An Underrated Potential Risk of Bronchiectasis: Lymph Node Metastasis of a Pulmonary Tumorlet

Abstract

Pulmonary tumorlets occur as the result of extensive scar caused by bronchiectasis or other inflammatory processes. They are minute lesions found in close association with the bronchioles and may rarely metastasize to lymph nodes. We present a 35-year-old male patient who underwent bilobectomy inferior with a diagnosis of bronchiectasis of 20 years duration. Histologic examination showed cystic bronchiectasis with areas of multiple neuro-endocrine tumor-lets in addition to metastatic peribronchial lymph nodes. We emphasize the significance of early surgical treatment of bronchiectasis showing little to no response to medical therapy as well as peribronchial lymph node dissection.

Precursor lesions of endocrine system neoplasms

“…69,70 They are usually seen singly, but sometimes form small aggregates termed neuroepithelial bodies, localised within the ciliated respiratory epithelium. 77,78 The latter suggests that tumourlets should be better termed as microinvasive low grade pulmonary neuroendocrine tumours or, alternatively, microcarcinoids. 65,71,72 The tumourigenesis of pulmonary NETs seems to be very complex.…”

Surgical Management of Bronchiectasis: A Collective Review of 339 Patients with Long-term Follow-up

“…Pulmonary tumorlets which may show metastatic features to peribronchial lymph nodes may be associated with long-standing bronchiectasis due to extensive scar tissue. Thus, some authors suggest performing peribronchial and hilar lymph node dissection in brochiectatic patients to exclude possible pulmonary tumorlets and lymph node metastasis [18]. We usually do not perform a standard lymph node dissection in our bronchiectatic patients except in patients with pathological lymph node enlargement.…”

Bronchiectasis: Retrospective Analysis of Clinical and Pathological Findings in a Tertiary-Care Hospital

“…Although the NETs and carcinoids in our study did not show metastases, lymph node metastases of pulmonary NETs and carcinoids have rarely been reported in the literature [19]. erefore, the lymph nodes in the macroscopic specimens of the bronchiectasis cases should be obtained with care.…”