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A5596 - Pediatric Endobronchial Tumor Leading to Recurrent Pneumonia
Author Block: L. Greenawald1, A. R. Shenoy2; 1Division of Pulmonology, Nemours/A. I. duPont Hospital for Children, Wilmington, DE, United States, 2Division of Pulmonology, Nemours/A.I.duPont Hospital for Children, Wilmington, DE, United States.
INTRODUCTION: Recurrent, focal pneumonias are uncommon in pediatrics. Underlying causes for recurrent focal pneumonia include aspiration of foreign body (FB), immunodeficiency syndromes, congenital pulmonary malformations, or endobronchial obstruction. We describe the clinical presentation and diagnostic evaluation of a pediatric patient with endobronchial tumor causing recurrent left lower lobe (LLL) pneumonia. CASE REPORT: An adopted Asian female initially presented to pulmonary clinic at 12 years of age with recurrent throat tightness and wheezing. There was no history of pneumonia and her physical exam was unremarkable. Pulmonary function testing (PFT) revealed mild, reversible airflow obstruction and air-trapping. Chest radiograph (CXR) was normal. Treatment included albuterol as needed for asthma and exercises for vocal cord dysfunction. Her symptoms resolved and the family pursued no further evaluation. After 2 years, she returned to pulmonary clinic following several courses of antibiotics and steroids for LLL pneumonia over 3 months. Symptoms included daily chest pain, cough and reported, audible wheezing. Symptoms partially improved with albuterol and a short trial of inhaled corticosteroids (ICS). Aspiration of FB was denied. Exam was remarkable for focal wheezing in LLL. Treatment included airway clearance and ICS. Serial CXRs demonstrated occurrence, resolution and subsequent recurrence of a subtle LLL opacity. Chest CT demonstrated “finger-in-glove” mucous impaction, saccular bronchiectasis, and centrilobular pulmonary nodules distal to the LLL superior segmental bronchus. Laboratory evaluation was negative for Allergic Bronchopulmonary Aspergillosis, immunodeficiency or Cystic Fibrosis. Flexible bronchoscopy demonstrated a pink, obstructive, endobronchial mass within the LLL superior segmental bronchus. Otolaryngology assisted with intraoperative biopsy. Pathology was consistent with low-grade mucoepidermoid carcinoma. Bronchial cultures were obtained. Referrals were placed to Oncology and Surgery clinic. She is scheduled to undergo therapeutic LLL resection. Surveillance plan includes Chest CT and bronchoscopy within 3-6 months and thereafter to evaluate for recurrence. DISCUSSION: This case report highlights a rare occurrence of pediatric endobronchial malignancy diagnosed through history, focal physical exam findings and repeated specialized imaging. Limited studies that include pediatric patients suggest that malignant tumors (including carcinoids or mucoepidermoid carcinomas) are more common than benign lesions (Roby et al, Arch Otolaryngol Head Neck Surg. 2011; 137 (9): 925-929). Pulmonary mucoepidermoid carcinomas account for 0.1-0.2% of lung cancer. Treatment for low-grade tumors is primarily surgical. There is conflicting data on prognostic factors or recurrence (Hsieh et al, PLOS One. 2017; 12 (5): e0176918).