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Endobronchial lipoma. Therapeutic considerations.Cir
Esp. 2006 Aug;80(2):109-10.
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.
Endobronchial lipoma in a patient with Churg-Strauss syndrome.Thorac
Cardiovasc Surg. 2006 Jun;54(4):283-5.
Churg-Strauss
syndrome (CSS) is a disorder characterized by hypereosinophilia and
systemic vasculitis complicating a preexisting asthma. We report
here a case of CSS with an endobronchial lesion, initially
considered to be an endobronchial granuloma of CSS, which was
finally diagnosed as a lipoma, a very rare benign tumor of the
tracheobronchial tree. To our knowledge, this is the first case in
the literature presenting with these two rare entities.
Endobronchial lipomas and their treatment: one case report.
Rev Laryngol Otol Rhinol (Bord).
2005;126(3):147-9.
PURPOSE: Starting from a clinical observation of an endobronchial
lipoma and in the light of worldwide literature, the aim of this
case report is to specify the epidemiology, the key points of the
diagnosis and the advantage of endoscopy both in the diagnosis and
the treatment of these rare benign bronchopulmonary tumours.
CLINICAL CASE: Recent pneumopathy in the right superior lobe
bronchial area in a 73 year old female, symptomatic with cought.
Biopsy exeresis gave the histological diagnosis. DISCUSSION AND
CONCLUSION: The clinical symptoms due to bronchial obstruction
associated with the conventional radiological and computed
tomography signs orientate the diagnosis definitively obtained
through the anatomopathological study. This histological study is
carried out from biopsies performed either during a bronchial
fibroscopy or during a tracheobronchoscopy. By confronting the
benign macroscopic aspect and the data from the extemporaneous
anatomopathological study of the lesion, endoscopy provides an
early-stage diagnosis and makes it possible to perform a concomitant
and conservative treatment before the stage of irreversible broncho-pulmonary
complications. It also avoids the risks and sequelae of classical
surgery by thoracotomy.
Cryorecanalization
of an endobronchial lipoma.Pneumologie.
2005 Oct;59(10):685-8.
In this case
presentation the advantages of a new method of cryoextraction of an
endobronchial lipoma are demonstrated. With an improved probe with
high mechanical stability large areas of the lipoma can be frozen
and removed from the bronchial wall. The tissue is directly
extracted from the tumor. Cryorecanalization permits during one
procedure the reopening of an endoluminal airway obstruction.
Pleural
empyema associated with endobronchial lipoma.
Arch Bronconeumol. 2005
Mar;41(3):172-4.
Bronchial
benign tumors comprise fewer than 4% of pulmonary neoplasms.
Endobronchial lipoma is an extremely rare benign neoplasm accounting
for only 0.1% to 0.5% of all lung tumors. Clinical symptoms of
lipoma depend on the location of the tumor, the severity of
bronchial obstruction, and the functional and anatomical effects on
the parenchyma distal to the obstruction. Computed axial tomography
usually reveals the adipose composition of the lipomatous tumor. We
report the case of an 83-year-old man diagnosed with
community-acquired pneumonia that led to complications: pleural
empyema caused by Haemophilus influenzae infection and atelectasis
of the right middle and lower lobes secondary to a lipomatous
endobronchial obstruction. Removal of the bronchial lipoma was
performed by laser resection.
Endobronchial lipoma: successful therapy by bronchoscopical laser
resection vs. surgery.Pneumologie.
2004 Nov;58(11):769-72.
BACKGROUND: Endobronchial lipoma is a very rare benign lung tumor.
Therapeutic alternatives are the interventional bronchoscopic laser
resection or surgical treatment. METHODS: From 1996 to 2002 we
diagnosed 16 patients with endobronchial lipoma in our institution.
We examined the clinical data of the patients and their influence on
the individual patient treatment. RESULTS: 14 (88 %) out of the 16
patients (60 +/- 14 y.) were male. Clinical symptoms were cough (81
%), dyspnea (75 %), pulmonary infiltration (63 %) and fever (31 %).
In the right lung 11 lipomas (69 %) were located, in the left lung 5
lipomas (31 %). The distribution to main bronchus, upper lobe,
middle lobe and lower lobe bronchus were 2 (12.5 %), 6 (37.5 %), 2
(12.5 %) und 6 (37.5 %). 14 (88 %) lipomas were found in the central
airways, 2 were located in the periphery of the lung. All lipomas in
the central airways were successfully treated by bronchoscopic laser
therapy with a mean of 1.1 +/- 0.3 laser sessions. One patient died
of concomitant bronchial carcinoma before therapy. Surgical
treatment was only necessary in a very peripherally located huge
lipoma and a lipoma with extensive parenchym destruction.
CONCLUSIONS: Bronchoscopic laser resection should be considered as
first line therapy in cases of endobronchial lipoma. It is safe,
successful, rapid and less expensive compared to surgical resection.
Surgery should only be indicated in patients with lipomas with very
peripherally localisation or parenchym destruction, extrabronchial
growth, suspected malignancy or technical problems at bronchoscopic
resection.
Computed
tomography diagnosis of post-obstructive atelectasis by an
endobronchial lipoma.
J Formos Med Assoc. 2004
Feb;103(2):148-50.
Endobronchial lipoma is a rare benign tumor in the bronchial tree.
We report a case of endobronchial lipoma in a 73-year-old man with
hemoptysis. Chest radiograph revealed atelectasis of the right upper
lung. Bronchoscopy revealed a well-defined endobronchial lesion in
the right upper lobe bronchus with near total occlusion, but a
biopsy was not performed. An endobronchial tumor was identified on
CT scan with demonstration of fat within the tumor. Endobronchial
lipoma was diagnosed and a sleeve lobectomy of the right upper lobe
bronchus was performed. The pathological diagnosis was submucosal
lipoma. The patient's symptoms improved during follow-up of more
than 1 year. CT scan can be used to diagnose endobronchial lipoma
and can help in the development of a management plan.
Endobronchial lipoma: review of 64 cases reported in Japan.Chest.
2003 Jan;123(1):293-6.
BACKGROUND:
Several recent studies discuss bronchoscopic techniques for treating
endobronchial lipoma, an extremely rare benign tumor. OBJECTIVES: To
describe the epidemiology of endobronchial lipoma and to propose
appropriate therapeutic policies for treating this tumor. METHODS:
We reviewed 64 cases of endobronchial lipoma: 33 cases previously
reported in 30 different articles, and 31 case reports presented at
thoracic meetings in Japan. RESULTS: Of the 64 patients included in
this study (50 male and 14 female; mean age, 60 years), 40 patients
had endobronchial lipoma in the right lung and 23 patients had it in
the left lung. The overwhelming majority of the tumors (n = 61) were
found in the first three subdivisions of the tracheobronchial tree.
Forty-eight patients (75%) were symptomatic, and their symptoms
included cough, sputum, hemoptysis, elevated temperature, and
dyspnea. Additionally, abnormal radiographic findings were reported
for 51 patients (80%): 18 patients had atelectasis, 14 patients had
infiltration or consolidation, 6 patients showed volume loss of the
lung, and mass shadow was identified in 9 patients, and another
abnormality including pleural effusion was found in 4 patients.
Forty patients underwent surgical resection: 4 pneumonectomies, 24
lobectomies, 8 bilobectomies, and 4 resections by bronchotomy.
Bronchoscopic resection was carried out in 17 cases: 7 cases by
Nd-YAG laser, 5 cases by electrosurgical snaring forceps, and
another 5 cases with a combined therapy using both procedures.
CONCLUSIONS: Bronchoscopic resection should be considered as the
first choice of treatment for endobronchial lipoma; however,
surgical therapy is indicated for patients who show the possibility
of a complicated malignant tumor, who have destructive peripheral
lung disease, who have extrabronchial growth, or who may have
technical difficulties during the bronchoscopic procedure.
Endobronchial lipoma accompanied with primary lung cancer: report of
a case.
Surg Today. 2002;32(5):402-5.
A
72-year-old man was found to have an endobronchial lipoma
accompanied with primary lung cancer. A left lower lobectomy with a
mediastinal lymph node dissection and a sleeve resection of the
lingual bronchus with telescoping bronchial anastomosis were done.
The pathological staging was T1N2M0, stage IIIA. A histological
examination showed well-differentiated squamous cell carcinoma in
segment 10, in addition to the presence of mature adipose tissue
which was diagnosed to be a benign endobronchial lipoma originating
from the lingual bronchus. The postoperative course was uneventful
and the patient was discharged 13 days after the operation. However,
he had a recurrence in the subcarinal lymph node, and died 8 months
after surgery.
Endobronchial lipoma: a series of three cases and the role of
electrocautery.Respiration.
2000;67(6):689-92.
Lipomas are
rare endobronchial tumors that may cause severe parenchymal damage
due to bronchus obstruction and subsequent pneumonia. Therefore,
accurate diagnosis and radical treatment are essential. We describe
three cases of endobronchial lipoma. One patient presented with
hemoptysis, two patients were initially diagnosed as COPD. They were
all treated by electrocautery which achieved complete removal. We
recommend electrocautery as an easy and cost-effective alternative
for removal of intraluminal tumors including lipoma.
Endobronchial lipoma: a report of three cases.
Jpn J Clin Oncol. 1996 Feb;26(1):53-7.
Although
lipomas are common benign neoplasms of soft tissue, endobronchial
lipoma is rare. We have treated three patients with endobronchial
lipoma over the five years. In two of them lesions were located in
segmental or subsegmental bronchi and produced no symptoms. There
are very few such cases reported in the English medical literature.
In the first case, pneumonectomy was performed because of
destruction of the lung due to recurrent pneumonia. The second case
had no symptoms and the tumor was located at the bifurcation of
right B4a and B4b. A right middle lobectomy was performed, because
the distal end of the tumor could not be visualized by fiberoptic
bronchoscopy. In the third case, which was a case of lung cancer, an
endobronchial lipoma was found during fiberoptic bronchoscopy, and
was completely removed endoscopically. Due to their benign nature,
endobronchial lipomas should be initially treated with endoscopic
surgery or endoscopic laser vaporization. Nevertheless, if the tumor
is large and dumbbell-shaped on tomography or CT, endoscopic
procedures are not appropriate. Furthermore, if destructive
pulmonary change due to the tumor is severe, the remaining
peripheral lung will not recover after endoscopic procedures, even
if they are removed successfully. When the biopsy specimen is too
small to allow evaluation of the whole tumor, surgical resection
should also be considered for definitive diagnosis.
Endobronchial lipomas. Apropos of 4 cases.
Rev Pneumol Clin. 1996; 52(6):373-7.
We present 4
cases of endobronchial lipomas observed in our department over the
last fifteen years. Histological diagnosis was obtained in all cases
after endobronchoscopy and biopsy. Endobronchial exeresis was
possible in one patient, lobectomy was required in a second. For the
other two patients, surgery was not performed due to the patient's
age and the small size of the tumor. Radiography, bronchoscopy and
computed tomography findings suggested the diagnosis which was
confirmed at pathology examination of the biopsy or surgical
specimen. Treatment for endobronchial lipoma should be as
conservative as possible either by endobronchial or laser resection.
Thoracotomy should only be used when bronchial or pulmonary
alterations are irreversible.
Endobronchial lipomas: a clinicopathologic study of four cases.Mod
Pathol. 1994 Feb;7(2):212-4.
Four cases
of endobronchial lipomas are presented. The patients were men
between 45 and 54 yr of age. Clinically, two of the patients
presented with cough and one with shortness of breath. Two lesions
were located in the left lower lobe, one in the right upper lobe,
and one in the right lower lobe. Because of the clinical suspicion
of malignancy, all patients underwent radical surgical procedures;
lobectomy was performed in 3 patients, and pneumonectomy in one.
Grossly, all the lesions were characterized by well-circumscribed,
soft, yellow nodules that ranged in size from 1.2 to 3.0 cm in
greatest diameter. Histologically, the tumors resembled lipomas in
other locations, i.e., they were composed of mature adipose tissue
devoid of atypia. In two cases, prominent spindle cell areas were
also present similar to those of spindle cell lipoma. Identification
of the lesion by endoscopic and radiologic means may help avoid
unnecessary radical surgery. A review of the literature on these
unusual lesions is presented along with a discussion of their
differential diagnosis.
A case of
asymptomatic endobronchial lipoma followed for 4 years.Nihon
Kyobu Shikkan Gakkai Zasshi. 1992
Oct;30(10):1879-83.
Bronchoscopy
was performed on a 68-year-old male patient with pulmonary
tuberculosis, and revealed a yellow smooth polypoid tumor in the
lumen of the left upper division bronchus. The histopathological
diagnosis of the biopsy specimen was endobronchial lipoma. Since the
patient did not have any symptoms due to the lipoma, we performed
treatment for tuberculosis and continued careful observation of the
tumor. During the subsequent 4 years, the patient developed no
complications such as obstructive pneumonia, and the size of the
tumor under bronchoscopic observation did not change. Endobronchial
lipoma is a very rare benign tumor. Almost all reported cases have
undergone operation or endoscopic surgery. This case is the first
that was followed over 4 years without surgical procedure. The
findings of follow-up bronchoscopic examination suggest that the
growth rate of endobronchial lipoma is very slow. Furthermore, we
reviewed 36 cases of endobronchial lipoma in the Japanese
literature, including our case. Smoking seems to have a strong
relation to the occurrence of the tumor. It is noteworthy that 6
cases had separate malignancies, but the direct relationship between
endobronchial lipoma and such malignancies is unclear.
A case
report of endobronchial lipoma.Nihon
Kyobu Shikkan Gakkai Zasshi. 1990
Mar;28(3):519-24.
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.
Endobronchial lipomas. Apropos of 16 cases.
Rev Pneumol Clin.
1989;45(5):203-5.
Intrabronchial lipomas are rare and benign tumours. Sixteen cases
treated between 1956 and 1988 at the Marie Lannelongue Surgical
Centre, Paris, are reviewed. The patients presented with various
symptoms such as cough, haemoptysis, infection or dyspnoea.
Radiography was abnormal in 15 cases, and the lesion was regularly
located at bronchoscopy. Treatment was chiefly surgical. Owing to
the slow and silent growth of intrabronchial lipomas, there is a
risk of progressive bronchial obstruction resulting in
bronchopulmonary lesions. With an early detection, treatment should
be as conservative as possible. |
