Lung cancer: symptoms. Benign tumor in the lungs

It is possible to detect a tumor in the lungs and determine what it may be with a detailed examination. People of different ages are susceptible to this disease. Formations arise due to disruption of the process of cell differentiation, which can be caused by internal and external factors.

Neoplasms in the lungs are a large group of various formations in the lung area that have characteristic structure, location and nature of origin.

Neoplasms in the lungs can be benign or malignant.

Benign tumors have different genesis, structure, location and various clinical manifestations. Benign tumors are less common than malignant tumors and account for about 10% of total number. They tend to develop slowly and do not destroy tissue, since they are not characterized by infiltrating growth. Some benign tumors tend to transform into malignant ones.

Depending on the location there are:

Central - tumors from the main, segmental, lobar bronchi. They can grow inside the bronchus and surrounding lung tissue.
Peripheral - tumors from surrounding tissues and walls of small bronchi. They grow superficially or intrapulmonarily.

Types of benign tumors

There are the following benign lung tumors:

Briefly about malignant tumors

Increase.

Lung cancer (bronchogenic carcinoma) is a tumor consisting of epithelial tissue. The disease tends to metastasize to other organs. It can be located in the periphery, the main bronchi, or grow into the lumen of the bronchus or organ tissue.

Malignant neoplasms include:

Lung cancer has the following types: epidermoid, adenocarcinoma, small cell tumor.
Lymphoma is a tumor that affects lower sections respiratory tract. It may occur primarily in the lungs or as a result of metastases.
Sarcoma is a malignant tumor consisting of connective tissue. Symptoms are similar to those of cancer, but develop more quickly.
Pleural cancer is a tumor that develops in the epithelial tissue of the pleura. It can occur primarily, and as a result of metastases from other organs.

Risk factors

The causes of malignant and benign tumors are largely similar. Factors that provoke tissue proliferation:

Smoking active and passive. 90% of men and 70% of women who have been diagnosed with malignant tumors in the lungs are smokers.
Contact with hazardous chemicals and radioactive substances due to professional activities and environmental pollution in the area of residence. Such substances include radon, asbestos, vinyl chloride, formaldehyde, chromium, arsenic, and radioactive dust.
Chronic respiratory diseases. The development of benign tumors is associated with the following diseases: chronic bronchitis, chronic obstructive pulmonary disease, pneumonia, tuberculosis. The risk of malignant neoplasms increases if there is a history of chronic tuberculosis and fibrosis.

The peculiarity is that benign formations can be caused not by external factors, but by gene mutations and genetic predisposition. Malignancy and transformation of the tumor into malignant also often occur.

Any lung formations can be caused by viruses. Cell division can be caused by cytomegalovirus, human papillomavirus, multifocal leukoencephalopathy, simian virus SV-40, and human polyomavirus.

Symptoms of a tumor in the lung

Benign lung formations have various signs that depend on the location of the tumor, its size, existing complications, hormonal activity, the direction of tumor growth, and impaired bronchial obstruction.

Complications include:

abscess pneumonia;
malignancy;
bronchiectasis;
atelectasis;
bleeding;
metastases;
pneumofibrosis;
compression syndrome.

Bronchial patency has three degrees of impairment:

1st degree – partial narrowing of the bronchus.
2nd degree – valvular narrowing of the bronchus.
3rd degree – occlusion (impaired patency) of the bronchus.

Symptoms of the tumor may not be observed for a long time. The absence of symptoms is most likely with peripheral tumors. Depending on the severity of the symptoms, several stages of the pathology are distinguished.

Stages of formations

Stage 1. It is asymptomatic. At this stage, partial narrowing of the bronchus occurs. Patients may have a cough with a small amount of sputum. Hemoptysis is rare. During examination, the x-ray does not reveal any abnormalities. Tests such as bronchography, bronchoscopy, and computed tomography can show the tumor.

Stage 2. Valve narrowing of the bronchus is observed. At this point, the lumen of the bronchus is practically closed by the formation, but the elasticity of the walls is not impaired. When you inhale, the lumen partially opens, and when you exhale, it closes with the tumor. In the area of the lung that is ventilated by the bronchus, expiratory emphysema develops. As a result of the presence of bloody impurities in the sputum and swelling of the mucous membrane, complete obstruction (impaired patency) of the lung may occur. Inflammatory processes may develop in the lung tissues. The second stage is characterized by a cough with the release of mucous sputum (pus is often present), hemoptysis, shortness of breath, increased fatigue, weakness, chest pain, elevated temperature(due to the inflammatory process). The second stage is characterized by alternation of symptoms and their temporary disappearance (with treatment). An X-ray image shows impaired ventilation, the presence of an inflammatory process in a segment, lobe of the lung, or an entire organ.

To be able to make an accurate diagnosis, bronchography, computed tomography, and linear tomography are required.

Stage 3. Complete obstruction of the bronchial tube occurs, suppuration develops, and irreversible changes in lung tissue and their death occur. At this stage, the disease has such manifestations as impaired breathing (shortness of breath, suffocation), general weakness, excessive sweating, chest pain, elevated body temperature, cough with purulent sputum (often with bloody particles). Sometimes pulmonary hemorrhage may occur. During examination, an x-ray may show atelectasis (partial or complete), inflammatory processes with purulent-destructive changes, bronchiectasis, extensive education in the lungs. To clarify the diagnosis, a more detailed study is necessary.

Symptoms

Symptoms of low-quality tumors also vary depending on the size, location of the tumor, the size of the bronchial lumen, the presence of various complications, and metastases. The most common complications include atelectasis and pneumonia.

In the initial stages of development, malignant cavity formations, originating in the lungs, show few signs. The patient may experience the following symptoms:

general weakness, which intensifies as the disease progresses;
increased body temperature;
fast fatiguability;
general malaise.

Symptoms initial stage development of neoplasms are similar to signs of pneumonia, acute respiratory viral infections, bronchitis.

The progression of a malignant formation is accompanied by symptoms such as cough with sputum consisting of mucus and pus, hemoptysis, shortness of breath, and suffocation. When the tumor grows into the vessels, pulmonary hemorrhage occurs.

A peripheral lung mass may not show signs until it invades the pleura or chest wall. After this, the main symptom is pain in the lungs that occurs when inhaling.

In later stages, malignant tumors appear:

increased constant weakness;
weight loss;
cachexia (depletion of the body);
the occurrence of hemorrhagic pleurisy.

Diagnostics

To detect tumors, the following examination methods are used:

Fluorography. A preventive diagnostic method, x-ray diagnostics, which allows you to identify many pathological formations in the lungs. read this article.
Plain radiography of the lungs. Allows you to identify spherical formations in the lungs that have a round outline. An x-ray image reveals changes in the parenchyma of the examined lungs on the right, left or both sides.
CT scan. Using this diagnostic method, the lung parenchyma, pathological changes in the lungs, and each intrathoracic lymph node are examined. This study prescribed when differential diagnosis of round formations with metastases, vascular tumors, and peripheral cancer is necessary. Computed tomography allows a more accurate diagnosis to be made than x-ray examination.
Bronchoscopy. This method allows you to examine the tumor and perform a biopsy for further cytological examination.
Angiopulmonography. It involves performing invasive radiography of blood vessels using a contrast agent to detect vascular tumors of the lung.
Magnetic resonance imaging. This diagnostic method is used in severe cases for additional diagnostics.
Pleural puncture. Study in the pleural cavity with a peripheral tumor location.
Cytological examination of sputum. Helps determine availability primary tumor, as well as the appearance of metastases in the lungs.
Thoracoscopy. It is carried out to determine the operability of a malignant tumor.

Fluorography.

Bronchoscopy.

Angiopulmonography.

Magnetic resonance imaging.

Pleural puncture.

Cytological examination of sputum.

Thoracoscopy.

It is believed that benign focal formations of the lungs are no more than 4 cm in size, larger focal changes talk about malignancy.

Treatment

All neoplasms are subject to surgical treatment. Benign tumors must be immediately removed after diagnosis in order to avoid an increase in the area of affected tissue, trauma from surgery, the development of complications, metastases and malignancy. For malignant tumors and benign complications, a lobectomy or bilobectomy may be required to remove a lobe of the lung. With the progression of irreversible processes, a pneumonectomy is performed - removal of the lung and surrounding lymph nodes.

Bronchial resection.

Central cavity formations localized in the lungs are removed by resection of the bronchus without affecting the lung tissue. With such localization, removal can be done endoscopically. To remove tumors with a narrow base, a fenestrated resection of the bronchial wall is performed, and for tumors with a wide base, a circular resection of the bronchus is performed.

For peripheral tumors, surgical treatment methods such as enucleation, marginal or segmental resection are used. For large tumors, lobectomy is used.

Lung formations are removed using thoracoscopy, thoracotomy and videothoracoscopy. During the operation, a biopsy is performed, and the resulting material is sent for histological examination.

For malignant tumors, surgical intervention is not performed in the following cases:

when it is not possible to completely remove the tumor;
metastases are located at a distance;
impaired functioning of the liver, kidneys, heart, lungs;
The patient's age is more than 75 years.

After removal of the malignant tumor, the patient undergoes chemotherapy or radiation therapy. In many cases, these methods are combined.

They make up 1-2% of all lung tumors. Benign tumors most often arise from the walls of the bronchi. As a rule, symptoms of the disease occur in the form of bronchial adenoma and hamartoma (70% of all benign lung tumors).

Symptoms of the development of benign lung tumors

Symptoms of the disease depend on the location and size of the tumor and their hormonal activity. >The clinical course of benign lung tumors, as with a number of other diseases, can be distinguished:

preclinical, asymptomatic period;

period of initial clinical symptoms;

a period of pronounced clinical symptoms caused by complications (abscess pneumonia, atelectasis, bronchiectasis, pulmonary fibrosis, malignancy and metastasis).

The mechanism of development of a benign lung tumor

With the development of infection in the bronchial tree, body temperature periodically rises, a cough appears with the release of mucopurulent sputum, and shortness of breath, which is usually regarded as bronchopneumonia. Such clinical symptoms characteristic of the second period of the disease. When bronchial patency is restored and the infection is eliminated, the clinical symptoms of a lung tumor often disappear for several months.

Constant persistent obstruction of the bronchial tube by a tumor, grossly disrupting its patency, leads to the formation of post-stenotic bronchiectasis and ulcers in the lung tissue. The volume of lung damage depends on the caliber of the bronchus obstructed by a benign tumor.

Symptoms of different types of benign lung tumors

Depending on the location of the tumor, it can be central or peripheral. Central tumors originate from large bronchi (main, lobar, segmental). They can grow endobronchially (into the lumen of the bronchus) or peribronchially. Sometimes a mixed pattern of growth is observed. Benign tumors develop:

from the bronchial epithelium (adenomas, carcinoids, papillomas, cylindromas, polyps);

from mesodermal tissue (fibromas, leiomyomas, chondromas, hemangiomas, lymphangiomas);

from neuroectodermal tissue (neurinoma, neurofibroma);

from embryonic rudiments (congenital lung tumors - hamartoma, teratoma).

Signs of central benign lung tumors

Central endobronchial tumors of the lungs (usually adenomas) develop slowly. Initially, transient partial bronchoconstriction appears, which is asymptomatic or accompanied by a cough with the release of a small amount of sputum. Patients, especially smokers, do not attach any importance to this, since their general condition and performance are not impaired. During an X-ray examination, only upon careful examination can one notice symptoms of benign lung tumors in the form of hypoventilation of the area of the lung associated with the affected bronchus.

When lung tumor, increasing in size, blocks most of the lumen of the bronchus, valve stenosis occurs, in which the lumen of the bronchus partially opens during inhalation and is closed by the tumor during exhalation.

As a result, expiratory emphysema occurs. With complete obstruction of the bronchus, atelectasis, stagnation of the detachable mucous membrane of the bronchus distal to the narrowing and an inflammatory process in the bronchial wall and lung develop.

Central peribronchial lung tumors grow slowly, and complete bronchial obstruction rarely occurs. Symptoms of the disease also develop slowly. The nature of the tumor is assessed only during surgery, which most often ends with resection of a lobe or the entire lung.

Symptoms of peripheral benign lung tumors

Peripheral tumors develop from the walls of smaller bronchi and surrounding tissues. There are subpleural and deep intrapulmonary peripheral lung tumors.

Peripheral tumors often develop asymptomatically and may be detected incidentally during X-ray examination. A large lung tumor reaching the chest wall or diaphragm can cause chest pain and difficulty breathing. When the tumor is localized in the medial parts of the lung, pain occurs in the heart area. When a large bronchus is compressed, the so-called centralization of a peripheral tumor is noted. The symptoms in these cases are similar to the clinical picture of the central tumor.

Symptoms of pulmonary hamartoma

Hamartoma is a congenital benign tumor of the lungs, which may contain various elements of germinal tissue, including islands of mature cartilage of atypical structure, slit-like cavities lined with glandular epithelium, smooth muscle fibers, thin-walled vessels, fatty and connective tissue layers. A hamartoma is a dense, capsule-less, round tumor with a smooth or slightly rough surface. Despite the absence of a capsule, it is clearly demarcated from the surrounding tissue.

Most often, lung tumors of this type are located in the anterior segments in the thickness of the lung tissue or subpleurally. Large lung tumors can compress not only the surrounding lung tissue, but also the bronchi and blood vessels, which is manifested by corresponding clinical symptoms. Malignancy with hamartomas is practically not observed.

Signs of rare benign lung tumors

Rare benign lung tumors are a very diverse group of diverse tumors, which, despite the rarity of individual forms, generally constitute almost 20% of all benign neoplasms.

This group includes:

papillomas,

leiomyomas,

teratomas,

vascular and neurogenic tumors.

Papilloma and teratoma are located mainly in the thickness of the lung, i.e. they have a central localization.

Other types of tumors can have both central and peripheral localization. Mostly vascular lung tumors (hemangioendotheliomas and hemangiopericytomas) have the ability to become malignant. These tumors are classified as conditionally benign.

Symptoms of pulmonary adenoma

Lung adenoma develops from the epithelium of the glands of the bronchial mucosa. As a rule (80-90%), this type of benign lung tumor is localized in the large bronchi, i.e. it is a central tumor. Based on their microscopic structure, there are several types of adenomas:

carcinoid (carcinoid),

cylindromatous (cylindroma),

mucoepidermoid

And mixed type, in which a combination of cylindroma and carcinoid cells is observed.

Benign pulmonary adenoma of the carcinoid type

Of the listed types of benign lung tumors, more than 80% are carcinoid-type adenomas. However, only in 2-4% of cases, according to the statistics of treatment of benign lung tumors, they cause carcinoid syndrome. Bronchial adenomas of the carcinoid type develop from poorly differentiated epithelial cells related to neuroendocrine cells of neuroectodermal origin (Kulchitsky cells). They are able to accumulate substances that are precursors of biogenic amines, subject them to decarboxylation and convert them into biologically active substances - polypeptide hormones, adrenaline, serotonin, etc.

Secretion of these hormones and biologically active substances by a lung tumor can cause carcinoid syndrome. Similar neuroendocrine cells are found in some endocrine glands, the gastrointestinal tract, and other organs. Due to the fact that all these cells are capable of accumulating substances that are precursors of amines and subjecting amines to decarboxylation, they are combined into one system, which in English is called Amin Precursor Uptake and Decarboxylation (abbreviated as the APUD system).

Symptoms of carcinoid syndrome with lung tumors

Clinical picture carcinoid syndrome is unstable, manifests itself:

periodic attacks of heat in the head, neck and upper extremities, dermatosis,

bronchospasm,

mental disorders.

With this type of lung tumor, the content of serotonin and its metabolite in the urine, 5-hydroxyindolylacetic acid, increases sharply and suddenly in the blood. The frequency and severity of attacks increase with malignancy (5-10%) of a lung tumor of the carcinoid type, which has all the symptoms of a malignant tumor - infiltrative unlimited growth, the ability to metastasize to almost all distant organs and tissues.

Unlike cancer, carcinoid is characterized by slow growth and later metastasis. Mucoepidermoid type adenomas are also prone to malignancy and are therefore considered potentially malignant lung tumors.

Diagnosis of benign lung tumor

Physical examination reveals:

shortening of percussion sound over the area of atelectasis (pneumonia, abscess),

weakening or absence of respiratory sounds, voice tremors.

Typically, with a benign lung tumor, dry and moist rales are heard.

Body temperature during periods of exacerbation of the inflammatory process is increased.

Patients complain of weakness, weight loss, and sometimes hemoptysis. Performance is reduced or lost.

All of these symptoms of a benign lung tumor, characteristic of the third period of the disease, sharply reduce the quality of life of patients.

Instrumental diagnosis of benign pulmonary tumor

X-ray examination reveals characteristic symptoms: rounded shape, smooth contours of the shadow. The presence of calcareous inclusions in a lung tumor is not pathognomonic, since they can be present in tuberculosis, peripheral carcinoma, and echinococcosis. Pulmonary angiography and fine-needle biopsy make it possible to differentiate a benign lung tumor from a malignant one.

With a benign tumor, the vessels go around the tumor in the lung; with a malignant tumor, “amputation” of the vessels approaching it is visible. Bronchoscopy, the most important method for diagnosing the disease, can reveal:

displacement of bronchial branches,

changing the angle of their departure,

sometimes narrowing of the lumen of the bronchus due to compression from the outside.

The final diagnosis can be made by puncture biopsy, which is carried out under the guidance of computed tomography or ultrasound examination.

In cases where special research methods do not make it possible to make a diagnosis, thoracoscopy or thoracotomy is performed and a biopsy is performed.

Treatment methods for benign lung tumors

Surgery disease is the method of choice. The earlier the tumor is removed, the less trauma and volume surgical intervention, less risk of complications and irreversible changes in the lungs. Early tumor removal avoids the risk of malignancy and metastasis.

Tumor treatment methods

In the early stage of development of a central, obviously benign tumor, located on a very thin stalk, it can be removed through a bronchoscope. However, such treatment is associated with the danger of bleeding and insufficient radical removal of the tumor, with the need for repeated endoscopic control and possible biopsy the wall of the bronchus on which the tumor stalk was located.

It is recommended to remove central tumors by sparing resection of the bronchus (without lung tissue). If the base of the tumor is narrow, then it can be removed by bronchotomy or economical fenestrated resection of part of the bronchial wall at the base of the tumor. The resulting hole in the bronchial wall is sutured.

For large formations that have a wide base, benign lung tumors are treated in the form of a circular resection of the bronchial tube with interbronchial anastomosis. If the diagnosis is made late, when irreversible changes have occurred in the lung distal to the obstruction of the bronchus (poststenotic abscesses, bronchiectasis, fibrosis of the lung tissue), a circular resection of the bronchus is performed along with the affected one or two lobes of the lung and an interbronchial anastomosis with the bronchus of the remaining healthy lobe (lobes) of the lung is performed .

With irreversible changes in the entire lung, the only thing possible operation pneumonectomy remains.

Peripheral tumors, depending on the size and depth of their location in the thickness of the lung, are removed by enucleation, marginal or segmental resection of the lung, and in case of significant size of the lung tumor and irreversible changes in the lung tissue, a lobectomy is performed.

Benign lung tumors - a collective concept that includes a large number of tumors of various origins and histological structures, having different localization and features of the clinical course.
Although benign lung tumors are much less common than cancer, they make up about 7-10% of all lung tumors.
Often the distinction between benign and malignant lung tumors is very arbitrary. Some benign tumors initially have a tendency to malignancy, with the development of infiltrative growth and metastasis. However, the vast majority of authors believe that the existence of the concept of “benign lung tumors” as a clinical and morphological group is completely justified. Despite the difference in histological structure, benign lung tumors share slow growth over many years, the absence or paucity of clinical manifestations before complications occur, and most importantly, the relative rarity of malignancy, which sharply distinguishes them from lung cancer or sarcoma and determines other approaches to the choice of tactics and methods of surgical treatment.
Classification and pathological anatomy
From point of view anatomical structure All Benign lung tumors are divided into central and peripheral. TO central include tumors from the main, lobar and segmental bronchi. The main direction of growth in relation to the bronchial wall can be different and is characterized by predominantly endobronchial, extrabronchial or mixed growth. Peripheral tumors develop from more distal bronchi or from elements of lung tissue. They can be located at different distances from the surface of the lungs. There are superficial (subpleural) and deep tumors. The latter are often called intrapulmonary. They can be localized in the hilar, middle or cortical zones of the lung.
Peripheral benign tumors are somewhat more common than central ones. Moreover, they can equally often be localized in both the right and left lungs. For central benign lung tumors, right-sided localization is more typical. Unlike cancer lung benign tumors predominantly develop from the main and lobar bronchi, rather than from segmental bronchi.
Adenomas are the most frequent type histological structure of central tumors, and hamartomas- peripheral. Of all the rare benign tumors, only papilloma has a predominantly central localization, and teratoma located in the thickness of the lung tissue. The remaining tumors can be either central or peripheral, although peripheral localization is more typical for neurogenic neoplasms.

Adenoma
All adenomas are epithelial tumors, developing mainly from the glands of the bronchial mucosa. Among all benign lung tumors, adenomas account for 60-65%. In the vast majority of cases (80-90%) they are centrally localized.
Central adenomas, starting to develop in the wall of the bronchus, most often grow expansively into the lumen of the bronchus, pushing back the mucous membrane, but not growing through it. As the tumor grows, compression of the mucous membrane leads to its atrophy and sometimes to ulceration. With the endobronchial type of growth, adenomas appear quite quickly and signs of bronchial obstruction increase. With extrabronchial growth, the tumor can spread within the bronchus or outside of it. Often there is a combination of different types of tumor growth - mixed growth. Taking into account the benign nature of the course of most carcinoids, cylindrimas and mucoepidermoid tumors in clinical practice, it is advisable to consider them as benign tumors with a tendency to malignancy and on this basis conditionally retain the term “adenomas” for them, which histological structure are divided into 4 main types: carcinoid type (carcinoids), mucoepidermoid type, cylindromatous type (cylindromas) and combined adenomas, which combine the structure of carcinoids and cylindrimas.
Carcinoids among all adenomas, they occur most often, in 81-86%. These tumors develop from poorly differentiated epithelial cells. The cells are arranged in solid islands in the form of tubes and rosettes and form mosaic structures.
There are highly differentiated (typical) carcinoid, moderately differentiated (atypical) carcinoid and poorly differentiated (anaplastic and combined) carcinoid. Tumor malignancy develops in 5-10% of cases. Malignant carcinoid has infiltrative growth and the ability to lymphogenous and hematogenous metastasis to distant organs and tissues - liver, other lung, bones, brain, skin, kidneys, adrenal glands, pancreas. It differs from cancer in its slower growth and much later metastasis, radical operations give good long-term results, local relapses are much less common.
Adenomas of other histological types are much less common than carcinoids. They also have the ability to become malignant.

Hamartoma
The term “hamartoma” (from the Greek “hamartia” - error, flaw) was originally proposed in 1904 by E. Albrecht for dysembryogenetic liver formations. It has many synonyms. In American literature, hamartomas are often called chonroadenomas.
Hamartoma is the second most common benign tumor of the lungs and the first among peripheral formations of this localization. More than half of all peripheral benign lung tumors (60-64%) are hamartomas.
Hamartoma is a tumor of congenital origin, in which various elements of germinal tissue may be present. In most hamartomas, islands of mature cartilage of atypical structure are found, surrounded by layers of fat and connective tissue. Slit-like cavities lined with glandular epithelium may occur. The tumor may include thin-walled vessels, smooth muscle fibers, and accumulations of lymphoid cells.
Hamartoma most often is a dense, round formation, with a smooth or, more often, finely lumpy surface. The tumor is completely clearly demarcated from the surrounding tissue, has no capsule and is surrounded by displaced pulmonary tissue. Hamartomas are located in the thickness of the lung - intrapulmonary or superficial - subpleural. They can compress the vessels as they grow and bronchi of the lung, but they do not germinate.
Hamartomas are most often located in the anterior segments of the lungs. They grow slowly, and cases of rapid growth are casuistry. The possibility of their malignancy is extremely small; observations of the transformation of a hamartoma into a malignant tumor - hamartoblastoma - are only possible.

Fibroids lungs are found among other benign tumors of this location in 1-7.5% of cases. The disease occurs predominantly in men, and both the right and left lungs can be affected equally often. Typically, peripheral localization of the tumor is observed. Peripheral fibromas can sometimes be connected to the lung by a narrow stalk. Fibroids, as a rule, are small in size - 2-3 cm in diameter, but can reach gigantic tumor sizes, occupying almost half of the tumor. chest cavity. There is no convincing data on the possibility of malignancy of pulmonary fibroids.
Macroscopically, fibroma is a dense tumor node of a whitish color with a smooth smooth surface. With central localization of fibroma during bronchoscopy, the endobronchial surface of the tumor has a whitish or reddish color due to hyperemia of the mucous membrane. Ulcerations can sometimes be seen on the mucous membrane covering the fibroma.
The tumor has a well-formed capsule that clearly demarcates it from the surrounding tissues. The consistency of the tumor is densely elastic. On the section, the tumor tissue is usually grayish in color, areas of varying density are noted, and sometimes there are foci of ossification and cystic cavities.
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Papiloma - a tumor that develops exclusively in the bronchi, mainly large ones. Another name for papilloma is fibroepithelioma. It is quite rare, occurring in 0.8-1.2% of all benign lung tumors. In most cases, bronchial papilomas are combined with papilomas of the trachea and larynx. The tumor is always covered with epithelium on the outside and grows exophytically, that is, into the lumen of the bronchus, often completely obstructing it. Over time, papillomas can become malignant.
Macroscopically, papilloma is a delimited formation on a stalk or broad base with an uneven lobulated fine- or coarse-grained surface, with a color ranging from pink to dark red. By appearance papilloma may resemble “cauliflower,” “raspberries,” or “cockscomb.” Its consistency is usually soft-elastic, less often - hard-elastic.

Oncocytoma - epithelial tumor, most likely arising from the bronchial glands, in which specific large light cells with zosinophilic granularity of the cytoplasm and a small dark nucleus are found - oncocytes, which form the basis of the neoplasm. Oncocytomas occur in the salivary and thyroid glands, kidneys. Primary pulmonary localization of the tumor is an extremely rare phenomenon; about ten similar observations have been described in the literature.
Lung oncocytomas are detected in young and middle-aged people, localized in the wall of the bronchus, protruding into its lumen in the form of a polypoid formation, sometimes completely obstructing it and growing peribronchially in the form of a clearly defined node. There is also a lung tumor of peripheral localization. Oncocytomas have a thin capsule that separates them from surrounding tissue. They have a benign course.

Vascular tumors occur in 2.5-3.5% of all cases of benign lung tumors. Neither include hemangioendothelioma, hemangiopericytoma and capillary hemangioma. In addition, other vascular tumors are found in the lungs - cavernous hemangioma, glomus tumor, tumors from lymphatic vessels - lymphangiomas. All of them can have both central and peripheral localization.
All vascular tumors have a round shape, a dense or densely elastic consistency and a connective tissue capsule. The surface color varies from light pink to dark red. The size of the tumor can vary - from a few millimeters in diameter to very significant (20 cm or more). Small vascular tumors are diagnosed, as a rule, when they are localized in large bronchi and develop hemoptysis or pulmonary hemorrhage.
Hemangioendotheliomas and hemangiopericytomas have rapid, often infiltrative growth, a tendency to malignant degeneration, followed by rapid generalization of the tumor process. Many authors suggest classifying these vascular tumors as conditionally benign. In contrast to them, capillary and cavernous hemangiomas are not prone to malignancy, are characterized by limited growth, and increase slowly.

Neurogenic tumors can develop from nerve sheath cells (neurinoma, neurofibroma), from sympathetic cells nervous system(ganglioneuromas), from non-chromaffin paraganglia (chemodectomas and pheochromocytomas). Of the benign neurogenic tumors in the lungs, neuromas and neurofibromas are predominantly observed, and chemodectomas are much less common.
In general, neurogenic tumors are rarely detected in the lungs, accounting for about 2% of all cases of benign neoplasms. They can occur at any age, equally often in both the right and left lungs. All neurogenic tumors in the vast majority of cases have a peripheral location. Sometimes they are connected to a lung stalk. Central tumors with endobronchial localization are very rare. Neuromas and neurofibromas are sometimes observed simultaneously in both lungs. Multiple pulmonary neurofibromas can be a manifestation of neurofibromatosis - Recklinghausen's disease.
Neurogenic tumors usually grow slowly, in rare cases reaching large sizes. Macroscopically, they are rounded dense nodes with a pronounced capsule; on a section they have a grayish-yellow color. The question of the possibility of malignancy of neurogenic tumors is highly controversial. Along with the existing opinion about a purely benign course of the disease, a number of authors provide observations of malignancy in neurogenic lung tumors. Moreover, some authors suggest that neuromas are potentially malignant neoplasms.

Lipoma - benign tumor of adipose tissue. It is quite rare in the lungs. Mostly lipomas develop in large bronchi (main, lobar), the wall of which contains adipose tissue detected by microscopic examination, but they can also occur in more distal parts of the bronchial tree. Lung lipomas can also have peripheral localization. Lung lipomas are somewhat more common in men; their age and location are not typical. With the endobronchial location of the tumor, the clinical manifestations of the disease increase as the drainage function of the affected parts of the lung is disrupted with characteristic symptoms. Detection of a peripheral lung lipoma is usually an incidental radiological finding. The tumor grows slowly and malignancy is not typical for it.
Macroscopically, lipomas have a round or lobular shape, a dense elastic consistency, and a clearly defined capsule. On the cut they yellowish color, lobular structure. The bronchoscopic picture of endobronchial lipoma is characteristic - a smooth-walled formation about round shape, pale yellow. On microscopic examination, the lipoma consists of mature fat cells, with connective tissue septa separating the islands of adipose tissue.
Leiomyoma is a rare benign tumor of the lungs that develops from the smooth muscle fibers of the bronchial wall or blood vessels. More common in women. It can have both central and peripheral localization. Central tumors have the appearance of a polyp on a stalk or broad base. Peripheral leiomyomas can be in the form of multiple nodes. Tumors grow slowly, sometimes reaching significant sizes. Leiomyomas have a soft consistency and are surrounded by a well-defined capsule.

Teratoma - formation of dysembryonic origin, usually consisting of several types of tissues. It may be in the form of a cyst or a dense tumor. It has many synonyms - dermoid, dermoid cyst, complex tumor, embryoma, etc. It is relatively rare in the lungs - about 1.5-2.5% of all cases of benign neoplasms. It is detected mainly at a young age, although observations of teratomas have been described in elderly and even old age. Teratoma grows slowly; in the presence of a cyst, its suppuration may develop due to secondary infection. The tumor may become malignant. Malignant teratoma (teratoblastoma) has invasive growth, growing into the parietal pleura and neighboring organs. Teratomas are always located peripherally, and lesions are often observed upper lobe left lung. The tumor has a round shape, a lumpy surface, and a dense or densely elastic consistency. The capsule is clearly defined. The wall of the cyst consists of connective tissue, lined from the inside with single-layer or multilayer epithelium. A dermoid cyst can be unilocular or multilocular, and the cavity usually contains yellow or brownish fat-like masses, hair, teeth, bones, cartilage, sweat and sebaceous glands.

Clinic and diagnostics
Benign lung tumors are observed equally often in men and women. They are most often recognized in faces young up to 30-35 years. The symptoms of benign lung tumors are varied. They depend on the location of the tumor, the direction of its growth, the degree of bronchial obstruction, and the presence of complications.
To complications The course of benign lung tumors includes: atelectasis, pneumofibrosis, bronchiectasis, abscess pneumonia, bleeding, compression syndrome, tumor malignancy, metastasis.
Benign lung tumors may not have any clinical manifestations of the disease for quite a long time. This is especially true for peripheral tumors. Therefore, in accordance with the characteristics of the clinical course, several stages are distinguished:
Stage I - asymptomatic;
Stage II - with initial and
Stage III - with pronounced clinical manifestations.
With central tumors, the speed and severity of the development of clinical manifestations of the disease and complications are largely determined by the degree of bronchial obstruction. There are 3 degrees of bronchial obstruction:
I - partial bronchoconstriction;
II - valvular or valve bronchostenosis;
III - bronchial occlusion.
In accordance with the three degrees of bronchial obstruction, three clinical periods of the disease are distinguished.
First clinical period corresponds to partial bronchostenosis, when the lumen of the bronchus is not yet significantly narrowed. It is most often asymptomatic. Patients sometimes note a cough, the appearance of a small amount of sputum, and rarely hemoptysis. General condition remains good. The X-ray picture is often normal. Only sometimes there are signs of hypoventilation of the lung area. The intrabronchial tumor itself can be detected by linear tomography, bronchography, and CT.
Second clinical period associated with the occurrence of so-called valvular or valve bronchial stenosis. It occurs when the tumor already occupies most of the lumen of the bronchus, but the elasticity of its walls is still preserved. With valvular stenosis, the lumen of the bronchus partially opens at the height of inspiration and is closed by the tumor during exhalation. In the area of the lung ventilated by the affected bronchus, expiratory emphysema occurs. During this period, complete obstruction of the bronchus may occur due to swelling of the mucous membrane and blood sputum. At the same time, ventilation disturbances and inflammatory phenomena occur in the lung tissue located to the periphery of the tumor. Clinical symptoms of the second period are already clearly expressed: body temperature rises, cough with mucous or mucopurulent sputum appears, shortness of breath, there may be hemoptysis, chest pain, weakness, and fatigue appear.
An X-ray examination, depending on the location and size of the tumor, the degree of bronchial obstruction, reveals ventilation disturbances and inflammatory changes in a segment, several segments, a lobe of the lung or in the entire lung. The phenomena of hypoventilation and even atelectasis of the lung area, during this period, can be replaced by a picture of the development of its emphysema and vice versa. The supposed diagnosis, as in the first period, can be clarified with linear tomography, bronchography, CT.
In general, the second period is characterized by an intermittent course of the disease. Under the influence of treatment, swelling and inflammation in the tumor area decrease, lung ventilation is restored and the symptoms of the disease may disappear for some period.
Third clinical period and its clinical manifestations are associated with complete and persistent obstruction of the bronchus by the tumor, with the development of pulmonary suppuration in the area of atelectasis, irreversible changes in the lung tissue and its death. The severity of the clinical picture largely depends on the caliber of the obstructed bronchus and the volume of affected lung tissue. Characteristic are long promotions body temperature, chest pain, shortness of breath, sometimes suffocation, weakness, increased sweating, general malaise. A cough occurs with purulent or mucopurulent sputum, often mixed with blood. With some types of tumors, pulmonary hemorrhage may develop.
During this period, partial or complete atelectasis of the lung, lobe, segment with the possible presence of inflammatory purulent-destructive changes, bronchiectasis is determined radiologically. Linear tomography reveals a “bronchus stump”. The most accurate assessment of the intrabronchial tumor itself and the condition of the lung tissue is possible using computed tomography data.
The motley, uncharacteristic picture of physical symptoms in central lung tumors is dominated by dry and moist rales, weakening or complete absence of respiratory sounds, and local dullness of percussion sound. In patients with long-term obstruction of the main bronchus, asymmetry is detected chest, narrowing of the intercostal spaces, deepening of the supraclavicular and subclavian fossae, lag of the corresponding half of the chest during respiratory movements.
The severity and rate of development of bronchial obstruction depends on the intensity and nature of tumor growth. For tumors growing peribronchially, clinical symptoms develops slowly, complete obstruction of the bronchus rarely occurs.
Peripheral benign lung tumors do not manifest themselves in the first, asymptomatic period. In the second and third, i.e. During the initial period and the period of pronounced clinical manifestations, the symptoms and clinical picture of peripheral benign tumors are determined by the size of the tumor, the depth of its position in the lung tissue and the relationship with the adjacent bronchi, vessels, and organs. A large tumor, reaching the chest wall or diaphragm, can cause chest pain and difficulty breathing; when localized in the medial parts of the lung - pain in the heart area. If the tumor causes arrosion of the vessel, hemoptysis or pulmonary hemorrhage occurs. When a large bronchus is compressed, the so-called “centralization” of the peripheral tumor occurs. The clinical picture in this case is due to the phenomena of impaired bronchial patency of a large bronchus and is similar to the clinical picture of the central tumor.
Peripheral benign lung tumors are usually detected without difficulty through the usual x-ray examination. At the same time, they are displayed in the form of rounded shadows of various sizes with clear, but not entirely even contours. Their structure is often homogeneous, but there may be dense inclusions: blocky calcifications, characteristic of hamartomas, bone fragments in teratomas. A detailed assessment of the structure of benign tumors is possible using CT data. This method allows you to reliably determine, in addition to dense inclusions, the presence of fat, characteristic of lipomas, hamartomas, fibromas, and fluid - in vascular tumors, dermoid cysts. CT scan using the contrast bolus amplification technique also allows for the degree of densitometric indicators pathological formations It is sufficiently reliable to carry out differential diagnosis of benign tumors with peripheral cancer and metastases, tuberculomas, and vascular tumors.

Bronchoscopy is the most important method for diagnosing central tumors. When it is performed, a tumor biopsy is performed, which makes it possible to make an accurate morphological diagnosis. Obtaining material for cytological and histological studies It is also possible with peripheral lung tumors. For these purposes, transthoracic aspiration or puncture biopsy and transbronchial deep catheterization are performed. Biopsies are performed under x-ray guidance.
A peculiar clinical picture, the so-called “carcinoid syndrome,” in some cases may be accompanied by the course of lung carcinoids. Characteristic properties These tumors are the secretion of hormones and other biologically active substances.
The clinical picture of carcinoid syndrome is characterized by periodically occurring sensations of heat in the head, neck and upper extremities, diarrhea, bronchospasm attacks, dermatosis, and mental disorders. In women with bronchial adenomas, during the period of hormonal changes associated with the ovarian-menstrual cycles, hemoptysis may be observed. Carcinoid syndrome does not occur frequently in bronchial carcinoids, only in 2-4% of cases, which is 4-5 times less common than in carcinoid tumors digestive tract. When an adenoma of the carcinoid type becomes malignant, the frequency of development and severity of the clinical manifestations of carcinoid syndrome increases significantly.

– malignant tumors that originate in the mucous membrane and glands of the bronchi and lungs. Cancer cells divide quickly, enlarging the tumor. Without proper treatment, it grows into the heart, brain, blood vessels, esophagus, and spine. The bloodstream carries cancer cells throughout the body, forming new metastases. There are three phases of cancer development:

The biological period is from the moment the tumor appears until its signs are recorded on x-rays (grade 1-2).
Preclinical - asymptomatic period manifests itself only on x-rays (grade 2-3).
Clinical shows other signs of the disease (grade 3-4).

Causes

The mechanisms of cell degeneration are not fully understood. But thanks to numerous studies, chemical substances, capable of accelerating cell transformation. We will group all risk factors according to two criteria.

Reasons beyond a person's control:

Genetic predisposition: at least three cases of a similar disease in the family or the presence of a similar diagnosis in a close relative, the presence of several different forms of cancer in one patient.
Age after 50 years.
Tuberculosis, bronchitis, pneumonia, scars on the lungs.
Problems of the endocrine system.

Modifiable factors (what can be influenced):

Smoking is the main cause of lung cancer. When tobacco is burned, 4,000 carcinogens are released, covering the bronchial mucosa and burning living cells. Together with the blood, the poison enters the brain, kidneys, and liver. Carcinogens settle in the lungs until the end of life, covering them with soot. Smoking experience of 10 years or 2 packs of cigarettes per day increases the chance of getting sick by 25 times. Passive smokers are also at risk: 80% of exhaled smoke comes from them.
Professional contacts: asbestos-related factories, metallurgical enterprises; cotton, linen and felt mills; contact with poisons (arsenic, nickel, cadmium, chromium) at work; mining (coal, radon); rubber production.
Poor ecology, radioactive contamination. The systematic influence of air polluted by cars and factories on the lungs of the urban population changes the mucous membrane of the respiratory tract.

Classification

There are several types of classification. In Russia, there are five forms of cancer depending on the location of the tumor.

Central cancer- in the lumen of the bronchi. In the first degree, it is not detected on photographs (masks the heart). The diagnosis may be indicated indirect signs X-ray: decreased airiness of the lung or regular local inflammation. All this is combined with a persistent cough with blood, shortness of breath, and later chest pain and fever.
Peripheral cancer penetrates into the lungs. Painful sensations no, the diagnosis is determined by x-ray. Patients refuse treatment, not realizing that the disease is progressing. Options:
- Cancer of the apex of the lung grows into the vessels and nerves of the shoulder. In such patients, osteochondrosis takes a long time to be treated, and they get to the oncologist late.
- The cavity form appears after the collapse of the central part due to lack of nutrition. Neoplasms up to 10 cm are confused with an abscess, cysts, tuberculosis, which complicates treatment.
Pneumonia-like cancer treated with antibiotics. Without getting the desired effect, they end up in oncology. The tumor is distributed diffusely (not in a node), occupying most of the lung.
Atypical forms: brain, liver, bone create metastases in lung cancer, and not the tumor itself.
- The hepatic form is characterized by jaundice, heaviness in the right hypochondrium, deterioration of blood tests, and enlarged liver.
- The cerebral one looks like a stroke: a limb does not work, speech is impaired, the patient loses consciousness, headache, convulsions, double vision.
- Bone – pain symptoms in the spine, pelvic region, limbs, fractures without injury.
Metastatic neoplasms originate from a tumor of another organ with the ability to grow, paralyzing the functioning of the organ. Metastases up to 10 cm lead to death from decay products and dysfunction of internal organs. The primary source is the maternal tumor cannot always be determined.

According to histological structure (cell type), lung cancer can be:

Small cell– the most aggressive tumor, quickly occupies and metastasizes already at early stages. Frequency of occurrence – 20%. Forecast – 16 months. with non-advanced cancer and 6 months. - when widespread.
Non-small cell It is more common and characterized by relatively slow growth. There are three types:
- squamous cell lung cancer (from flat lamellar cells with slow growth and a low incidence of early metastases, with areas of keratinization), prone to necrosis, ulcers, and ischemia. 15% survival rate.
- adenocarcinoma develops from glandular cells. It spreads quickly through the bloodstream. Survival rate is 20% with palliative treatment, 80% with surgery.
- large cell carcinoma has several varieties, is asymptomatic, and occurs in 18% of cases. Average survival rate 15% (depending on type).

Stages

Lung cancer stage 1. A tumor up to 3 cm in diameter or a bronchial tumor in one lobe; there are no metastases in neighboring lymph nodes.
Lung cancer stage 2. A tumor in the lung is 3-6 cm, blocks the bronchi, grows into the pleura, causes atelectasis (loss of airiness).
Lung cancer stage 3. A tumor of 6-7 cm spreads to neighboring organs, atelectasis of the entire lung, the presence of metastases in neighboring lymph nodes (root of the lung and mediastinum, supraclavicular zones).
Lung cancer stage 4. The tumor grows in the heart, large vessels, fluid appears in the pleural cavity.

Symptoms

Common symptoms of lung cancer

Fast weight loss,
no appetite,
decline in performance,
sweating,
unstable temperature.

Specific signs:

a debilitating cough without an obvious reason is a companion to bronchial cancer. The color of the sputum changes to yellow-green. IN horizontal position, physical exercise, in the cold, coughing attacks become more frequent: a tumor growing in the area of the bronchial tree irritates the mucous membrane.
Blood when coughing is pinkish or scarlet, with clots, but hemoptysis is also a sign.
Shortness of breath due to inflammation of the lungs, collapse of part of the lung due to tumor blockage of the bronchial tube. With tumors in large bronchi, organ shutdown may occur.
Chest pain due to the penetration of cancer into the serous tissue (pleura), growing into the bone. At the beginning of the disease there are no warning signs; the appearance of pain indicates an advanced stage. The pain can radiate to the arm, neck, back, shoulder, intensifying when coughing.

Diagnostics

Diagnosing lung cancer is not an easy task, because oncology looks like pneumonia, abscesses, and tuberculosis. More than half of tumors are detected too late. For the purpose of prevention, it is necessary to undergo an x-ray annually. If cancer is suspected, they undergo:

Fluorography to determine tuberculosis, pneumonia, lung tumors. If there are deviations, you need to take an x-ray.
X-ray of the lungs more accurately assesses the pathology.
Layer-by-layer X-ray tomography of the problem area - several sections with the focus of the disease in the center.
Computed tomography or magnetic resonance imaging with the introduction of contrast on layer-by-layer sections shows in detail and clarifies the diagnosis according to explicit criteria.
Bronchoscopy diagnoses central cancer tumors. You can see the problem and take a biopsy - a piece of affected tissue for analysis.
Tumor markers test the blood for a protein produced only by the tumor. The NSE tumor marker is used for small cell cancer, the SSC and CYFRA markers are used for squamous cell carcinoma and adenocarcinoma, and CEA is a universal marker. The diagnostic level is low; it is used after treatment for early detection of metastases.
Sputum analysis has a low probability of suggesting the presence of a tumor if atypical cells are detected.
Thoracoscopy - examination through camera punctures in pleural cavity. Allows you to take a biopsy and clarify changes.
A biopsy with a CT scan is used when there is doubt about the diagnosis.

The examination must be comprehensive, because cancer masquerades as many diseases. Sometimes they even use exploratory surgery.

Treatment

Type (radiological, palliative,) is selected based on the stage of the process, histological type of tumor, medical history). The most reliable method is surgery. For stage 1 lung cancer, 70-80%, stage 2 - 40%, stage 3 - 15-20% of patients survive the control period of five years. Types of operations:

Removal of a lobe of the lung corresponds to all principles of treatment.
Marginal resection removes only the tumor. Metastases are treated in other ways.
Removal of the lung completely (pneumoectomy) - with a tumor of 2 degrees for central cancer, 2-3 degrees - for peripheral cancer.
Combined operations - with the removal of part of the adjacent affected organs.

Chemotherapy has become more effective thanks to new drugs. Small cell lung cancer responds well to polychemotherapy. With the right combination (taking into account sensitivity, 6-8 courses with an interval of 3-4 weeks), survival times increase 4 times. Chemotherapy for lung cancer. runs courses and gives positive result for several years.

Non-small cell cancer is resistant to chemotherapy (partial tumor resorption occurs in 10-30% of patients, complete resorption is rare), but modern polychemotherapy increases survival rate by 35%.

They also treat with platinum preparations - the most effective, but also the most toxic, which is why they are administered with large (up to 4 liters) amounts of liquid. Possible adverse reactions: nausea, intestinal disorders, cystitis, dermatitis, phlebitis, allergies. The best results are achieved with a combination of chemotherapy and radiation therapy, simultaneously or sequentially.

Radiation therapy uses gamma-ray installations of beta-trons and linear accelerators. The method is designed for inoperable patients of grade 3-4. The effect is achieved due to the death of all cells of the primary tumor and metastases. Good results receive at small cell cancer. In case of non-small cell irradiation, irradiation is carried out according to a radical program (in case of contraindications or refusal of surgery) for patients of 1-2 degrees or for palliative purposes for patients of 3 degrees. Standard dose for radiation treatment– 60-70 gray. In 40% it is possible to achieve a reduction in the oncological process.

Palliative care - operations to reduce the impact of the tumor on the affected organs to improve the quality of life with effective pain relief, oxygenation (forced oxygen saturation), treatment of associated diseases, support and care.

Traditional methods are used exclusively to relieve pain or after radiation and only in consultation with a doctor. Relying on healers and herbalists for such a serious diagnosis increases the already high risk of death.

Forecast

The prognosis for lung cancer is unfavorable. Without special treatment, 90% of patients die within 2 years. The prognosis is determined by the degree and histological structure. The table presents data on the survival rate of cancer patients for 5 years.

Stage lung cancer	Small cell cancer	Non-small cell cancer
1A tumor up to 3cm
1B a tumor of 3-5 cm does not spread to others. areas and lymph nodes
2A tumor 5-7cm without metastasis to lymph nodes or up to 5 cm, legs with metastases.
2B tumor 7cm without metastasis or less, but with damage to neighboring lymph nodes
3A tumor more than 7 cm with damage to the diaphragm, pleura and lymph nodes
3B spreads on diaphragm, middle of the chest, lining of the heart, other lymph nodes
4 the tumor metastasizes to other organs, accumulation of fluid around the lung and heart

Benign lung tumors are a broad concept that implies a fairly large number of neoplasms that differ from each other in etymology, morphological structure, place of formation, but have several main common features, these are:

slow growth over several years;
no metastasis or very little spread;
absence of clinical manifestations before complications;
impossibility of degeneration into oncological neoplasms.

Benign lung tumors are a dense nodular formation of an oval or round shape. They develop from highly differentiated cells, which in their structure and functions are in many ways similar to healthy ones. However, the morphological structure of the neoplasm differs significantly from normal cells.

Benign tumor affects the lung much less often than malignant. It is mainly diagnosed in people under forty years of age, regardless of gender.

The methods and tactics of treating this pathology differ significantly from the methods of combating cancerous tumors organ.

The reasons for the appearance of benign tumors today are difficult to clearly identify, since research in this direction continues. However, a certain pattern of this pathology has been identified. Factors that provoke mutation of typical cells and their degeneration into atypical ones include:

heredity;
disorders at the gene level;
viruses;
smoking;
bad ecology;
aggressive UV radiation.

Classification of benign tumors

Benign tumors of the respiratory system are categorized according to the following criteria:

anatomical structure;
morphological composition.

An anatomical study of the disease provides complete information about where the tumor originated and in which direction it is growing. According to this principle, lung tumors can be central or peripheral. The central neoplasm is formed from large bronchi, the peripheral one - from distal branches and other tissues.

Histological classification designates tumors in accordance with the tissues from which they were formed this pathology. There are four groups of pathological formations:

epithelial;
neuroectodermal;
mesodermal;
germinal, these are congenital tumors - teratoma and hamartoma.

Rarely occurring forms of benign lung tumors are: fibrous histiocytoma (tissues of inflammatory origin are involved), xanthomas (connective or epithelial tissues), plasmacytoma (neoplasm arising in connection with a disorder of protein metabolism), tuberculomas. Most often, the lungs are affected by adenoma of central location and hamartoma with peripheral location.

According to clinical manifestations There are three degrees of development of the disease. The key point in determining the stage of growth of the central tumor is bronchial patency. So:

the first degree is marked by partial blockage;
the second is manifested by a violation respiratory function on exhalation;
third degree is complete dysfunction of the bronchus, it is excluded from their breathing.

Peripheral tumors in the lungs are also determined by three stages of pathology progression. At the first stage, clinical symptoms do not appear, at the second they are minimal, the third stage is characterized by acute symptoms pressure of the tumor on nearby soft tissues and organs, painful sensations appear in the sternum and heart area, and difficulty breathing appears. When the tumor damages the blood vessels, hemoptysis and pulmonary hemorrhage occur.

Depending on the degree of tumor development, accompanying symptoms appear. At the initial stage, when the bronchial tube is slightly obstructed, there are practically no special symptoms. From time to time you may experience a cough with copious sputum, sometimes with signs of blood. General health is normal. On at this stage It is impossible to detect a tumor using X-ray; more methods are used to diagnose it. deep methods research.

At the second stage of tumor development, bronchial valve stenosis is formed. With a peripheral tumor, the inflammatory process begins. At this stage, anti-inflammatory therapy is used.

Complete bronchial obstruction occurs at the third clinical stage of a benign neoplasm. The severity of the third degree is also determined by the volume of the neoplasm and the area of the organ affected by it. This pathological condition is accompanied high temperature, attacks of suffocation, coughing with purulent sputum and blood, and even pulmonary bleeding. A third-degree benign lung tumor is diagnosed using X-rays and tomography.

Diagnosis of benign neoplasms

Benign tumors are easily identified using x-ray examination and fluorography. On x-rays, the pathological compaction is indicated as a dark round spot. The structure of the neoplasm has dense inclusions. The morphological structure of the pathological compaction is studied using CT scan of the lungs. Using this procedure, the density of atypical cells and the presence of additional inclusions in them are determined. The CT method allows you to determine the nature of the formation, the presence of metastases and other details of the disease. Bronchoscopy is also prescribed, together with which a biopsy is performed for a deep morphological examination of the neoplasm material.

Neoplasms of a peripheral location are studied using transthoracic puncture or biopsy under ultrasound guidance. Pulmonary angiography examines vascular tumors in the lungs. If all the diagnostic methods described above do not allow obtaining complete data on the nature of the tumor, then thoracoscopy or thoracomy is used.

Treatment of lung tumors

Any pathological change in the body requires proper attention from medicine and, of course, a return to a normal state. The same applies to tumor neoplasms, regardless of their etymology. A benign tumor must also be removed. The degree of complexity of surgical intervention depends on early diagnosis. Removing a small tumor is less traumatic for the body. This method makes it possible to minimize risks and prevent the development of irreversible processes.

Centrally located tumors are removed using gentle bronchial resection without damaging the lung tissue.

Neoplasms on a narrow base undergo fenestrated resection of the bronchial wall, after which the lumen is sutured.

The tumor in the wide part of the base is removed by circular resection, after which an interbronchial anastomosis is performed.

In severe stages of the disease, when pathological seals in the respiratory organ grow and cause a number of complications, the doctor decides to remove its lobes. When irreversible processes begin to appear in the lungs, pneumonectomy is prescribed.

Lung neoplasms that are peripherally located and localized in the lung tissue are removed using enucleation, segmental or marginal resection.

Large tumors are removed using lobectomy.

Benign neoplasms in the lungs with a central location, which have a thin stalk, are removed endoscopic method. When performing this procedure, there is a risk of bleeding, as well as incomplete removal of tumor tissue.

If there is a suspicion of a malignant tumor, then the material obtained after removal is sent for histological examination. In the case of a malignant tumor, the entire spectrum is performed necessary procedures with this pathology.

Benign lung tumors respond well to treatment. Once removed, their reoccurrence is quite rare.

The exception is carcinoid. The prognosis for survival with this pathology depends on its type. If it is formed from highly differentiated cells, then the result is positive and patients are 100% free from this disease, but with poorly differentiated cells the five-year survival rate does not exceed 40%.

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