Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

A Rare Case of Bronchial Epithelial-Myoepithelial Carcinoma with Solid Lobular Growth in a 53-Year-Old Woman / 결핵및호흡기질환

Epithelial-myoepithelial carcinoma (EMC) of lung is a minor subset of salivary type carcinoma of lung of known low grade malignancy. Histologically, two-cell components forming duct-like structure with inner epithelial cell layer and outer myoepithelial cell layer are characteristics of EMC. In salivary gland, dedifferentiation of conventional low grade malignancy has been reported and is thought to be related with poor prognosis. However, precise histomorphology and prognostic factors of pulmonary EMC have not been clarified due to its rarity. Herein, we reported a rare case of EMC presented as endobronchial mass in a 53-year old woman, which showed predominant solid lobular growth pattern and lymph node metastases.

Análise da imunoexpressão da podoplanina (D2-40), da proteína nuclear Ki-67 e da catepsina D-34 e suas relações com metástase em pacientes operados por tumor carcinoide típico broncopulmonar / Analysis of the immunoexpression of podoplanin (D2-40), of the nuclear protein Ki-67, and of cathepsin D-34 and their relation to metastasis in patients operated for typical bronchopulmonary carcinoid tumor

Os tumores carcinoides broncopulmonares típicos são considerados tumores de baixo grau de malignidade, o que faz com que muitas vezes seja negligenciada sua capacidade de gerar metástases e levar a óbito. A atual impossibilidade de se fazer predições fidedignas do potencial metastático para individualizar a terapêutica e o manejo clínico do paciente portador de tumor carcinoide típico muitas vezes impõe situações de dúvida nas decisões da prática clínica diária. O conhecimento das características moleculares e genéticas desses tumores é a esperança de melhor compreensão de sua história natural, da identificação de seus fatores prognósticos e da avaliação de novas propostas terapêuticas. O objetivo deste estudo foi quantificar três imunomarcadores: o D2-40, o CD-34 e o Ki-67 e avaliar se eles são capazes de predizer metástase. Como informação adicional também foram avaliadas as variáveis clínicas e suas associações com metástases. Material e métodos: Foram analisados prontuários de 97 pacientes submetidos à cirurgia para tratamento de tumor carcinoide típico broncopulmonar e que apresentavam período de acompanhamento pós operatório de cinco anos completos. Foi estabelecido um banco de dados epidemiológicos, anátomopatológicos, cirúrgicos e clínicos relacionados à doença. Os blocos de parafina contendo os tumores primários, metastáticos e os linfonodos ressecados foram recuperados e reavaliados por dois patologistas para confirmação do diagnóstico histológico. Após confirmação diagnóstica foram realizadas as reações imunohistoquímicas para o D2-40, o CD34 e Ki-67. As variáveis demografia, gênero, idade, localização do tumor, tamanho do tumor, margem comprometida, total de linfonodos dissecados e a quantificação dos marcadores Ki-67, CD34 e podoplanina (área linfática e densidade) foram comparadas a cinco desfechos: metástase linfática; metástase em linfonodos hilares, peribrônquicos e pulmonares ipsilaterais (N1); metástase em linfonodos mediastinais...

Typical bronchopulmonary carcinoid tumors are slow-growing tumors considered to be of low malignancy, a fact that often underscores their capacity to generate metastasis that leads to death. The literature does not contain any assessment of the metastatic potential that would allow for individualized and optimized therapy that could have a positive impact upon the survival rate of patients. Genetic and biomolecular studies are the most promising venues for better comprehension of the behavior and natural history of such tumors. The objective of this investigation was to analyze three immunomarkers associated to malignity phenotypes: D2-40, CD-34, and Ki-67, and to verify whether or not they are associated to metastasis. D2-40 is a specific marker of the proliferation of the lymphatic endothelium and allows for the quantification of lymphangiogenesis. CD-34 identifies the endothelial cells of micro vessels and quantifies angiogenesis. Ki-67 in turn is a marker of neoplasia cell proliferation. As additional information several clinical variables were scrutinized for their association to metastasis. Ninety-seven subjects were assessed herein. These had undergone surgery for typical bronchopulmonary carcinoid tumor and all had complied with a full 5-year follow-up period. The paraffin blocks containing the primary and metastatic tumors and the dried lymph nodes were recovered. Once the histologic diagnosis was confirmed immunohistochemical reactions were performed for D2-40, Ki-67, and CD-34. The variables demography, gender, age, tumor site, tumor size, compromised margin, total dissected lymph nodes and quantification of D2-40 (lymphatic area and density), Ki-67 and CD-34 markers were compared to 5 outcomes: lymphatic metastasis, metastasis in hilar, peribronchic and ipsilateral pulmonary lymph nodes (N1), metastasis in ipsilateral mediastinal lymph nodes (N2), haematogenic metastasis, and lymphatic or haematogenic metastasis. It was concluded that there is...

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy / 결핵및호흡기질환

Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

Primary Endobronchial Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue: CT Findings in 7 Patients

OBJECTIVE: To investigate CT and 18F-flurodeoxyglucose (18F-FDG) positron-emission tomography/CT findings of primary endobronchial marginal zone B-cell lymphoma of the bronchus-associated lymphoid tissue (BALT). MATERIALS AND METHODS: From June 2006 through April 2012, seven patients (six female, one male; age range, 21-61 years; mean age, 49 years) were examined who were pathologically diagnosed with the primary endobronchial marginal zone B-cell lymphoma of BALT. We evaluated the locations and characteristics of the lesions on CT and 18F-FDG-PET/CT scans. The lesions were classified into the following three patterns: 1) solitary intraluminal nodule; 2) several tiny nodular protrusions; and 3) diffuse wall thickening. RESULTS: A solitary intraluminal nodule was observed in four patients (57.1%), several tiny nodular protrusion in two patients (28.6%), and diffuse wall thickening in one patient (14.3%). The lesions were categorized into 3 major locations: confined to the trachea (n = 3), confined to the lobar bronchus (n = 2), and diffuse involvement of the trachea and both main bronchi (n = 2). All lesions demonstrated homogeneous iso-attenuation as compared with muscle on pre- and post-enhancement scans. Secondary findings in the lungs (n = 3; 42.9%) included postobstructive lobar atelectasis (n = 1), air trapping (n = 1), and pneumonia (n = 1). On 18F-FDG-PET/CT (n = 5), 4 lesions showed homogeneous uptake with maximum standardized uptake values (mSUV), ranging 2.3-5.7 (mean mSUV: 3.3). One lesion showed little FDG uptake. CONCLUSION: Primary endobronchial marginal zone B-cell lymphoma of the BALT manifests as three distinct patterns on CT, with the solitary intraluminal nodule presenting as the main pattern. Most lesions demonstrate homogeneous but weak FDG uptake on 18F-FDG-PET/CT.

A Case of an Endobronchial Fibroepithelial Polyp / 대한내과학회지

Benign endobronchial polyps are rare manifestations, which presents a diagnostic dilemma for both the clinician and the pathologist. A 44-year-old male presented an asymptomatic endobronchial mass incidentally discovered on chest computed tomography scan during a regular health checkup. A bronchoscopic examination revealed a 5-mm-sized multilobular benign polyp located at the orifice of left lower lobar bronchus, and the polyp was removed using multiple forcep biopsies. The pathologic report showed that it was a fibroepithelial polyp. Herein, we describe a rare case of an endobronchial fibroepithelial polyp and provide a brief review of the published literature.

A Case of an Endobronchial Fibroepithelial Polyp / 대한내과학회지

Benign endobronchial polyps are rare manifestations, which presents a diagnostic dilemma for both the clinician and the pathologist. A 44-year-old male presented an asymptomatic endobronchial mass incidentally discovered on chest computed tomography scan during a regular health checkup. A bronchoscopic examination revealed a 5-mm-sized multilobular benign polyp located at the orifice of left lower lobar bronchus, and the polyp was removed using multiple forcep biopsies. The pathologic report showed that it was a fibroepithelial polyp. Herein, we describe a rare case of an endobronchial fibroepithelial polyp and provide a brief review of the published literature.

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.

Ressecção minimamente invasiva por broncoscopia de tumores brônquicos benignos / Minimally invasive bronchoscopic resection of benign tumors of the bronchi

OBJETIVO: Tumores benignos primários da traqueia e dos brônquios principais são incomuns. A broncoscopia intervencionista permite o diagnóstico e o tratamento de algumas dessas lesões. MÉTODOS: Revisamos quatro casos tratados endoscopicamente em nossa instituição. RESULTADOS: Dois pacientes tinham hamartoma, e dois pacientes apresentaram lipoma endobrônquico. Em todos os casos, a técnica de intervenção para a ressecção foi o uso de alça de polipectomia e eletrocautério. A única complicação relatada foi um episódio de broncoespasmo. CONCLUSÕES: O tratamento broncoscópico minimamente invasivo é um método seguro e efetivo para o tratamento bem-sucedido de alguns tumores benignos da via aérea principal, com um baixo índice de complicações.

OBJECTIVE: Primary benign tumors of the trachea and main bronchi are uncommon. Interventional bronchoscopy allows the diagnosis and the treatment of some of these lesions. METHODS: We reviewed four cases endoscopically treated at our institution. RESULTS: Two patients had hamartoma, and two patients had endobronchial lipoma. In all of the cases, the interventional technique for the resection was the use of a polypectomy snare and electrocautery. The only complication reported was one episode of bronchospasm. CONCLUSIONS: Minimally invasive bronchoscopic resection is a safe, effective method for treating selected benign tumors of the main airway and has a low complication rate.

An Endobronchial Lipoma Treated by Bronchoscopic Excision / 대한내과학회지

A 68-year-old man presented with partial atelectasis of the right middle lobe on chest X-ray. Computed tomography of the chest revealed a hypodense mass in the middle lobe. Bronchoscopy showed a round mass obstructing the right middle lobe bronchus, and a biopsy specimen revealed only chronic inflammation. The tumor was removed using rigid bronchoscopy, and a diagnosis of endobronchial lipoma was made. An endobronchial lipoma is a very rare benign tumor that may cause parenchymal lung damage due to bronchial obstruction and subsequent pneumonia. We report this case to emphasize the role of endoscopic treatment in the management of endobronchial lipoma.

Lobectomía pulmonar en manguito, reporte de un caso y revisión de la literatura / Sleeve pulmonary lobectomy: case report and literature review

La lobectomía pulmonar con broncoplastia (lobectomía en manguito) se introdujo para las resecciones de cáncer pulmonar en pacientes que no toleraban una neumonectomía. Sin embargo, con el paso del tiempo se ha ido consolidando como un procedimiento oncológico, aunque persisten algunas preguntas sin resolver en la literatura.Se presenta el caso de un paciente con cáncer pulmonar al que se le practicó una lobectomía en manguito y se revisa la literatura al respecto, tratando de responder las preguntas sobre la validez de este procedimiento como una cirugía oncológica, los riesgos quirúrgicos y los efectos fisiológicos en la función pulmonar.A pesar de requerir una anastomosis bronquial, la lobectomía en manguito es un procedimiento oncológicamente válido y comparable a una neumonectomía pero con un menor impacto funcional en el pulmón, por lo que se recomienda en los pacientes que anatómicamente la necesitan.

Lung bronchoplastic techniques (sleeve lobectomy) were introduced for patients suffering lung cancer who did not tolerate a pneumonectomy, however with time they are now considered an oncologic procedure but there are still some unanswered questions in the literature.The case of a patient with lung cancer who underwent a sleeve lobectomy and a review of the literature are reported in order to answer the questions about the validity of this procedure as an oncologic procedure, the operative risks and the physiologic effects on lung function.Although a bronchial anastomosis is needed, the sleeve lobectomy is a valid oncologic procedure comparable to a pneumonectomy but without the lung functional impact of this operation, and is recommended for patients which anatomically require it.

Tumor glômico endobrônquico com atelectasia de lobo superior direito / Bronchial glomus tumor with right upper lobe atelectasis

Tumores glômicos são raras neoplasias benignas de tecidos moles. Relatamos o caso de um paciente de 32 anos de idade que apresentava atelectasia em lobo superior direito devido a um tumor endobrônquico. O paciente foi submetido a lobectomia superior direita e broncoplastia em cunha. O diagnóstico patológico foi de tumor glômico endobrônquico. Até onde sabemos, essa apresentação com atelectasia em lobo superior direito nunca foi relatada. O tumor glômico deve ser considerado no diagnóstico diferencial de lesões endobrônquicas que causam atelectasia lobar.

Glomus tumors are uncommon benign soft tissue neoplasms. We report the case of a 32-year-old male who presented with right upper lobe atelectasis due to an endobronchial tumor. The patient underwent right upper lobectomy and wedge bronchoplasty. The pathological diagnosis was bronchial glomus tumor. To our knowledge, this presentation (with right upper lobe atelectasis) has never before been reported. Glomus tumor should be considered in the differential diagnosis of endobronchial lesions causing lobar atelectasis.

Endobronchial metastasis from prostate cancer: analysis of cases and review of the literatures / 中华老年医学杂志

Objective To analyze the clinical,radiologic and pathological features of endobronchial metastasis from prostate cancer, and its diagnosis and treatment. Methods Ten cases of endobronchial metastasis from prostate cancer with pathological evidence in our hospital were retrospectively analyzed.The clinical, radiologie andpathological features and the diagnostic procedures and treatment of the cases were reported and analyzed while combined with literature. ResultsAn average age at diagnosis of advanced prostate cancer was 65.5 years. Emoptysis(5/10), cough (4/10), dyspnea (4/10) and weight loss (5/10) were the common symptoms.Chest X-ray disclosed hilar and mediastinal lymphadenopathy (4/10), hilar mass (3/10) or atelectasis (2/10) . Bronchoscopic examination revealed that most of lesion located in single lobar or segmental bronchus (6/10). Bilateral upper lobe were most susceptibly involved(7/10). Polypoid lesions or mass in lumen of bronchi(8/10)were more frequent than infiltrative lesion(2/10), which could obstruct the orifice of the bronchi in different extent. Immunohistochemical staining for prostate specific antigen or prostatic acid phosphatase was positive, and most patients responded well to endocrine therapy. Conclusions Clin.ical and radiologic features of endobronchial metastasis from prostate cancer are similar to those of primary bronchogenic carcinoma. Immunohistoehemical study is helpful for differential diagnosis and the short-term efficacy of endocrine therapy is significant.

Atelectasia pulmonar recurrente secundaria a una metástasis endobronquial de un carcinoma de colon: Caso clínico / Recurrent left lung atelectasis caused by an endobronchial metastasis of a colon cancer: Report of one case

Endobronchial location of metastases is uncommon. We report a 83 year-old woman with a history of a ¡eft hemicolectomy due to tubular colon adenocarcinoma, three years ago. She consulted in the emergency room for progressive dyspnea, cough an mucous sputum. There was abolition of breath sounds and dullness in the ¡eft hemithorax. Chest X ray examination showed a complete opacity of the ¡eft lung. She was treated as a pneumonia and her left lung expanded again. Three weeks later, left lung atelectasis relapsed. A bronchial biopsy showed a moderately differentiated adenocarcinoma, compatible with colon adenocarcinoma. Immunohistochemistry confirmed the colonic origin of the tumor. The patient rejected radiotherapy and is alive after 11 months of follow up.

Endobronchial Chondroid Hamartoma : A case report / 대한흉부외과학회지

Pulmonary hamartoma is a common benign tumor of the lung, but endobronchial hamartoma is a rare tumor. Although bronchoscopic rcemoval or removal by bronchotomy or sleeve resection with preservation of the lung may be possible, when irreversible lung damage has occurred because of chronic obstruction and pneumonitis, pulmonary resection may be indicated. We herein report a case of endobronchial hamartoma which was treated by left upper lobectomy. A 42-year-old female with 3-week history of cough and left chest pain visited our hospital. Bronchoscopy showed total occlusion of the orifice of the left upper lobe bronchus by a lobulated endobronchial tumor and bronchoscopic biopsy was failed due to bleeding. A left upper lobectomy was performed because of severe consolidation of the left upper lobe by chronic obstruction. The patient was discharged on postoperative 14th day.

Granular Cell Tumor Arising from the Left Main Bronchus : A case report / 대한흉부외과학회지

Granular cell tumors (GCT) are uncommon benign neoplasms. Their location is mostly in the the skin, tongue, and breast; appearance in other parts of the body is rare, but it has been reported. They have also been reported to occur synchronously in multiple organs and metachronously in a single organ. The incidence of GCTs in the tracheobronchial tree is unknown and pulmonary GCTs are uncommon, with approximately 100 reported cases in the literature. We present the case of a 33-year-old man with a granular cell tumor of the left main bronchus. The tumor was found at bronchoscopy performed to exclude suspected endobronchial mass with symptoms of pneumonia. Biopsies revealed the histological pattern of a benign granular cell tumor. He underwent resection of the left main bronchus followed by end to end anastomosis of left main bronchus. He has not had any recurrence of the tumor during the 1 year follow-up.

Endobronchial Leiomyoma Combined with Pulmonary Sequestration: A case report / 대한흉부외과학회지

A 42-year-old female was admitted to our hospital complaining of a dyspnea. Chest X-ray showed left atelectasis. A mass was detected in left main bronchus by computed tomography and bronchoscopy. The mass was diagnosed as a endobronchial leiomyoma by biopsy exam. After open thoracotomy and bronchotomy, mass removal was done and middle lobe was ventilated normally. Aberrant arterial supply from descending aorta to left lower lobe of the lung was detected and left lower lobectomy was done. The lower lobe of the left lung was pathologically diagnosed as intralobar pulmonary sequestration. Herein we report a rare coexistent case of endobronchial leiomyoma and intralobar pulmonary sequestration.

Endobronchial Chondroid Hamartoma Removed by Segmentectomy: Surgical Experience of One Case / 대한흉부외과학회지

In comparison to parenchymal hamartoma, endobronchial hamartoma is rare benign neoplasm of the lung. Most parenchymal hamartomas are asymptomatic and are found incidentally. However, endobronchial hamartomas are frequently discovered through respiratory symptoms as a result of bronchial irritation or obstruction. A 47-year-old male patient was admitted to our hospital due to dry cough 1 month prior to admission. On bronchoscopic examination, a polypoid mass was found completely obliterating the anterior segmental bronchus of the left upper lobe. We report a case of endobronchial chondroid hamartoma, which was resected by anterior segmentectomy of the left upper lobe.

Primary Schwannoma of Bronchus: 2 case report / 대한흉부외과학회지

Most tumors of the tracheobronchial tree are malignant, and benign tumors are less than 10%. Especially, the incidence of primary neurogenic tumors of the lung has been estimated to be less than 2 percent of primary lung cancer, and majority of these tumors are originated from Schwann cells. These tumors can be presented either as a solitary benign neoplasm or as a malignant form, which is rare. We present two cases of bronchial Schwannoma managed by means of lobectomy.

Bronchogenic Squamous Cell Carcinoma in Patient with Swyer-James Syndrome: One Case Report / 대한흉부외과학회지

Swyer-James syndrome is a rare disease with patients presenting with unilateral hyperlucent lungs and hypoperfusion due to hypoplasia of the pulmonary artery and bronchiolitis obliterans. A unilateral hyperlucent lung generally develops after a lower respiratory tract infection during early childhood. In extremely rare cases, an association of bronchogenic carcinoma with Swyer-James syndrome has been reported. We report a case of bronchogenic squamous cell carcinoma associated with Swyer-James syndrome that performed right upper lobectomy and lymph node dissection with a relevant literature review.