A rare case of bronchial glomus tumor

A 48-year-old man was admitted because of bloody sputum in whom a chest computed tomography (CT) scan and fiberoptic bronchoscopy demonstrated a polypoid tumor in the left main bronchus. The tumor was surgically resected, and the pathological and immunohistochemical findings led to diagnosis of the tumor as a bronchial glomus tumor.     

Fourteen‐year‐old girl with endobronchial carcinoid tumour presenting with asthma and lobar emphysema

Introduction: Bronchial carcinoid tumours seldom occur in children, and represent a rare cause of pulmonary obstruction. Because of low clinical suspicion and the variable ways of presentation, diagnosis may be delayed. Objectives: We report on a patient with this tumour. It is hoped that increased awareness of the tumour can lead to earlier diagnosis. Methods: Report of a case. Results: This case describes a 14‐year‐old previously healthy girl, presenting with asthma‐like symptoms throughout 2 years, decreased lung function and emphysema in left lower lobe on chest x‐ray. Computerized tomography (CT) showed an intraluminal process in the left main bronchus and emphysema in both the upper and lower left lobe and showed no signs of metastasis or spread to lung tissue. Bronchoscopy showed an inflammatory polyp. Surgical resection demonstrated a typical carcinoid tumour. Later control biopsy revealed no persisting malignant tissue. The asthma symptoms returned and a new bronchoscopy showed scarring and narrowing of the left bronchus. Treatment comprised of dilatation by bronchoscopy plus daily combination corticosteroids and beta‐2‐agonist inhalation and the symptoms improved. No signs of relapse 16 months postdiagnosis. Conclusions: The case clearly shows the delay, which is common in the diagnosis of children with bronchial carcinoid tumours. Symptoms of the obstructive nature of the tumour are variable and might present as emphysema seen on x‐ray and CT. Carcinoid tumour should be considered in children with longstanding pulmonary symptoms with no response to conventional treatment. Prognosis is good but long‐term follow up is needed. Please cite this paper as: Andersen JB, Mortensen J, Damgaard K, Skov M, Sparup J, Petersen BL, Rechnitzer C and Borgwardt L. Fourteen‐year‐old girl with endobronchial carcinoid tumour presenting with asthma and lobar emphysema. The Clinical Respiratory Journal 2010; 4: 120–124.     

Pulmonary artery sarcoma mimicking pulmonary thromboembolism

A 30 years old male patient was referred to our hospital with a diagnosis of pulmonary thromboembolism due to thorax-computerized tomography (CT) angiography, revealing a thrombus totally occluding left main pulmonary artery. The lesion was evaluated as tumoural mass. Positron emission tomography (PET)-CT revealed pathologic uptake at pulmonary artery mass. Due to localization of tumour, left pneumonectomy was performed. The pathological diagnosis revealed to be pulmonary artery sarcoma. The patient was presented because pulmonary artery sarcomas are very rare tumors and can mimick pulmonary thromboembolism. The true prevalence is underestimated as many pulmonary artery sarcomas are misdiagnosed as pulmonary thromboembolism. PET-CT may help to make a differential diagnosis.     

Malignant glomus tumor in pleural cavity

Glomus tumors, an uncommon hypervascular tumor, arise from modified smooth muscle cells of the glomus body that plays a significant role in the regulation of skin circulation. The tumors are usually located in the extremities, typically in the subungual region of the fingers. Primary glomus tumors of the chest are extremely rare, and to our knowledge, there are no cases have been described in thoracic cavity to date. We here report a case of intrathoracic glomus tumor in a 31-year-old man who presented with a persistent chest pain. Chest computed tomography scans demonstrated an irregularly shaped mass in the left thorax. Left thoracotomy was performed under the suspicious diagnosis of unexplained thorax tumor, and a tumor located in the left upper portion of thorax was founded. Complete resection of tumor along with the partial structure of chest wall was performed. Postoperative diagnosis was malignant glomus tumor.     

Mucoepidermoid bronchial carcinoma. Review of the literature apropos of a new case]

Muco-epidermoid bronchial tumours are rare and characterized by the coexistence of epidermoid, mucus-secreting and intermediate cells. The authors report the case of a 22-year old unmarried woman hospitalized for exploration of a febrile dyspnoea related to a right superior lobar atelectasis. Endoscopy showed a smooth, pediculate tumour arising from the right superior lobar bronchus where bronchial biopsy was negative. Right superior lobectomy was performed through thoracotomy and established the diagnosis of muco-epidermoid bronchial tumour. Surgery was followed by radiotherapy of the chest. Over a 5-year follow-up period there was no local or extrathoracic recurrence, and the patient is in good condition.     

Bronchial adenoma presenting with chronic asthma and obstructive pneumonia: a case report

A rare case of primary pulmonary neoplasm is reported. The patient was a 38-year-old woman presenting with obstructive pneumonia. Fiberoptic bronchoscopy revealed an endobronchial mass obstructing the left main bronchus: a reddish polypoid mass which bled on contract that was suggestive of bronchial adenoma. The patient also had a long-standing history of bronchial asthma and hemoptysis and the delay in establishing the eventured diagnosis was caused by the minor symptoms mimicking those of asthma. A persistent restrictive lung and the presentation of obstructive pneumonia were important clues which warranted further investigation by computed tomography (CT) scan and bronchoscopy. The patient underwent rigid bronchoscopy with CO2-laser ablation under general anesthesia. Histopathology confirmed a bronchial adenoma. The clinical response was excellent. Bronchial adenoma should be considered in young patients presenting with asthma, hemoptysis and obstructive pneumonia. Bronchoscopic CO2-laser ablation is an effective treatment and provides an alternative to aggressive thoracotomy.     

A case of intrapulmonary schwannoma that should be distinguished from lung cancer

A 32-year-old woman was referred to our division because of abnormal shadow on a chest X-ray film taken at an annual health survey. Chest X-ray films and chest CT scanning revealed a smooth-surface mass at the left hilus. A bronchoscopic examination revealed severe extraluminal compression in the left basal bronchus but no visible tumors. Surgical treatment was performed on the suspicion of lung cancer. Since the intraoperative frozen section examination revealed a benign tumor, the tumor mass was resected. Based on intraoperative and pathological findings, benign intrapulmonary schwannoma associated with the left basal bronchus was diagnosed. Only 15 cases of intrapulmonary schwannoma have been reported in Japan.     

甲型H1N1流感的病原学与流行病学

目的：通过临床病例分析，了解肺内神经鞘瘤的临床和影像表现，提高鉴别诊断能力。方法：对1979年1月－2001年10月期间收治的7例肺内神经鞘瘤的临床、影像学表现及诊断依据进行分析。结果：主要症状：小量咯血、咳嗽、发热、气促、胞痛。纤维支气管镜检查：支气管腔内见新生物3例，外压性狭窄2例。影像表现：左总支气管腔内见结节阻塞2例；肺内单发肿块4例；多发肿块1例（2个病灶）。肿块边缘光整3个（良性2个，恶性1个），毛糙3个（恶性）。CT增强扫描，表同为网格样强化1个（良性）、周边强化1个（恶性）、不均质强化4个（良性1个，恶性3个）。伴支气管和肋骨受压2例。恶性神经鞘瘤中见胸膜浸润伴胸液1例、血管受侵2例。结论：肺内神经鞘瘤罕见，临床及影像学表现缺乏特异性。肿瘤大小和密度对良恶性鉴别无特征意义，肿瘤边界不光整提示恶性可能，相邻结构侵犯是提示恶性病变的重要征象。     

Bronchial repair with pulmonary preservation for severe blunt trauma

After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib fractures, left-sided tension pneumothorax, hemothorax and left upper lobe bronchus rupture at its origin. An emergency left thoracotomy revealed an almost complete avulsion of the upper lobe bronchus from the main stem bronchus, a severely damaged pulmonary artery, and a concurrent deep intraparenchymal lower lobe laceration. Since the patient was hemodynamically stable, a decision was made to preserve as much lung as possible. In the event of complex pulmonary trauma, pulmonary preservation is desirable since emergency pneumonectomy is usually associated with high mortality. Early bronchoscopic assessment, careful anesthetic management, and meticulous surgical technique with liberal use of fibrin glue were crucial to successful outcome.     

Pulmonary myofibroblastic pseudotumor: a rare surgical pathology

Pulmonary myofibroblastic pseudotumors are rare surgical pathologies, of unknown origin, with benign behavior and a good prognosis if completely resected. We present a 21-year-old male with a solitary pulmonary nodule found during a routine chest X-ray with CT scan confirmation. After a 16-month follow-up, the nodule increased in size and the patient developed mild dyspnea. He underwent an elective left postero-lateral thoracotomy and excision of the mass with an upper lobectomy. Pathologic studies revealed a pulmonary myofibroblastic pseudotumor.     

A case of endobronchial inflammatory pseudotumor invading the mediastinum

A 50-year-old-male was admitted to our hospital in March 2007, complaining of cough and hemoptysis for 3 months. Postero-anterior chest X-ray showed an opacity on right upper zone. Computed tomography of the thorax showed a mass lesion occupying the right upper lobe and superior segment of the lower lobe and invading the mediastinum. Fiberoptic bronchoscopy showed total occlusion of the right upper lobe bronchus by the mass and infiltration of the bronchus intermedius. Bronchoscopic biopsies were nondiagnostic. PET-CT revealed SUVmax of 18.8. Right thoracotomy was performed. Vena cava superior and right pulmonary artery was invaded by the mass. Biopsies were performed. Histopathologic examination demonstrated an inflammatory pseudotumor. Corticosteroid treatment was started. The tumor was clinically and radiologically unresponsive to corticosteroids. He was referred to oncology department for radiotherapy. The patient died on November 2007.     

Bronchogenic cyst: an uncommon cause of congenital lobar emphysema

We report a case of a 1-month-old boy who has developed respiratory distress. Chest X-ray and CT scan showed over distension of the left upper lobe and a mediastinal shift in favour of congenital lobar emphysema (CLE) of the left upper lobe. One month after uneventful lobectomy, he was readmitted at hospital for another episode of respiratory distress. Chest radiography revealed relapse of compressive emphysema in the remaining left lobe. Gastro oesophageal transit and MRI were performed, which have shown a mediastinal cystic mass. Accordingly, the patient underwent thoracotomy. Surgical examination found a subcarinal bronchogenic cyst which compressed the main left bronchus, causing the CLE of both upper and lower left lobes. Histological examination of removed cyst confirmed these data. Authors discuss causes of diagnostic delay.     

高分辨CT、胸部平片及病理学诊断肺磨玻璃结节临床分析

目的分析高分辨CT与胸部平片联合用于肺磨玻璃结节鉴别诊断的价值,以提高肺磨玻璃结节早期检出率,为临床合理治疗提供影像学依据。 方法选择2018年1月至2019年12月经手术病理结果或穿刺活检证实860例肺磨玻璃结节患者作为分析对象,全部患者在术前均接受胸部平片检查与高分辨CT检查,且均经高分辨率CT与胸部平片发现有肺部结节征象;记录手术病理及穿刺活检结果;观察患者胸部平片与高分辨CT检查主要征象,分析各检查方法单独及联合用于肺磨玻璃结节鉴别诊断的价值。 结果860例患者中经证实恶性385例,其中289例经手术病理确诊,96例经穿刺活检明确,包括原位腺癌135例,微浸润腺癌155例,浸润性腺癌72例,其他23例,恶性率为44.8%;860例肺磨玻璃结节患者经胸部平片检查结果显示,肺结节直径范围为1.0～3.0 cm;肺结节的分布：326例左肺,534例右肺;经高分辨CT检查结果显示,良恶性病变肺磨玻璃结节病灶大小比较,差异无统计学意义(P>0.05),恶性结节表现出不规则形、毛刺征、分叶征、界面清楚光整、空泡征、支气管征等征象占比均高于良性组(P<0.05);胸部平片、高分辨CT单独及联合诊断肺磨玻璃结节的曲线下面积分别为0.847、0.876、0.940,均>0.8,诊断价值好,且联合诊断的曲线下面积最大。 结论胸部平片与高分辨CT联合检测,并结合病理学对提高肺磨玻璃结节早期良性病变及恶性肿瘤进行鉴别诊断的正确率有重要价值。     

A case of extramedullary plasmacytoma in the mediastinum]

A 80-year-old man was admitted to our hospital for examination of a mediastinal mass. Chest CT showed a 6 x 9 cm mass in the left anterior mediastinum. The left main bronchus and pulmonary artery were invaded by the mass. Bronchoscopic examination showed compression of the left main bronchus by the mass and enlarged lymph nodes. The left upper lobe and lingular bronchi were almost occluded. The overlying mucosa was invaded by tumor tissue. Microscopic findings of specimen obtained by transtracheal biopsy showed plasma cells of various sizes were at different stages of differentiation. Immunohistochemical staining revealed IgA monoclonality. Whole-body bone scan and bone marrow aspiration excluded multiple myeloma and a diagnosis of extramedullary plasmacytoma was made. Serum protein electrophoresis showed an IgA monoclonal gammopathy. Immunoelectrophoresis of the serum revealed an IgA kappa monoclonal component. These suggested that tumor cells were producing monoclomal IgA kappa light chain. Radiotherapy was effective in reducing the size of the plasmacytoma, and serum IgA reverted to normal. A 67-Ga scan showed strongly increased uptake in the left anterior mediastinum. Chest CT after radiotherapy showed that the decreased mass had an extrapleural sign against the mediastinal pleura. We determined that the origin of the plasmacytoma was probably the mediastinum. We reported a rare case of extramedullary plasmacytoma in the mediastinum.     

Unusual malignant tracheal tumour presenting with acute airway obstruction

A 25-year-old male presented with features of acute airways obstruction. He was diagnosed to have a lower tracheal mass with near total tracheal obstruction and complete obstruction of the left main bronchus. The tumour was resected successfully using a two-step method of ventilation. Histopathology of the mass revealed it to be a spindle cell sarcoma. Subsequently, local irradiation and systemic chemotherapy was given.     

A case of obstructive ventilatory disturbance caused by bronchial wall granulation due to a fish bone]

A 62-year-old man was admitted to Kawasaki Medical School Kawasaki Hospital after suffering from wheezing for one year. His chest X-ray film showed no significant findings in the lung fields and mediastinum. A chest CT film showed a small protrusion at the posterior wall of the right main bronchus. Bronchofiberscopy disclosed a polypoid tumor with a smooth surface in the right main bronchus, confirming the finding of the chest CT, and a restiform eminence at the truncus intermedius. The restiform eminence was revealed to be a fish bone after removal from the bronchus using the forceps of a bronchofiberscope. Histological examination of a bronchoscopic biopsy specimen from the tumor of the right main bronchus showed inflammatory granulation tissue. We confirm subsequently questioned the patient who revealed that he had aspirated another fish bone two months earlier, and we presumed that the tumor of the right main bronchus might be granulation tissue secondary to the impaction of a fish bone. The patient was not aware that he had aspirated a foreign body, but it was presumed that he had aspirated the fish bone one year earlier, coinciding with the onset of wheezing. Immediately after removal, his wheezing disappeared. Comparison of the results of pulmonary function tests after removal with those before showed improvement of V25/predicted V25 ratio from 24% to 72%, and improvement of V50/V25 ratio from 3.7 to 2.4. This is considered to be a rare case of bronchial granulation due to a foreign body, which was recognized as a small polypoid tumor by chest CT.     

Desmoid tumour in thoracotomy scar 5 years after excision of a left giant atrial appendage aneurysm in female with a family history of Gardner's syndrome.

A very large desmoid tumour extensively involving the chest wall and the left anterior abdominal wall is described in a patient with a family history of Gardner's syndrome. The desmoid arose at the site of a thoracotomy scar due to the removal of a large aneurysm of the left atrial appendage five years before. Both a plastic surgeon and a thoracic surgeon were required to remove the tumour. Aneurysmal dilatation of the left atrium is extremely rare and has not been reported in association with Gardner's syndrome before.     

Right thoracotomy for carinal resection with left thoracoscopic pneumonectomy as a new approach for left sleeve pneumonectomy: a case report

A 43-year-old woman, with a history of asthma that had been treated for the previous 3 years, was diagnosed with an endobronchial tumor, based on chest computed tomography. A biopsy proved the tumor to be adenoid cystic carcinoma. For carinal involvement and submucosal extension in the left main bronchus, rigid bronchoscopy was done to maintain airway patency, and then a left sleeve pneumonectomy was done via a right thoracotomy and left video-assisted thoracoscopic surgery. The distance between the tumor-free left main bronchus and the carina was large; therefore, preservation of the left lung would have compromised the healing of the carinal tracheobronchoplasty and led to life-threatening complications. This case revealed that endobronchial lesions should be highly suspected after treatment for asthma fails. It also highlighted that, because the carina naturally deviates to the right, combined right thoracotomy and left video-assisted thoracoscopic surgery for left sleeve pneumonectomy provides an anatomical advantage for carinal tracheobronchoplasty. Furthermore, the combination reduces the postoperative physiological burden that could be caused by bilateral thoracotomy.     

Thoracic actinomycosis: three cases

Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases.     

Radiographic relationship of the origin of the bronchial arteries to the left main bronchus

The purpose of this study was to demonstrate that the relationship of the left main bronchus to the bronchial arteries is a reliable radiographic landmark for accurate catheterization of the right and left bronchial arteries. Sixty-six bronchial angiograms and chest radiographs in 43 patients were reviewed. The relationship of the tip of the catheter during initial bronchial angiography (used as the point of bronchial arterial origin) and the radiolucent shadow of the left main bronchus in patients with and without radiographic evidence of anatomic distortion caused by pulmonary disease was categorized into three groups: within the shadow of the left main bronchus, near the left main bronchus, and far from the left main bronchus. The origin of the right and left bronchial arteries was within or near the shadow of the left main bronchus in 94% of bronchial angiograms performed in patients with and without distorted thoracic anatomy. The most frequent location was within the shadow of the left main bronchus. The left main bronchus can be used as a reliable reference point for catheterization of the right or left bronchial arteries in patients with and without thoracic anatomic distortion.