View Abstract

A4075 - Endobronchial Mucous Gland Adenoma: A Rare Cause of Recurrent CHF
Author Block: R. Hilton, B. T. Hehn, M. Jacobs; Pulmonary Critical Care, Thomas Jefferson University, Philadelphia, PA, United States.
BACKGROUND: Mucous gland adenoma is an extremely rare benign tumor which is known to arise from the mucus secreting cells of bronchial mucosa. While the tumor is classically non-malignant, with sufficient size such an adenoma can precipitate airway compromise. We present a case of recurrent CHF exacerbations, an emergent intubation, and subsequent discovery of a mucous gland adenoma.CASE: This is a 41-year-old female with a history of poorly controlled nonischemic cardiomyopathy status post ICD placement and recurrent episodes of shortness of breath. The patient had multiple hospital stays over 2 years after NICM diagnosis for CHF exacerbation, which was attributed to non-compliance, poorly controlled obstructive sleep apnea, and even COPD and asthma. She was hospitalized for complications of pacemaker placement including pocket infection and lead malfunction. The patient was admitted and taken to the operating room for ICD lead extraction. During induction of anesthesia, the patient rapidly developed respiratory failure requiring intubation. Following difficult intubation, emergent bronchoscopy at that time showed endobronchial circumferential mass. The patient underwent emergent debulking of the tumor bronchoscopically. The patient was successfully extubated without further complication. Subsequent pathology revealed the mass to be a mucous gland adenoma, with TTF1 negative, napsin A negative, and a low proliferation rate on Ki-67 testing. Of note, the patient has had multiple office visits in the two years since without hospitalization for CHF.DISCUSSION: In the case described, multiple returns to the hospital were presumed to be compliance related, and further atypical diagnoses like late onset asthma and early onset COPD were used to explain refractory treatments to shortness of breath. The case described emphasizes the importance of considering a broad spectrum of potential exacerbating features to CHF. It also highlights a very rare endobronchial tumor and a particularly unusual circumstance in which the diagnosis was made.