Downloaded from http://thorax.bmj.com/ on June 18, 2015 - Published by group.bmj.com
Thorax Online First, published on March 31, 2015 as 10.1136/thoraxjnl-2015-206923 Chest clinic
IMAGES IN THORAX
Endobronchial lipoma mimicking bronchial carcinoid tumour Yvonne Nussbaumer-Ochsner,1 Frank Rassouli,1 Frank Uhlmann,2 Robert Thurnheer1 Pulmonary Division, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland 2 Pathology Division, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland Correspondence to Dr Yvonne NussbaumerOchsner, Pulmonary Division, Cantonal Hospital of Muensterlingen, Spitalcampus 1, Muensterlingen 8596, Switzerland; yvonne. [email protected] Received 10 February 2015 Revised 23 February 2015 Accepted 26 February 2015
A 68-year-old smoker on aspirin/clopidogrel due to recent percutaneous coronary intervention (PCI) / stenting presented with intermittent haemoptysis. Bronchoscopy revealed an endoluminal tumour in a right-lower-lobe segment (figure 1). No biopsy was taken due to bleeding risk. Aspirate analysis showed sparse cells with granular cytoplasm, and a presumptive diagnosis of bronchial carcinoid was made. CT scan showed no lymphadenopathy. After stopping clopidogrel and absent signs for progression on CT scan/bronchoscopy, right-lower lobectomy was performed. Histological analysis revealed a submucosal lipoma (figure 2). Differential diagnosis of endobronchial tumours encompasses benign (eg hamartoma, lipoma)1 and malignant lesions (eg bronchial carcinoid, metastasis, mucoepidermoid or adenocystic carcinoma).2 Biopsy has to be weighed against bleeding risk especially if a bronchial carcinoid is considered. Retrospectively, a lipoma could have been suspected based on the density of the lesion (−122 HU) and the endoscopic appearance. The management of our case was misled by the cells with granular
Figure 2 Sagittal section through the bronchus containing the endobronchial tumour (asterisk). The tumour originates from the submucosal layer of the bronchus. Upper edge: magnification of the tumour surface. The tumour is composed of mature fat and covered by respiratory epithelium.
Chest clinic
1
cytoplasm in the aspirate—arising from a ganglion beside the lipoma—and underlies the importance of a multistep-based diagnostic algorithm. Contributors YN-O was responsible for data collection and writing the manuscript. FU was responsible for the acquisition of the figures. FR and RT revised the manuscript. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
REFERENCES Figure 1 Bronchoscopic view of a well-circumscribed, yellowish polypoid mass obstructing a segment of the right lower lobe.
1 2
Cao D, Sun Y, Yang S. Endobronchial lipoma: an unusual cause of bronchial obstruction. Case Rep Med 2011;2011:939808. Li Z, Zarogoulidis P, Kougioumtzi I, et al. Surgical approaches of endobronchial neoplasms. J Thorac Dis 2013;5 (Suppl 4):S378–82.
To cite: NussbaumerOchsner Y, Rassouli F, Uhlmann F, et al. Thorax Published Online First: [please include Day Month Year] doi:10.1136/thoraxjnl2015-206923 Nussbaumer-Ochsner Y, et al. Thorax 2015;0:1. doi:10.1136/thoraxjnl-2015-206923
1
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd (& BTS) under licence.
Downloaded from http://thorax.bmj.com/ on June 18, 2015 - Published by group.bmj.com
Endobronchial lipoma mimicking bronchial carcinoid tumour Yvonne Nussbaumer-Ochsner, Frank Rassouli, Frank Uhlmann and Robert Thurnheer Thorax published online March 31, 2015
Updated information and services can be found at: http://thorax.bmj.com/content/early/2015/03/31/thoraxjnl-2015-20692 3
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Articles on similar topics can be found in the following collections Thorax Images in Thorax (110) Cardiothoracic surgery (607) Screening (oncology) (340) Health effects of tobacco use (184) Airway biology (1024) Health education (1088) Hemoptysis (68) Journalology (91) Smoking (925) Tobacco use (926)
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Thorax Online First, published on March 31, 2015 as 10.1136/thoraxjnl-2015-206923 Chest clinic
IMAGES IN THORAX
Endobronchial lipoma mimicking bronchial carcinoid tumour Yvonne Nussbaumer-Ochsner,1 Frank Rassouli,1 Frank Uhlmann,2 Robert Thurnheer1 Pulmonary Division, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland 2 Pathology Division, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland Correspondence to Dr Yvonne NussbaumerOchsner, Pulmonary Division, Cantonal Hospital of Muensterlingen, Spitalcampus 1, Muensterlingen 8596, Switzerland; yvonne. [email protected] Received 10 February 2015 Revised 23 February 2015 Accepted 26 February 2015
A 68-year-old smoker on aspirin/clopidogrel due to recent percutaneous coronary intervention (PCI) / stenting presented with intermittent haemoptysis. Bronchoscopy revealed an endoluminal tumour in a right-lower-lobe segment (figure 1). No biopsy was taken due to bleeding risk. Aspirate analysis showed sparse cells with granular cytoplasm, and a presumptive diagnosis of bronchial carcinoid was made. CT scan showed no lymphadenopathy. After stopping clopidogrel and absent signs for progression on CT scan/bronchoscopy, right-lower lobectomy was performed. Histological analysis revealed a submucosal lipoma (figure 2). Differential diagnosis of endobronchial tumours encompasses benign (eg hamartoma, lipoma)1 and malignant lesions (eg bronchial carcinoid, metastasis, mucoepidermoid or adenocystic carcinoma).2 Biopsy has to be weighed against bleeding risk especially if a bronchial carcinoid is considered. Retrospectively, a lipoma could have been suspected based on the density of the lesion (−122 HU) and the endoscopic appearance. The management of our case was misled by the cells with granular
Figure 2 Sagittal section through the bronchus containing the endobronchial tumour (asterisk). The tumour originates from the submucosal layer of the bronchus. Upper edge: magnification of the tumour surface. The tumour is composed of mature fat and covered by respiratory epithelium.
Chest clinic
1
cytoplasm in the aspirate—arising from a ganglion beside the lipoma—and underlies the importance of a multistep-based diagnostic algorithm. Contributors YN-O was responsible for data collection and writing the manuscript. FU was responsible for the acquisition of the figures. FR and RT revised the manuscript. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
REFERENCES Figure 1 Bronchoscopic view of a well-circumscribed, yellowish polypoid mass obstructing a segment of the right lower lobe.
1 2
Cao D, Sun Y, Yang S. Endobronchial lipoma: an unusual cause of bronchial obstruction. Case Rep Med 2011;2011:939808. Li Z, Zarogoulidis P, Kougioumtzi I, et al. Surgical approaches of endobronchial neoplasms. J Thorac Dis 2013;5 (Suppl 4):S378–82.
To cite: NussbaumerOchsner Y, Rassouli F, Uhlmann F, et al. Thorax Published Online First: [please include Day Month Year] doi:10.1136/thoraxjnl2015-206923 Nussbaumer-Ochsner Y, et al. Thorax 2015;0:1. doi:10.1136/thoraxjnl-2015-206923
1
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd (& BTS) under licence.
Downloaded from http://thorax.bmj.com/ on June 18, 2015 - Published by group.bmj.com
Endobronchial lipoma mimicking bronchial carcinoid tumour Yvonne Nussbaumer-Ochsner, Frank Rassouli, Frank Uhlmann and Robert Thurnheer Thorax published online March 31, 2015
Updated information and services can be found at: http://thorax.bmj.com/content/early/2015/03/31/thoraxjnl-2015-20692 3
These include:
References Email alerting service
Topic Collections
This article cites 1 articles, 0 of which you can access for free at: http://thorax.bmj.com/content/early/2015/03/31/thoraxjnl-2015-20692 3#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Thorax Images in Thorax (110) Cardiothoracic surgery (607) Screening (oncology) (340) Health effects of tobacco use (184) Airway biology (1024) Health education (1088) Hemoptysis (68) Journalology (91) Smoking (925) Tobacco use (926)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
