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Objectives In the literature, inconsistent associations between the primary locations of lung adenocarcinomas (ADCs) with patient prognosis have been reported, due to varying definitions for central and peripheral locations. In this study, we investigated the clinical characteristics and prognoses of ADCs located in the main bronchus. Methods A total of 397,189 lung ADCs registered from 2004 to 2013 in the National Cancer Database (NCDB) were extracted and divided into main bronchus-located ADCs (2.5%, N = 10,111) and non-main bronchus ADCs (97.5%, N = 387,078). The ADCs located in the main bronchus and those not in the main bronchus were compared in terms of patient prognosis, lymph node involvement, distant metastases and other clinical features, including rate of curative-intent resection, histologic grade, and stage. Results ADCs located in the main bronchus had significantly worse patient survival than those in the non-main bronchus, both for all patients (HR = 1.82, 95% CI 1.78–1.86) and for those undergoing curative-intent resection (HR = 2.49, 95% CI 2.23–2.78). Furthermore, ADCs located in the main bronchus had a significantly higher rate of lymph node involvement and distant metastasis than those not in the main bronchus, when stratified by tumor size (trend test, p < e −16 ). Multivariate analysis of overall survival showed that main bronchus location is a prognostic factor (HR = 1.15, 95% CI 1.08–1.23) independent of other clinical factors. Conclusions Main bronchus location is an independent predictor for metastasis and worse outcomes irrespective of stage and treatment. Tumor primary location might be considered in prognostication and treatment planning. [ABSTRACT FROM AUTHOR]

A 57-year-old man was admitted to our department 10 years ago, diagnosed with tracheal adenoid cystic carcinoma. After discontinuing chemotherapy and radiotherapy, the disease recurred in December 2016. Apatinib mesylate (500 mg/day) was administered and computed tomography revealed that his symptoms were significantly relieved. Treatment with apatinib mesylate represents a novel method of treatment for tracheal adenoid cystic carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: The endobronchial brachytherapy (EBBT) is an established treatment method for tumors of the tracheobronchial system, however, little is known about the tolerance dose for organ at risk (OAR) in EBBT. The purpose of this study is to analyze patients with superficial bronchial carcinoma treated with definitive EBBT, and to investigate a relationship between late complications and dose for OAR. Material and methods: Endobronchial brachytherapy was performed 6 Gy per fraction for three to four fractions with or without external beam radiation therapy (EBRT). For the purpose of dosimetric analysis, the wall of the lower respiratory tract (LRT: trachea, main bronchus, and lobar bronchiole), trachea, and main bronchus (TMB) was extracted. D0.5cc, D1cc, and D2cc of LRT and TMB were calculated in each EBBT session and added together. V100, V150, and V200 of LRT were also calculated. Results: Between March 2008 and April 2014, EBBT was performed in 14 patients for curative intent. The 2-year overall survival (OS), progression-free survival (PFS), and local recurrence free survival (LRFS) was 82.1%, 77.9%, and 91.7%, respectively. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014). Conclusions: It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT. [ABSTRACT FROM AUTHOR]

Tracheobronchial rupture is a rare but life-threatening injury encountered after blunt chest traumas. It is especially seen in pediatric patients because of the complete conduction of traumatic kinetic energy and the direct exposure to the airway, due to the increased elasticity of the chest wall and other anatomical structures. We report the case of an eight-year-old boy, who presented with right-sided pneumothorax, following blunt chest trauma. He deteriorated despite a thoracic drain and, during the emergency thoracotomy was finally diagnosed with a main bronchial rupture, and was treated with isolated end-to-end bronchial anastomosis. The repair of right main bronchial rupture was performed with complete preservation of the right lung; the boy was discharged from the hospital on postoperative day 10, and was followed up asymptomatically for the following 32 months. This rare thoracic surgery case of pediatric patients is discussed in light of recent literature for diagnosis and surgical management. [ABSTRACT FROM AUTHOR]

Purpose: Intensive progress in prenatal medicine results in performing airway management in the fetus affected by life-threatening congenital malformations. This study aimed to examine age-specific reference intervals and growth dynamics for length, proximal and distal external transverse diameters, and projection surface areas of the two main bronchi at varying gestational ages, including their relative growth in length and projection surface area. Materials and methods: Using anatomical dissection, digital image analysis and statistics, length, proximal and distal external transverse diameters, and projection surface areas of the right and left main bronchi were examined in 73 human fetuses (39 males, 34 females) aged 14-25 weeks, derived from spontaneous abortions and stillbirths. Results: Statistical analysis showed no sex differences. Between the 14 and 25th week of gestation, the lengths of the right and left main bronchi increased from 1.43 ± 0.18 to 3.18 ± 0.39 mm, and from 2.97 ± 0.16 to 7.58 ± 1.95 mm, in accordance with the functions: $$ y = - 4.850 + 2.452 x \; \text{ln}\left( {\text{Age}} \right) \pm 0.400\;{\text{and}}\;y = - 15.005 + 7.093x \; \text{ln} \left( {\text{Age}} \right) \pm 0.579 $$ , respectively. The proximal external transverse diameters of the right and left main bronchi varied from 2.13 ± 0.41 to 4.24 ± 0.20 mm, and from 1.84 ± 0.06 to 3.67 ± 0.66 mm, following the logarithmic models: $$ y = - 8.666 + 4.018x \; \text{ln}{\rm (Age)} \pm 0.367\;{\text{and}}\;y = - 6.938 + 3.305x{\text{ ln(Age) }} \pm 0.323 $$ , respectively. The distal external transverse diameter rose from 2.09 ± 0.47 to 4.24 ± 0.20 mm, as $$ y = - 8.723 + 4.021x{\text{ ln(Age)}} \pm 0.392 $$ for the right main bronchus, and from 1.85 ± 0.04 to 3.67 ± 0.66 mm, like $$ y = - 6.924 + 3.280x{\text{ ln(Age)}} \pm 0.348 $$ for the left one. On either side, there were no statistically significant differences between values of the proximal and distal transverse diameters of the main bronchus. The projection surface areas of the right and left main bronchi ranged from 2.95 ± 0.19 to 13.34 ± 2.12 mm, and from 5.57 ± 0.21 to 28.52 ± 5.24 mm, as $$ y = - 10.212 + 0.943x{\text{ Age}} \pm 1.739 $$ and $$ y = - 19.119 + 1.875x{\text{ Age}} \pm 3.054 $$ . The two main bronchi revealed a proportionate increase in both length and projection surface area, since the right-to-left bronchial length ratio and the right-to-left bronchial projection surface area ratio were stable, 0.41 ± 0.07 and 0.47 ± 0.08, respectively, throughout the analyzed period. Conclusions: The main bronchi show no sex differences. The right and left main bronchi grow logarithmically in length and external transverse diameter, and linearly in projection surface area. The right and left main bronchi evolve proportionately, with the right-to-left bronchial ratios of 0.41 ± 0.07 for length, and 0.47 ± 0.08 for projection surface area. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma family tumors (ESFT), which include Ewing's sarcoma and primitive neuroectodermal tumors (PNET), have been reported to originate in a variety of sites, mostly in the extremities. Previous reports have shown ESFT originating in the thoracic region, such as chest wall and peripheral lung. We herein report the first case of the ESFT that originated in the main bronchus. Endobronchial snare resection was followed by five courses of chemotherapy (VDC-IE; including vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide) and sequential radiation. After the treatment, the patient's condition has improved, and he has remained disease-free for the past year. [ABSTRACT FROM AUTHOR]

Summary: We report a case of left main bronchial glomus tumor in a 39-year-old man who presented with a cough he had had for 1 month. A computed tomography (CT) scan revealed a polypoid tumor in the membranous portion of the left main bronchus. The tumor showed marked enhancement on the early phase of dynamic contrast-enhanced CT, and it was thought to be a hypervascular tumor. The tumor was carefully resected by a rigid bronchoscope, and the pathological and immunohistochemical findings yielded a diagnosis of glomus tumor. Marked enhancement of early phase dynamic contrast-enhanced CT may be useful for a diagnosis of bronchial glomus tumor. [Copyright &y& Elsevier]

There are two main bronchi breathing tubes originating from the bottom of the trachea and lung projecting to each, allowing passage of air toward and from the bronchioles. The objective of this work was to verify the morphological term inclusion as the back wall of the main bronchus in Anatomic Terminology and texts for teaching gross anatomy. Terminologia Anatomica was analyzed and compared with various texts and journals of gross anatomy teaching, in order to verify if there are descriptions of the posterior wall of the main bronchi and whether it has been nominated. In the Terminologia Anatomica the term for the back wall of the main bronchus is not included. Therefore, it is proposed that the term "membranous wall" for bronchus be included in Terminologia Anatomica. [ABSTRACT FROM AUTHOR]