An Endobronchial Inflammatory Myofibroblastic Tumor Treated by Modified Left One-stoma-type Carinoplasty

Endobronchial inflammatory myofibroblastic tumor is a rare primary lung disease. A 39-year-old woman with dyspnea and a productive cough underwent complete surgical resection of a small-sized inflammatory myofibroblastic tumor that invaded the left main bronchus and the carina with lung-saving modified left one-stoma-type carinoplasty. We report this case with a review of literature.     

A case of adenoid cystic carcinoma of the left main bronchus, which was performed carinal resection and reconstruction while the aortic arch is pulled down

A 55-year-old woman, who had treated as bronchial asthma for eight months, was admitted to our hospital. Chest CT scan showed a mass in the left main bronchus. Bronchoscopic examination revealed a tumor obstructing the left main bronchus and invading the left lower portion of the trachea. The pathologic diagnosis was adenoid cystic carcinoma. Primary resection of the left main bronchus and the carina with the objective and one-stoma-type carinal reconstruction were performed by the left thoracotomy. We pulled down the aortic arch to obtain an operative field, and carried out the operative procedure at the upper side of the aortic arch. As the resection margin contained residual tumor, the postoperative irradiation (50 Gy) was added.     

Partial sleeve right pneumonectomy with carinal flap closure

We describe a technique used in 2 patients for resection of carcinoid tumor arising from the right main bronchus and extending along the lateral wall of the lower trachea. A flap was mobilized from the non-involved membranous posterior wall of the right main bronchus, which was left attached to the carina. This was used to close the defect in the lower trachea. Both patients did well after surgery and were followed-up for 10 to 17 years with no evidence of recurrence.     

Inflammatory myofibroblastic tumor of the lung- a case report

A 45-year-old man presented with a six-month history of progressive dyspnea with productive cough and wheezing. The patient was a heavy smoker and had a history of tongue cancer, hypertension, and asthma. Chest X-ray and computed tomography showed a mass lesion in the left hilar region and total collapse of the upper left lobe of the lung. Bronchoscopy revealed a whitish solid tumor obstructing the left upper lobe bronchus. Positron emission tomography showed increased tracer uptake in the lesion. A thoracoscopic lobectomy of the left upper lobe of the lung was performed. The final pathologic diagnosis was inflammatory myofibroblastic tumor.     

Left sleeve pneumonectomy for a rare lung tumor: A case report

Introduction and importancePrimary adenoid cystic carcinoma (ACC) of the lung is extremely rare. This tumor can be asymptomatic or have non characteristics symptoms, and the diagnosis is often late. The treatment of choice is surgery when it's possible.Case presentationWe herein report the case of a young patient with ACC of the left main bronchus. He had dyspnea and chest pain for 6 months. Complete atelectasis of the left lung was found on the chest x-ray. Bronchoscopy showed a tumor obstructing the LMB and invading the carina. The CT scan revealed a 5 cm tumor obstructing the left main bronchus (LMB) with extension to the carina and thoracic trachea. The extension assessment was without abnormalities. The treatment was surgical. A left carinal pneumonectomy by double lateral thoracotomy was performed. The postoperative results were satisfactory. There was no recurrence with a follow-up of 2 years.Clinical discussionThe therapeutic management of ACC is essentially based on surgical resection, which should be as radical as possible. However, complete resection is often difficult given the infiltrating nature of the tumor.ConclusionSleeve pneumonectomy with carinal resection is a curative option for patients with ACC of the main bronchi and carina that require expertise of the surgeons.     

Carinal reconstruction with wide airway resection by a new technique

Carinal reconstruction with wide airway resection by a new technique was conducted in two cases. A 61-year man with tracheal stenosis by tracheal cancer, 6 tracheal rings, 2 left bronchial rings, total right main bronchus, for which carina was resected and reconstructed by a new technique and for a 69 year man with lung cancer in right upper lobe, for which right upper-middle bilobectomy, S6 segmental resection and circumferential pulmonary artery resection were performed. The tracea, left main bronchus, and right basal segment bronchus were anastomosed by new technique and the right main pulmonary artery and basal segment artery was anastomosed subsequent to chemotherapy. Both patients discharged within seventeen postoperative days in consideration of the absence of postoperative complication. Bronchoscopic findings after reconstruction indicated neither stenosis nor dehiscence at the site of anastomosis. The new reconstructive method of carina permits simple anastomosis, the possibility of carina reconstruction even in the case of wide airway resection and loss tension at the site of anastomosis.     

Airway compression by the ascending aorta due to a thin thoracic cage

An 89-year-old woman with dyspnea and disturbed consciousness due to hypoventilation was admitted to our hospital. Chest radiography showed no abnormal shadow, but she was intubated for deteriorated hypoventilation. Bronchoscopy demonstrated obstruction of the left main bronchus at the carina. Computed tomography (CT) showed neither a mass lesion in the mediastinum nor an aortic aneurysm, but compression of the airway by the ascending aorta was observed. It was thought that the patient’s thin thoracic cage was unable to support the weight of the ascending aorta, which consequently compressed the left main bronchus. After inserting stents into both main bronchi, the patient’s consciousness improved, and respirator support was withdrawn. In aged, bedridden, thin patients with hypopnea or recurrent airway infection, CT and bronchoscopy should be performed to investigate airway patency.     

A case of tracheal neurilemoma

A 54-year-old woman was admitted to our hospital with a complaint of cough and severe exertional dyspnea. Her pulmonary function was remarkably decline, especially forced expiratory volume in 1 second was 410 ml (28.7%). A chest X-ray film showed an abnormal shadow in the right tracheobronchial portion. Chest CT and MRI scans showed a 38 x 46 mm round tumor in the carina involving the lower trachea and right main bronchus. Bronchoscopic examination revealed a submucosal tumor which obstructed the orfice of the right main bronchus. Pathological examination of tissue obtained by open excisional biopsy revealed a benign neurilemoma. Then we performed a tumor extirpation with tracheal partial resection and the defect of tracheobronchial wall was repaired by direct suture. Postoperative course was uneventful and her pulmonary function was improved. The tracheobronchial neurilemomas are rare. In this report we discuss the therapeutic management of a neurilemoma of the trachea on the basis of 12 domestic cases reviewed.     

Inflammatory myofibroblastic tumor of the larynx

BACKGROUND: Inflammatory myofibroblastic tumor, composed of myofibroblastic spindle cells with acute and chronic inflammatory cells, is an unusual, benign solid mass that mimics a neoplastic process. METHODS: We report a rare case of a patient with a laryngeal inflammatory myofibroblastic tumor. Laryngoscopy demonstrated a submucosal mass involving the right false cord. The mass was a well-enhanced supraglottic lesion on CT scan. It showed medially high signal intensity and peripherally low signal intensity on T2-weighted MR images, and it displayed a high magnetization transfer ratio; before surgery, it was believed to be a malignant tumor. Laryngoscopic biopsy was performed. Pathologic features of the specimen were diagnostic for inflammatory myofibroblastic tumor. RESULTS: Steroid therapy was chosen for further treatment. No recurrence was observed for 4 years. CONCLUSION: In patients with chronic hoarseness who have a malignant-looking submucosal laryngeal mass, inflammatory myofibroblastic tumor should be considered. Conservative surgery and steroid treatment are advocated because of laryngeal preservation.     

Surgical resection of adenocarcinoma arising from an accessory cardiac bronchus

A 62-year-old woman was referred to our hospital for evaluation of hemoptysis. Chest computed tomography demonstrated an accessory cardiac bronchus (ACB) arising from the carina with a well-defined mass approximately 3 cm in size. Fiberoptic bronchoscopy also revealed the presence of an ACB arising from the carina. We performed mass excision and en bloc resection of portions of the pericardium. Pathologic examination revealed that the tumor was an adenocarcinoma arising from an ACB.     

Left lower sleeve lobectomy for tuberculous stenosis of left main bronchus--a case report

A 35-year-old women complained exertional dyspnea during medication therapy for pulmonary tuberculosis. Thoracotomy was done under the diagnosis of stenosis of the left main bronchus and of obstruction of the left lower bronchus due to bronchial tuberculosis. The collapsed inferior lobe of the left lung with fibrotic change was resected. The left main bronchus was completely resected without only one cartilage ring nearest to the carina. The anastomosis of the left main bronchus end was performed to the end of the left lower lobe bronchus. This procedure of anastomosis is considered to be technically difficult for anatomical views, and its reports have been few. From our experience this operation can be performed safely by following modifications, 1) Botallo ligament was detached to obtain a wide operative filed for the end to end anastomosis of bronchus, 2) by taping of the trachea and the right main bronchus and applying traction by the tape, bronchial anastomosis was performed under direct view with great facility, and 3) omentopexy was added to prevent the suture insufficiency of the anastomosis.     

Inflammatory Myofibroblastic Tumor of the Ileocecal Mesentery Mimicking Abdominal Lymphoma in Childhood: Report of Two Cases

An inflammatory myofibroblastic tumor is an uncommon benign tumor located in various organs that can be misdiagnosed as a malignant neoplasm. We herein present two patients with ileocecal inflammatory myofibroblastic tumors. An abdominal mass was detected in a 13-year-old girl and a 15-year-old boy who presented with paleness, fatigue, intermittent fever, and night sweating. The radiological findings confirmed a mass originating from the ileocecal region. The presumptive diagnosis was Burkitt’s lymphoma. The histopathological diagnosis was inflammatory myofibroblastic tumor. After a surgical resection, all systemic symptoms rapidly resolved. Inflammatory myofibroblastic tumor is a rare pseudosarcomatous clinical and pathological entity. Although this tumor is more commonly reported in the lung, it can be detected in extrapulmonary sites, including the mesentery. Because the choice of treatment for this tumor is conservative surgery, an accurate preoperative analysis is important to avoid any unnecessary aggressive surgical intervention or other therapeutic approaches.     

A case of lung cancer underwent carinal resection with right upper lobectomy and carinal reconstruction with double-barreled anastomosis

A 70-year-old male complaining cough was admitted to our hospital. Bronchoscopic examination revealed a tumor mass which occluded the orifice of the right upper lobe. Chest computed tomographic (CT) scans gave the image of tumor invasion at the carina. The pathological diagnosis of the tumor was squamous cell carcinoma. Operation was accomplished by right posterolateral thoracotomy approach through the fifth rib bed. The carinal resection with right upper lobectomy was followed by a double-barreled anastomosis of the right intermediate trunk and left main-stem bronchus into the carina. The operation was successfully performed and was considered curative. The length of resected airway measured 4.0 cm from tracheal line of resection to the divided the right intermediate trunk. Reinforcement of the anastomosis was not performed in this case. No postoperative complication occurred but mild ischemia of the anastomosis. The patient died of recurrent tumor in a year and 2 months after operation.     

Tuberculous mediastinal mass presenting with stridor in a 3-month-old child

A 3-month-old boy with a history of intermittent stridor was found to have obstructive emphysema on chest x-ray. Further investigations found a mediastinal mass compressing the carina and left mainstem bronchus. The mass was excised and found to be of tuberculous origin.     

Endobronchial lipoma. Therapeutic considerations

Endobronchial lipoma is a very rare benign tumor. The most frequent clinical presentation is caused by airway obstruction. A computed tomography finding of a homogeneous mass with fat density not enhanced by intravenous contrast material is considered diagnostic of this kind of tumor. The definitive diagnosis is given by bronchoscopy and biopsy. The treatment of choice is endoscopic resection, although open resection is sometimes required. We present a case of endobronchial lipoma that involved the left main bronchus and extended through the bronchial carina. Endoscopic treatment was initially attempted. However, open resection through superior lobectomy with carinal resection and a bronchoplastic procedure were required to avoid left pneumonectomy.     

Obstructing endobronchial fibrous histiocytoma: potential for lung salvage.

In the past 10 years two children, ages 3 1/2 and 7 years, have been seen with central endobronchial fibrous histiocytoma causing complete atelectasis. Each child had a 4- to 6-month history of cough, dyspnea and fever. After antibiotic failure, x-rays demonstrated complete unilateral lung collapse. Bronchoscopy in case 1 demonstrated total occlusion of the left mainstem bronchus with 80% stenosis of the right. Left pneumonectomy was ultimately performed with removal of tumor frm the right bronchus. Ten years later the patient is well. Case 2 had an extrinsic etiology ruled out by computed tomography scan. Ventilation/perfusion scan showed no ventilation and only faint perfusion of the involved lung. Pulmonary function testing showed moderate to severe restrictive changes with air trapping. Total obliteration of the left mainstem with tumor projecting into the carina was observed on bronchoscopy. Endoscopic resection was not felt to be safe. Thoracotomy showed a totally atelectatic, edematous lung filled with pus. The left main bronchus was opened, the tumor removed, and the distal bronchus lavaged and selectively ventilated. Partial lung expansion was obtained. The child is well 1 1/2 years later with a normal chest radiograph, pulmonary function tests, and bronchoscopy. Fibrous histiocytomas of the lung, if in a central endobronchial location, can cause complete lung collapse. A combination of tumor resection, lavage, and selective ventilation should be attempted as an alternative to pneumonectomy, even if the lung appears to be nonsalvageable.     

Resection of the entire left mainstem bronchus for an inflammatory pseudotumor

We present the case of a 16-year-old white girl with a history of recurrent postobstructive pneumonia. Chest roentgenogram, chest computed tomography, and bronchoscopy revealed a mass in the left mainstem bronchus with an exophytic component. Multiple bronchoscopic biopsies confirmed the mass to be an inflammatory pseudotumor. After failing months of medical therapy with systemic steroids as well as several laser ablations, the tumor was removed through a left thoracotomy with resection of the entire left mainstem bronchus and reimplantation of the left upper and lower lobe into the trachea without complication or recurrence after 1 year.     

Ein seltener inflammatorisch myofibroblastärer Tumor der Lunge

This case presents an inflammatory myofibroblastic tumor of the lung (IMT). In the presented case the tumor was diagnosed in an advanced stage, when the bronchus of the upper lobe was already obstructed. In the x-ray examination of the lung we found a complete atelectasis of the left lung. The incidence of an IMT is observed in every age group, with a higher prevalence in teenagers and young adults. A complete R0-resection is the only curative option. A limited resection with histological free margins seems to be sufficient. Because of the advanced stadium a limited resection was technically impossible in the case presented. It is worth mentioning that recurrences can be observed even 10 years after an operation. Therefore, a long-term follow-up is advised.     

Clinical manifestation of mediastinal fibrosis and histoplasmosis.

We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2). Nine patients had severe stenosis of the trachea, carina, or main bronchus. Special stains identified Histoplasma capsulatum in surgical specimens in 9 patients. Surgical procedures were done for 18 of 20 patients (resection of subcarinal mass, 6; right middle and lower lobectomy, 5; carinal pneumonectomy, 4; esophagoplasty, 4; sleeve resection, 3 (with right main bronchus in 1, right lower and middle lobectomy in 1, and carina in 1); right upper lobectomy, 1; middle lobectomy, 1; and bronchoplasty of left main bronchus, 1. There were 4 deaths, 3 after complications of carinal pneumonectomy and 1 in a patient with tracheobronchial obstruction that could not be dilated. Two patients were treated with amphotericin and 4 with ketoconazole. Sclerosing mediastinitis secondary to histoplasmosis presents tremendous surgical challenges because of the intense fibrosis encountered. Bronchoplastic procedures are possible in spite of the intense fibrosis. High mortality rates after carinal resection may be encountered. The exact role of antifungal therapy is as yet undefined.