Kamata Satoshi, Ishida Itaru, Sugawara Takafumi, Yaegashi Hiroshi, Oura Hiroyuki
Department of Thoracic Surgery, Iwate Prefectural Central Hospital, Ueda 1-4-1, Morioka, 020-0066, Japan.
Department of Pathology, Iwate Prefectural Central Hospital, Ueda 1-4-1, Morioka, Japan.
BMC Surg. 2019 Jan 31;19(1):13. doi: 10.1186/s12893-019-0481-0.
Angiolipoma is a rare, benign tumor that primarily develops in the limbs and trunk. The occurrence of angiolipoma in the lungs is extremely rare; to date, only two cases of primary bronchial angiolipoma have been reported. Here, we report a case of angiolipoma of the right bronchus intermedius that was successfully treated with sleeve resection and reconstructive surgery.
This report presents a case of angiolipoma that developed in the right bronchus intermedius of a 68-year-old man. A chest CT revealed a 10-mm endobronchial mass that was clearly visible as a high-attenuation area of contrast enhancement. Bronchoscopy revealed a submucosal tumor on the anterior wall of the entrance to the right bronchus intermedius that was constricting the airway lumen. The tumor surface was covered with numerous engorged blood vessels, and the middle and inferior pulmonary lobes were intact. Bronchial sleeve resection of the right bronchus intermedius was performed. Histologically, a mixture of proliferating blood vessels and adipocytes were observed within the bronchus wall. Therefore, the pathological diagnosis was angiolipoma. Lung function was preserved, and complete resection of the tumor was achieved. At present (2 years and 7 months after surgery), the patient is recurrence-free.
Accordingly, using bronchial sleeve resection and end-to-end anastomosis techniques, we accomplished complete tumor excision and avoided the need to resect additional lung parenchyma. Our procedure preserved pulmonary function and yielded a curative result. Bronchoscopic intervention or minimal parenchymal resection should be considered as treatments for bronchial angiolipoma. Given the small number of reports of bronchial angiolipoma, the collection of additional data is important to elucidate the clinical characteristics of this rare tumor.
血管脂肪瘤是一种罕见的良性肿瘤,主要发生于四肢和躯干。血管脂肪瘤在肺部极为罕见;迄今为止,仅报道过两例原发性支气管血管脂肪瘤。在此,我们报告一例右中间支气管血管脂肪瘤,经袖状切除及重建手术成功治疗。
本报告呈现一例发生于一名68岁男性右中间支气管的血管脂肪瘤。胸部CT显示一个10毫米的支气管内肿物,在增强扫描时清晰可见为高密度强化区域。支气管镜检查发现右中间支气管入口前壁有一个黏膜下肿瘤,该肿瘤使气道管腔狭窄。肿瘤表面布满大量充血血管,中下肺叶完好。对右中间支气管进行了支气管袖状切除术。组织学检查显示支气管壁内有增生的血管和脂肪细胞混合存在。因此,病理诊断为血管脂肪瘤。肺功能得以保留,肿瘤实现了完整切除。目前(术后2年7个月),患者无复发。
因此,通过支气管袖状切除及端对端吻合技术,我们实现了肿瘤的完整切除,避免了额外切除肺实质的必要性。我们的手术保留了肺功能并取得了治愈效果。对于支气管血管脂肪瘤,应考虑支气管镜干预或最小限度的实质切除术作为治疗方法。鉴于支气管血管脂肪瘤的报道数量较少,收集更多数据对于阐明这种罕见肿瘤的临床特征很重要。