When Bronchiectasis Speaks: Uncovering Pulmonary Mucoepidermoid Carcinoma

Pulmonary mucoepidermoid carcinoma (PMEC) is an uncommon primary lung neoplasm, accounting for only 0.1-0.2% of all pulmonary malignancies.It originates from the submucosal glands of the tracheobronchial tree and frequently presents with nonspecific respiratory symptoms that mimic more common airway diseases such as asthma or chronic bronchitis, leading to diagnostic delays.We present the case of a 49-year-old nonsmoking female with a history of asthma who presented with persistent cough, progressive dyspnea, and unilateral radiographic abnormalities.Initial imaging revealed extensive right-sided bronchiectasis and a presumed mucus plug.Follow-up high-resolution computed tomography (HRCT) showed near-complete right lung collapse, cystic bronchiectasis, and a persistent endobronchial lesion.Bronchoscopy revealed a polypoidal mass occluding the right main bronchus.Histopathological evaluation confirmed a low-grade PMEC.PET-CT demonstrated mild FDG uptake without evidence of distant metastases.The patient underwent a right pneumonectomy with mediastinal lymph node dissection.Histopathology confirmed negative resection margins and no nodal involvement.Her postoperative recovery was uneventful, with complete resolution of symptoms.At 12 months, she remained asymptomatic with no evidence of recurrence on follow-up imaging and bronchoscopy.This case is unique in that a low-grade PMEC led to extensive cystic bronchiectasis and near-complete lung destruction, necessitating pneumonectomy, a rare outcome.It highlights the deceptive nature of central airway tumors mimicking asthma and the importance of early bronchoscopy in such presentations.This case also highlights the need to consider neoplasms in patients with focal bronchiectasis and persistent symptoms, especially when imaging shows central obstruction.Early bronchoscopy and timely surgery are key to good outcomes in low-grade PMEC.