Benign Tumors of the Lungs with Special Reference to Adenomatous Bronchial Tumors  ALFRED GOLDMAN, M.D., F.C.C.P., CHARLES L. CONNER, M.D.  Diseases of the Chest  Volume 17, Issue 6, Pages 644-680 (June 1950) DOI: 10.1378/chest.17.6.644 Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 1 HISTORY OF BRONCHIAL ADENOMA AS NEW CLINICAL ENTITY Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 2 AGE OF INCIDENCE — BRONCHIAL ADENOMA Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 3 Note the two types of glandular epithelium, clear serous and dark mucous secreting cells, which form the mixed glands of trachea and bronchi. The origin of adenomatous bronchial tumors is from the epithelium of these glands and their ducts. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 4, Case 12 G.D. Two sections from the same tumor, the gross picture of which is shown in Figure 15—Sections from surgical specimen removed by left lower lobectomy. Note the bone formation, muco-epithelial stroma, and the mixed tumor type of pattern. Total duration 20 years, alive and well 9½ years after lobectomy. Same case as Figures 7 and 15. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

Figure 5, Case 32 A.H. Tumor removed through a bronchoscope from subcarnial area. Duration 6 years. These different fields from the same section and show, above (Fig. 5), the pattern of a “mixed” tumor of a salivary gland, and below (Fig. 5A), an adenoma with a mucous connective tissue type of stroma. This is usually called mixed tumor or cylindroma, but cystic basal cell epithelioma is probably a more accurate description. Patient expired of asphyxial symptoms with local metastases 6½ years after onset. Radiation and bronchoscopic treatment. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 6, Case 35 A.P., female, age 14. Early adenomatous bronchial tumor glandular type. Microphoto showing solid glandular pattern of the sero-mucous glands. Groups of cells with small dark staining nuclei tending to differentiate into myoepithelium at the periphery of cell masses and along the septa. × 150 from surgical specimen removed at transpleural bronchotomy. Sections are similar to clear cell papillary cystadenoma of salivary glands (Bauer). Total duration 2 years, alive and well one year after bronchotomy. Same case as Figs. 18 and 19. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 7, Case 12 G.D. Artist's drawing of bronchoscopic views of adenomatous bronchial tumor, mixed tumor type, in the left lower lobe. Only the tip of this 7.0 cm. tumor is bronchoscopically visible, the larger extrabronchial portion, like the submerged portion of an iceberg, is invisible. Duration at time of this prelobectomy bronchoscopy 10½ years. Alive and well 9½ years after lobectomy, total duration 20 years. Same case as Figures 4 and 15. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 8, Case 34 S.S., age 37. Low power microphoto of adenomatous bronchial tumor, carcinoid type, showing sessile attachment of surgical specimen removed at transpleural bronchotomy from right subcarinal area. Note the cartilaginous rings removed with attached tumor. Higher power microphoto of tumor invading the intercartilaginous area of the bronchial wall taken from area marked by square in low power microphoto. This tumor area could not have been removed via the bronchoscope. Same case as Figures 20 and 21. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 9, Case 1 I.K. Artist's diagram from postmortem specimen. Large adenomatous bronchial tumor, carcinoid type, obstructing right stem bronchus, untreated. Death from brain abscess. Duration 20 years. Note impossibility of bronchoscopic removal. Same case as Figure 12. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 10, Case 37 JR. Adenomatous bronchial tumor, carcinoid type. Surgical specimen of removed right lower and right middle lobes showing section through tumor and abscess in right lower lobe. Note impossibility of bronchoscopic removal and the tumor infiltrating toward the sectioned trabeculated abscess wall. Duration 6 years; alive and well one year, multiple lobectomy and 16 months after surgical drainage of right lower lobe abscess and empyema. Same case as Figures 16 and 17. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 11, Case 2 J.B. Symptoms 12 years, when this tumor removed bronchoscopically in 1928; microscopic section of original biopsy carcinoid type. Patient, a woman now 56. Diagnosed carcinoma in 1928. Radiation therapy. Now (1950) patient has a regrowth with cystic bronchiectasis of the obstructed right lung. Is invalided because of hemoptysis and pulmonary suppuration, now 35 years since onset of symptoms. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 12, Case 1 I.K. X-ray film of chest January 4, 1921 showing empyema obscuring underlying tumor mass and destroyed right lung. Expired October 27, 1937 of brain abscess, duration 20 years. Carcinoid type adenomatous bronchial tumor. Same case as Figure 9. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 13, Case 10 F.J. November 3, 1938 serial selective bronchogram with lipiodol. Spot film showing cystic bronchiectasis limited to two segments of left lower lobe. Living and well, total duration 18 years, 10½ years after left lower lobectomy. Same case as Figure 14. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 14, Case 10 F.J. X-ray film of chest September 30, 1938 showing left lower lobe partial atelectasis due to carcinoid type of adenomatous bronchial tumor obstructing two segments of the left lower lobe. Duration 18 years, alive and well 10½ years after left lower lobectomy. Same case as Figure 13. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 15, Case 12 G.D. Artist's drawing of surgically resected left lower lobe. Adenomatous bronchial tumor, mixed tumor type. Duration 20 years; alive and well 9½ years after lobectomy. (Top) Section of tumor 7.0 cm. in diameter. Note shrunken abscessed and bronchiectatic lobe. (Bottom) External appearance showing numerous pleural adhesions. Same case as Figures 4 and 7. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

Figure 16, Case 37 J.R. Adenomatous bronchial tumor, carcinoid type, right intermediate bronchus. Surgical specimen of removed right middle and right lower lobes showing sessile attachment, complete obstruction to right lower and partial obstructiol to right middle lobe. Duration 6 years; living and well one year after multiple lobectomy and 16 months after surgical drainage of right lower lobe abscess an dempyema. Same case as Figures 10 and 17. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

Figure 17, Case 37 J.R. X-ray film of chest April 1, 1950, 12 months after multiple lobectomy right lower and middle lobes for adenomatous bronchial tumor, carcinoid vype, of the right intermediate bronchus. Lobectomy preceded by thoracotomy, rib resection and drainage of empyema and abscess il right lower lobe. Note expansion of right upper lobe. Duration 6 years; alive and well one year postoperatively. Same case as Figures 10 and 16. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 18, Case 35 AP. Early adenomatous bronchial tumor, clear cell, glandular type. Surgical specimen removed through left transpleural bronchotomy from left carinal area. Note pedicle with mucosa attached. Alive and well one year after bronchotomy with clear left lung. Total duration 2 years, left lung clear. Same case as Figure 6. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 19, Case 35 A.P. Cross section × 2 of adenomatous bronchial tumor, clear cell, glandular type removed from left subcarinal area by posterior transpleural bronchotomy. Bulk of tumor appeared to be serous secreting glandular epithelium. Total duration 2 years; alive and well one year after bronchotomy, left lung clear. Note the large cystic spaces. This is similar to clear cell papillary cystadenoma of salivary glands (Bauer). Same case as Figures 6 and 18. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 20, Case 34 S.S. Adenomatous bronchial tumor, carcinoid type, recurrent following bronchoscopic removal seven years before bronchotomy. Surgical specimen removed via transpleural bronchotomy, sessile attachment to right subcarinal area. Duration 8 years; alive and well 4 months postoperatively with clear right lung. Same case as Figures 8 and 21. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions

FIGURE 21, Case 34 S.S. X-ray film of the chest, April 10, 1950, 4 months after right transpleural bronchotomy. Preoperative complete atelectasis of the right lung cleared within a few days after surgery. Note the well aerated right lung. Same case as Figures 8 and 20. Diseases of the Chest 1950 17, 644-680DOI: (10.1378/chest.17.6.644) Copyright © 1950 The American College of Chest Physicians Terms and Conditions