Tracheobronchial mucoepidermoid carcinoma in four pediatric patients

Pediatric tracheobronchial mucoepidermoid carcinoma (MEC), also called pulmonary MEC, is a rare malignant primary lung neoplasm that is typically found in the large airways. Patients may present with symptoms such as cough, pneumonia, fever, hemoptysis, dyspnea, wheezing, chest pain, weight loss, and fatigue. These nonspecific symptoms (or lack of symptoms in some cases) often result in a delayed diagnosis. Chest CT typically demonstrates findings consistent with bronchial obstruction and diagnosis is made via histopathology. Surgical resection is the mainstay of treatment and children often have favorable outcomes. Here we present four cases of tracheobronchial MEC in children treated at three different hospitals. Our cases highlight the importance of having a broad differential that includes tracheobronchial MEC when a patient does not respond as expected to treatments such as inhaled steroids or antibiotics, and especially if the patient has hemoptysis and/or weight loss. As the use of pediatric interventional pulmonology becomes more common, we may see interventional pulmonology techniques utilized in the diagnosis and management of tracheobronchial MEC.