT during the study period: five (31.3%) with mucoepidermoid carcinoma (ME), three (18.8%) with inflammatory myofibroblastic tumors (IMT), two (12.5%) with sarcoma, two (12.5%) with papillomatosis, and one (6.3%) each with carcinoid carcinoma, adenoid cystic carcinoma (ACC), hemangioma, and schwannoma. Among them, ME was the most common type of tumor, and we used some statistical and machine learning techniques to predict ME, such as Gaussian naïve Bayes model, SVM(support vector machine) model, and decision tree model. The median age at diagnosis of PPTs was 9.3 years (range, 3–15 years), and the main clinical symptoms were cough (81.3%), breathlessness (50%), wheezing (43.8%), progressive dyspnea (37.5%), hemoptysis (37.5%), and fever (25%). The most frequent complication on chest imaging was atelectasis (56.3%), followed by bronchiectasis (25%) and emphysema (12.5%). Of the 16 patients, seven underwent surgical treatment, eight underwent bronchoscopic tumor resection, and one died. Of the 11 children followed-up, three experienced recurrence, including two who underwent subsequent tracheotomies, both of whom have varying degrees of post-activity shortness of breath. The other eight patients did not experience recurrence. No deaths were observed during follow-up. Conclusion PTTs are very rare in children, with ME having the highest incidence. And the SVM model showed high accuracy with respect to identifying ME. Chest CT and bronchoscopy can diagnose PTT effectively. Surgery is the treatment of choice, although bronchoscopic intervention can achieve good results in patients with unresectable tumors. The prognosis of the 11 followed-up children was good.

Bronchial cast hiding a lung cancer

A 70-year-old man was admitted for severe hypoxia, haemoptysis and cough. Chest-X-ray and CT-scan indicated a right-lower-lobe collapse. Bronchoscopy showed its occlusion by whitish dense mucus. Aspiration revealed a Bronchial Cast (BC) and a stenotic and inflamed orifice of the right-lower-lobe-bronchus which was biopsied. Histopathologic examination of BC showed fibrin with lymphocytes and neutrophils, and, surprisingly, also the presence of lung cancer. Although the association between BC and benign, myxoid-soft-tissue, tracheobronchial tumors has been described, the association with lung cancer has not previously been reported, and it remains unclear whether it is causal or casual.