Department of Respiratory Medicine, Lanxi People's Hospital, No. 1359, Xishan Road, Lanxi, Jinhua, 321100, Zhejiang Province, China.
BMC Pulm Med. 2020 Sep 22;20(1):251. doi: 10.1186/s12890-020-01287-4.
Endobronchial lipoma is an extremely rare benign tumor, which is generally located in the first three subdivisions of the tracheobronchial tree. According to the existing literature, all endobronchial lipomas are single (one per patient). Here, we report a rare case in which the patient presented with two endobronchial lipomas in the same patient, and underwent a bronchoscopic tumor resection in the left main bronchus and the left lower bronchus. Both tumors were pathologically confirmed as endobronchial lipoma.
A 52-year-old Chinese man presented at the clinic reporting a mild cough with yellow color sputum and exertional dyspnea for 2 weeks. He was a heavy smoker (45 pack-years). Chest auscultation demonstrated faint wheezing in left lower lobe. Computed tomography (CT) revealed two low-density endobronchial masses located in the middle segment of the left main bronchus and the posterior basilar segmental bronchus of the left lower lobe. The neoplasms measured a CT-attenuation value of -70HU, -98HU in density with air trapping and atelectasis in the segmental bronchus of the left lower lobe. The patient underwent interventional bronchoscopic management to remove the neoplasms by using an electrosurgical snare, cryotherapy, and electrocautery. The locations of the neoplasms were confirmed at the left main bronchus and the superior segment of the left lower lobe during bronchoscopic intervention. Histopathological examination confirmed that both tissues were consistent with lipomas. After 18 months of follow-up, the patient was free of symptoms and CT revealed that bronchiectasia remained in the superior segment of the left lower lobe; however, no mass lesion was present in the left bronchus.
This case suggests that an endobronchial lipoma can present as multiple lesions, and both proximal and distal types can simultaneously occur in the same patient. Thus, these findings help us further understand the biology of endobronchial lipomas.
支气管内脂肪瘤是一种极为罕见的良性肿瘤，通常位于气管支气管树的前三个分支。根据现有文献，所有支气管内脂肪瘤均为单发（每位患者一个）。在这里，我们报告了一例罕见病例，同一患者出现两个支气管内脂肪瘤，并在左主支气管和左下支气管行支气管镜肿瘤切除术。两个肿瘤均经病理证实为支气管内脂肪瘤。
一名 52 岁的中国男性因轻度咳嗽、咳黄色痰和活动后呼吸困难 2 周就诊。他是重度吸烟者（45 包年）。胸部听诊在左下叶可闻及轻微哮鸣音。胸部计算机断层扫描（CT）显示左主支气管中段和左下叶后基底段有两个低密度支气管内肿块。肿瘤的 CT 衰减值分别为-70HU 和-98HU，密度较低，伴有左下叶段支气管空气潴留和肺不张。患者接受介入性支气管镜检查，使用电外科圈套器、冷冻疗法和电灼术切除肿瘤。支气管镜介入时确认肿瘤位于左主支气管和左下叶上段。组织病理学检查证实两种组织均与脂肪瘤一致。18 个月随访时，患者症状消失，CT 显示左下叶上段仍存在支气管扩张，但左支气管未见肿块。
本例提示支气管内脂肪瘤可表现为多发病变，同一患者可同时出现近侧和远侧型。这些发现有助于我们进一步了解支气管内脂肪瘤的生物学特性。
