Left-sided pneumonectomy with circular resection of the tracheal bifurcation for primary epithelial-myoepithelial carcinoma of the lung under cardiopulmonary bypass

This report focuses on a rare malignant neoplasm – epithelial myoepithelial carcinoma (EMC) of the lung. This tumor accounts for less than 1% of all tumors in this anatomical location. This neoplasm is characterized by biphasic histological structure and predominant central growth in bronchial tree with frequent obstruction. The authors present a 57-year-old patient diagnosed with left lung EMC, complicated by circumferential invasion of tracheal bifurcation. After a comprehensive evaluation, including immunohistochemical analysis, the patient underwent radical surgical intervention consisting of left-sided pneumonectomy with circular resection of tracheal carina. Surgery was performed under cardiopulmonary bypass and involved three stages: median sternotomy and cannulation for cardiopulmonary bypass, lymph node dissection and cardioplegia, direct resection with subsequent end-to-end tracheobronchial anastomosis. Postoperative morphological examination revealed T3N3M0 stage and R0 resection status with lymphovascular invasion (L1, V1, Pn1). Postoperative period was complicated by respiratory insufficiency and pulmonary embolism, necessitating prolonged respiratory support and intensive care. This clinical example illustrates technical feasibility and efficacy of extended combined on-pump surgeries for locally advanced rare lung tumors, as well as importance of multidisciplinary approach in managing such complex cases.