Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China.
BMC Pulm Med. 2023 Aug 31;23(1):317. doi: 10.1186/s12890-023-02608-z.
Extra-adrenal myelolipoma is an unusual entity, and endobronchial myelolipoma is rarer, which is often ignored by clinicians, delaying the disease and affecting the prognosis.
A 71-year-old man with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus, with recurrent fever, cough, and expectoration for more than 2 weeks experienced relief in cough, phlegm reduction, and glycemic control with anti-inflammatory treatment. Further examination revealed that new growths obstructing all lobar bronchi impaired flexible bronchoscope entry. In order to relieve the patient's symptoms, under general anesthesia, we performed liquid nitrogen cryobiopsy at multiple bronchial openings, and then used argon plasma coagulation (APC) to achieve hemostasis. The pathological diagnosis was bronchial myelolipoma. The largest volume of the resected tissue was a mass measuring 0.6 cm × 0.4 cm × 0.3 cm at the bronchial opening of the upper lobe of the left lung. The patient's condition was stable and the symptoms were partially relieved after surgery. No recurrence was observed during the 12-month follow-up, although the long-term treatment efficacy is unknown.
Pathological biopsy is key to the diagnosis of endobronchial myelolipoma, and the development of the endobronchial myelolipomas may have been associated with long-term poor control of steroid levels in this patient.
肾上腺外髓脂肪瘤是一种不常见的实体瘤，而支气管内髓脂肪瘤则更为罕见，常被临床医生忽视，导致病情延误，影响预后。
一名 71 岁男性，有慢性阻塞性肺疾病（COPD）和 2 型糖尿病病史，因反复发热、咳嗽和咳痰超过 2 周就诊，经抗炎治疗后咳嗽缓解，咳痰减少，血糖控制良好。进一步检查发现，新生长的赘生物阻塞了所有肺叶支气管，妨碍了纤维支气管镜进入。为缓解患者症状，在全身麻醉下，我们在多个支气管开口处进行液氮冷冻活检，然后使用氩等离子体凝固（APC）止血。病理诊断为支气管髓脂肪瘤。切除组织中最大体积为左肺上叶支气管开口处的 0.6cm×0.4cm×0.3cm 大小的肿块。患者术后情况稳定，症状部分缓解。在 12 个月的随访中未观察到复发，但长期疗效尚不清楚。
病理活检是诊断支气管内髓脂肪瘤的关键，该患者支气管内髓脂肪瘤的发生可能与长期类固醇水平控制不佳有关。
