Primary endobronchial leiomyoma: a case report

Pulmonary leiomyoma is a rare benign tumor. It has been usually described as a single case. The aim of this paper is to present a case of endobronchial leiomyoma. A 43 year-old nonsmoker female presented to our center with complaint of cough and sputum production for two years. Her chest roentgenogram showed consolidation on lower zone of right lung. Computed tomography of thorax demonstrated a mass lesion partially obstructing lateral segment bronchus of right middle lobe and consolidation on right lower lung field. Fiberoptic bronchoscopy detected mass obstructing lateral segment bronchus of right middle lobe. The biopsy specimen obtained by fiberbronchoscopy revealed the diagnosis of endobronchial leiomyoma. There was no pathologic finding in uterine examination. Bilobectomy inferior was performed. The patient was healthy six months later.     

Use of microdebrider bronchoscopy for the treatment of endobronchial leiomyoma

Aims: Pulmonary leiomyomas are rare benign tumors that may cause symptoms when they spread endobronchially. Traditionally they were managed surgically or through interventional bronchoscopy with the aid of thermal modalities to assist in debulking of tumor. We report the novel use of microdebrider bronchoscopy to debulk an endobronchial leiomyoma in a symptomatic patient. Method/Results: The microdebrider successfully débrided the endobronchial leiomyoma. Conclusion: This modality can be successfully employed when oxygenation is an issue, preventing use of thermal modalities. In addition, use of microdebrider not only reduced procedure time but also decreased the risk of airway fire and damage to adjacent normal tissue in our patient. Please cite this paper as: Wahla AS, Khan I, Bellinger C, Haponik E and Conforti JF. Use of microdebrider bronchoscopy for the treatment of endobronchial leiomyoma. Clin Respir J 2011; 5: e4–e7.     

纤维支气管镜诊断支气管结核98例分析

目的　探索支气管结核的确诊手段及临床特征。方法　分析 98例支气管结核患者的临床表现及纤支镜结果。结果　主要症状包括咳嗽 72例 (73% ) ,咳痰、咯血、气喘、胸痛、发热等。纤支镜示 :支气管刷检结核菌阳性率 85 .71% ,组织活检阳性率 6 9.2 3% ,其中 4 1.84 %以炎性浸润改变为主 ,2 2 .4 5 %以溃疡型改变为主 ,11.2 3%以增殖改变为主 ,2 4 .4 9%以瘢痕狭窄改变为主。结论　当有支气管结核临床表现及 X线表现特异性不强时 ,进行纤支镜检查。当病理、细菌学均不能明确诊断 ,可进行试验性抗结核治疗 ,追踪观察以确诊     

A case of leiomyoma of the trachea]

An asymptomatic 59-year-old male in whom an abnormal shadow was detected on indirect chest X-ray film, was referred to our hospital for further examination. Further examinations revealed no problem at the previously checked site. However, bronchoscopy revealed a protruding hemispheric lesion on the membranous portion of the trachea 2 cm above the carina. The biopsy specimens revealed that the lesion was leiomyoma of the trachea. Transbronchoscopic biopsy was performed three times and the lesion disappeared. A few small fibrous nodules remained. The incidence of this primary tracheal tumor is rare, and benign lesions are much less common than malignant lesions. Furthermore, leiomyoma of the trachea is extremely rare. Only 20 cases have been reported in Japanese and English literature. The average age of the reported cases, including our case, was 49.3 years old. Among the male patients, most cases were around 50 years old but among female patients, there was no standard age for this disease. Clinical symptoms included coughing, dyspnea, wheezing and bloody sputum. There were several patients with severe dyspnea, two of which died. Ten patients (50%) had been misdiagnosed as having bronchial asthma. If a case is suspected to be bronchial asthma in which and where bronchodilators have little effect, we must always consider the possibility of this type of lesion, and perform further examinations and treatment.     

69例支气管结核临床分析

目的　探索支气管结核早期确诊手段及临床特征。方法 分析69例经纤维支气管镜 (纤支镜 )确诊的支气管结核患者临床表现、胸部X线、CT及纤支镜结果。结果 69例主要症状包括:咳嗽68例,咳痰44例,午后低热50例,盗汗49例,乏力48例,喘息18例,痰中带血13例。胸片及CT示:气管开口凹凸不平、不规则狭窄42例,有阻塞性肺炎26例,肺不张25例,肺内空洞14例,肺门淋巴结肿大11例。痰涂片结核菌阳性率为43.5%,痰结核菌培养阳性率36.2%。纤支镜示:刷检结核菌阳性率为55.1%,组织活检中56.7%证实为结核,其中40.6%为炎症浸润型,13.0%为增殖型,29.0%为溃疡型,26.1%为狭窄闭塞型。上述四种类型发现结核菌的阳性率分别为71.4%,77.8%,100%和55.6%。结论 当有支气管结核临床表现时,应行胸部X线、CT检查,对可疑病人作纤支镜。当病理、细菌学均不能明确诊断,应重复活检、刷检和试验性抗结核治疗,追踪观察以确诊。     

支气管结核246例诊断和介入治疗效果分析

目的　探讨支气管结核早期确诊手段、临床特征及介入治疗。方法 分析246例经支气管镜(纤支镜)确诊的支气管结核患者临床表现、胸部X线、CT、纤支镜结果 及介入治疗效果。结果 246例主要症状包括:咳嗽183例,咳痰92例。午后低热59例,盗汗78例,乏力84例,喘息67例,痰中带血23例。X线胸片及CT示:气管、支气管狭窄96例。有阻塞性肺炎31例,肺不张55例,肺内有空洞38例,痰涂片结核菌阳性率为43.5%,痰结核菌培养阳性率为35.3%。纤支镜示:刷检结核菌阳性率为56.5%,组织活检中58.4%证实为结核,其中42.2%为炎症侵润型、10.2%为增殖型、18.7%为溃疡型、17.1%为狭窄闭塞型。治疗效果:痰菌阴转2个月90.6%,6个月100%。结论 当有支气管结核临床表现时,应行胸部X线、CT检查、对可疑病人做纤支镜检查。当病理、细菌学均不能明确诊断,应试验性抗结核治疗,追踪观察以确诊。介入治疗支气管结核疗效可靠,安全性好。     

A resected case of endobronchial metastasis from breast carcinoma

A 54-year-old woman, who had received left radical mastectomy 12 years previously, was admitted with persistent cough and hemoptysis. Plain chest X-ray film showed no abnormality but fiberoptic bronchoscopy revealed that a polypoid lesion occluded the right truncus and the surrounding bronchial mucosa was firm and edematous. Biopsy specimen demonstrated adenocarcinoma. Right middle and lower sleeve bilobectomy was performed. The tumor occupied mainly the outer and submucosal layer of the bronchial wall. Histologically, this tumor showed scirrhous adenocarcinoma with the same pathologic appearance as the primary breast lesion. It is considered that endobronchial metastasis from breast carcinoma is not particularly uncommon, therefore any patient with a past history of breast cancer and respiratory symptoms should undergo fiberoptic bronchoscopy, particularly when the chest X-ray is normal or shows non-specific changes.     

胸片正常的支气管内膜结核15例临床分析

目的 探索胸片正常的支气管内膜结核的临床特征及早期确诊手段。方法 分析15例经纤维支气管镜(纤支镜)确诊的支气管内膜结核患者的临床表现、胸部X线(平片)及CT片、纤支镜检查结果。结果 15例中主要症状包括：咳嗽15例，气促5例，胸痛4例，发热3例，咯血2例，消瘦2例。15例的X线胸片正常。纤支镜检查示46．7％的病例有炎性浸润型病变，33．3％有增殖型病变，13．3％有溃疡型病变，6．7％有狭窄闭塞型病变。15例痰涂片行抗酸染色者中3例阳性，痰培养阳性1例；纤支镜刷片检查8例阳性，活组织检查7例证实为结核。结论 支气管内膜结核无特异性临床表现及胸部X线表现正常不能排除支气管内膜结核，确诊主要依靠纤支镜检查。对不明原因发热和呼吸道症状经积极治疗无效者，应怀疑支气管内膜结核而及时行纤支镜检查。通过镜下常规刷检找抗酸杆菌配合组织活检确诊率高。     

Bronchoscopic features and bronchoscopic intervention for endobronchial hamartoma

Background and objective: Bronchoscopic resection of endobronchial hamartomas has been reported to have a favourable outcome. This study describes the bronchoscopic features of endobronchial hamartoma and reports the clinical outcome of bronchoscopic intervention. Methods: A retrospective analysis was conducted of patients with histologically proven endobronchial hamartomas, diagnosed in the 10‐year period 1999–2009 to elucidate the clinical, radiological and bronchoscopic features of hamartoma and to describe the clinical outcomes. Results: Seventeen of the 135 patients with pulmonary hamartomas were diagnosed as having endobronchial hamartomas. CXR was abnormal in 11 of the 17 patients. On chest CT (n = 16), the median diameter of the lesion was 15.6 mm. Calcification and areas of focal fat in the lesion, the diagnostic CT findings of pulmonary hamartoma, were found in two of 16 (12.5%) patients. At bronchoscopy (n = 16), all tumours had a mass appearance and most were smooth surfaced round masses (50.0%) with 18.8% having a ‘stalk’. Bronchoscopic forceps biopsies were performed in 13 patients, which resulted in five patients (38.5%) being diagnosed with endobronchial hamartoma. Fifteen patients were treated with rigid or flexible bronchoscopic resection, one had lobectomy, and one had no intervention. No procedure‐related mortalities or late complications developed. Conclusions: Bronchoscopic intervention appears to be a safe and effective method to resect endobronchial hamartomas.     

Epstein-Barr virus-associated bronchial leiomyoma in a boy with cellular immunodeficiency

Bronchial leiomyoma is a rare disease in children. Recently, the association of leiomyoma and HIV infection was reported. We describe a boy with a cellular immunodeficiency, who had endobronchial leiomyoma. The tumor cells were positive for Epstein-Barr virus-encoded RNA-1 (EBER-1) and Epstein-Barr virus-determined nuclear antigen-2, suggesting a role of Epstein-Barr virus in the pathogenesis of leiomyoma.     

支气管内膜结核90例临床分析

目的探索支气管内膜结核（ＥＢＴＢ）的临床特征及早期确诊手段。方法分析９０例经纤维支气管镜（纤支镜）确诊的ＥＢＴＢ患者的临床表现、胸部Ｘ线（ＣＴ）、纤支镜检查结果。结果９０例中主要症状包括：咳嗽７５例,发热２７例,咯血２４例,胸痛１８例,气促１１例,消瘦７例。气道阻塞症状少,仅２例出现喘息。７例的Ｘ线表现正常,只有２例的ＣＴ检查结果提示ＥＢＴＢ。纤支镜检查示３８％的病例有炎症浸润型病变,９％有增殖型病变,２６％有狭窄闭塞型病变,１７％有溃疡型病变,１１％大致正常。５６例痰涂片行抗酸染色者中８例阳性,８６例行纤支镜刷片检查者中７３例阳性,５６例行活组织检查者中１７例证实为结核。结论ＥＢＴＢ缺乏特异性临床表现,胸部Ｘ线表现正常不能排除ＥＢＴＢ,ＣＴ诊断价值不高,确诊主要依靠纤支镜检查。对不明原因低热和呼吸道症状经积极治疗无效者,应怀疑ＥＢＴＢ而及时行纤支镜检查。行镜下常规刷检找抗酸杆菌和（或）组织活检阳性率高,且简便快捷,值得推广。     

X-ray-negative endobronchial tuberculosis with persistent irritating cough that resulted in unpredicted mass infection]

A 24-year-old woman was referred to another hospital because of a barking cough, but her chest radiograph showed no abnormality. Although she had been diagnosed as having other diseases and had been given medical treatment, the barking cough continued. Abnormalities of the chest radiograph appeared 11 months later, and endobronchial tuberculosis was diagnosed from the clinical history, chest CT and a sputum smear positive for acid-fast bacilli. We treated her with INH, RFP, EB for 6 months, and PZA for 2 months. However, truncus intermedius became obstructed nine months after treatment ended, and we re-opened it with a Dumon stent after coring it out using a rigid bronchoscope. Since the patient was a teacher, medical checkups of many people were required, and the number of prophylactic treatments carried out was 80. This was regarded as a mass infection. In the early stages, endobronchial tuberculosis may not show any abnormality on chest radiography, but may still cause mass infection. When a barking cough continues for a long time, endobronchial tuberculosis must be suspected, and examination of a sputum smear for acid-fast bacilli, as well as a sputum culture is necessary.     

Non-Hodgkin's lymphoma presenting as an endobronchial tumor: report of eight cases and literature review

Non-Hodgkin's lymphoma (NHL) involving the endobronchial tree is uncommon, and the initial presentation of NHL as an endobronchial tumor is extremely rare. In a series of 441 patients with newly diagnosed non-Hodgkin's lymphoma over a 7-year period, we reviewed the clinical features of eight patients who presented with an endobronchial tumor. All patients had local pulmonary disease without extrathoracic involvement. The major presenting symptoms were dyspnea, chest pain, cough, and hoarseness. None of the patients had systemic symptoms. Radiographs revealed lobar collapse in all cases. Five patients had mediastinal masses and three had isolated endobronchial lesions. Although MALT lymphoma is the most common primary pulmonary lymphoma, it was present in only one of our patients, while seven patients had aggressive lymphoma. All patients received chemotherapy. Six of the eight patients responded favorably to treatment with complete remission. The prognosis of patients with isolated endobronchial lymphoma is not worse than other local presentations of lymphoma. Bronchoscopic examination with biopsy is essential to differentiate these lesions from primary bronchongenic carcinoma.     

Endoscopic endobronchial metastasis]

Although the incidence of endobronchial metastasis in cases of extrathoracic tumors is 2 to 5 percent in autopsy reports, it is about 30 percent according to endoscopic examination (so-called endoscopic endobronchial metastasis). To confirm the nature of endoscopic endobronchial metastasis, we reviewed the records from 1980 to 1990, presuming the primary foci of metastasis. Of the 36 patients with metastatic pulmonary tumor, 6 (16.7%) were diagnosed as having endobronchial metastasis endoscopically. The primary tumors were colonic cancer (2), prostatic cancer (2), cancer of the tongue (1), and renal cell carcinoma (1). The chest X-ray findings were nodular shadow (3), atelectasis (2), and hilar lymphadenopathy with atelectasis (1). Three patients were treated by lobectomy and the others by systemic therapy alone. The presumed primary foci of metastasis were peripheral lung (3), mediastinal lymph node (1), and undetermined (2). The results of the present study suggest that so-called endoscopic endobronchial metastasis does not necessarily imply metastasis to the bronchial wall.     

A case of endobronchial fibroma associated with recurrent pneumonia]

We present a case of endobronchial fibroma in a 59-year-old man admitted for repeated pneumonia, successfully treated by endoscopic Nd-YAG laser. His chest X-ray showed an infiltrative shadow in the right lower lung field and a mass shadow within the truncus intermedius. Bronchoscopy revealed a polypoid mass with lobulated whitish surface, obstructing 90% of the lumen. A biopsy taken from the tumor was suggestive of fibroma histologically. Two previous case reports stated that endobronchial fibroma readily detaches from the bronchial wall during removal. The tumor was successfully removed without dropping any tumor fragment to obstruct the distal bronchus by means of biopsy forceps manually attached to an endoscope with endoscopic Nd-YAG laser. The resected tumor was mainly composed of collagen fibers with scanty spindle-shaped fibroblastic cells, which was considered consistent with endobronchial fibroma. Endobronchial fibroma is a rare benign lung tumor, and only seven cases have been reported in the Japanese literature. There was no recurrence at three years and nine months.     

A relapsing case of Wegener's granulomatosis presenting as an endobronchial mass

Wegener's granulomatosis (WG) relapse is frequent. Although lung involvement occurs in 85% of patients, endobronchial presentation of the disease is uncommon. We reported a relapsing case of WG presenting as an endobronchial mass. A 56- year-old man present ed with recurrence of WG following 14 months of cyclophosphamide and prednisolone therapy and 36 months of complete remission. At his first presentation, he was diagnosed as having WG with involvement of kidney, lung, upper airways, skin, joints and eyes. His chest X-ray showed bilateral patchy consolidation. Cytoplasmic-anti-neutrophil cytoplasmic antibodies (c-ANCA) was also present in high titres. c-ANCA was negative after therapy. At the time of relapse, he presented with nasal symptoms and hemoptysis. His chest X-ray showed right paracardiac opacity. Fiberoptic bronchoscopy revealed a mass lesion subtotally obstructing the proximity of right lower lobe. He has been given prednisolone in tapering doses and cyclophosphamide for 10 months.     

A case report of endobronchial lipoma

Endobronchial lipomas are rare benign tumors of the lung. Nineteen cases have been reported in Japan. We present a case of endobronchial lipoma obstructing the left B4b and chronic saccular bronchiectasis throughout the left upper lobe. A 42-year-old man, 174 cm tall and weighing 47 kg, was referred for investigation of an abnormal chest X-ray film. He had a history of pneumonia and pyothorax in infancy. The chest X-ray film showed linear densities and ill-defined, irregular opacities in the upper-middle lung field. CT scan and tomographic studies showed multiple cystic spaces in the left upper lobe in which the volume was diminished. An angiogram of the left bronchial artery showed peripheral hypervascularity in the left upper lobe and systemic-to-pulmonary artery shunt. Fiberoptic bronchoscopy revealed a smooth, pink mass obstructing B4b. Biopsy specimens were insufficient for histological diagnosis. Preoperatively, an inflammatory polyp in association with chronic saccular bronchiectasis was suspected. Left upper lobectomy was performed on January 13, 1989. Gross examination of the resected specimen showed a pedunculated polypoid mass, 1.5 X 1.2 X 0.6 cm, attached to the bronchial mucosa of B4bii and saccular ectatic changes of bronchi not only in the lingular division but also in upper division. Microscopically, the endobronchial tumor consisted of mature adipose tissue covered with columnar bronchial epithelium. The fat was fairly well localized in the submucosa, but was not encapsulated and did not enclose glands or smooth muscle fibers. The endobronchial lipoma was thought to originate in the bronchus of chronic saccular bronchiectasis.     

支气管结核86例临床分析

目的探讨支气管结核(EBTB)的临床特征。方法分析经纤维支气管镜(纤支镜)确诊的86例EBTB患者的临床表现、胸部X线、纤支镜检查结果等。结果纤支镜检查示大致正常仅占9%,37%有炎症浸润型病变,16%有增殖型病变,26%有狭窄闭塞型病变,12%有溃疡型病变。78例痰涂片行抗酸染色中10例阳性,86例行纤支镜刷片检查69例阳性,62例行活组织检查者中24例证实为结核。结论EBTB缺乏特异性临床表现,确诊主要依靠纤支镜检查。     

支气管内膜结核36例临床分析

近十年确诊支气管内膜结核36例,其中肺部无病变者17例(34.6％),女性多见(69.4％)。咳嗽、胸闷为主要症状,缺乏典型结核中毒症状。早期痰菌阳性率高。33.3％的患者胸部X线显示肺不张。经纤维支气管镜检查确诊26例。结果表明:早期痰菌检查仍是一简单易行的方法,晚期需纤维支气管镜检查确诊。     

Clinical characteristics and efficacy of bronchoscopic intervention for tracheobronchial leiomyoma

Background and objective: This study reports the clinical characteristics, efficacy and safety of bronchoscopic treatment of patients with tracheobronchial leiomyoma. Methods: A retrospective study of 10 patients with tracheobronchial leiomyoma who underwent bronchoscopic intervention between 2000 and 2007 at a single centre, documenting the clinical characteristics, treatment method and outcomes. Results: Seven men and three women were studied. The median age at diagnosis was 47 years (range 17–66). The most frequent symptoms were cough (n = 5) and dyspnoea (n = 4). The lesions were in the trachea in two patients, the right bronchi in six, and the left bronchi in two. On chest CT, the most frequent findings were a tracheobronchial mass without parenchymal lesion (n = 7). The tumours were removed by neodymium‐yttrium‐aluminum‐garnet laser treatment by rigid bronchoscopy under general anaesthesia (n = 9) and with flexible bronchoscopy under local (n = 1) anaesthesia. Two patients eventually underwent surgical resection because of late tumour recurrence at 16 months, after the bronchoscopic intervention, in one patient, and incomplete removal by bronchoscopic intervention in another patient. In eight of ten patients who were successfully treated by the bronchoscopic intervention, the clinical outcome was good during the median follow‐up period of 24.5 months. There were no procedure‐related mortalities or late complications. Conclusions: Patients with a tracheobronchial leiomyoma usually present with non‐specific respiratory symptoms and an endobronchial mass without parenchymal lesions. Bronchoscopic intervention is a safe and effective technique for the treatment of patients with a tracheobronchial leiomyoma.