대한흉부영상의학회 Weekly Chest Cases

Case No : 236 Date 2002-05-04

Courtesy of Byoung Wook Choi, M.D., Kyu Ok Choe, M.D. / Yonsei University Sinchon Severance Hospital, Seoul, Korea
Age/Sex 42 / F
Chief ComplaintDyspnea for one year, aggravated 2 weeks ago

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Diagnosis With Brief Discussion

Diagnosis: Endobrochial Leiomyoma
Radiologic Findings: Chest PA shows a well-defined round mass on distal left main bronchus without causing obstructive pneumonia or atelectasis. CT scan shows a homogeneously enhanced round mass, which is completely confined within endobronchial lumen and hyperinflation of left lung probably due to air trapping by check valve mechanism.
Brief Review: Endobronchial and endotracheal leiomyosarcomas are encountered uncommonly. Endobronchial leiomyomas are somewhat more common than endobronchial leiomyosarcoma; approximately 30 were reviewed in one series in 1983, and 85 cases had been reported by 1995. Multiple leiomyomas have been reported but are either hamartomas or metastases from uterine myomas.
Pathologically, bronchial tumors are typically located in the main or lobar airways. They are fleshy, are often pedunculated, and more or less completely fill the airway lumen; extension into the underlying tracheobronchial wall is unusual, even in the histologically malignant forms.
Radiographic findings consist of atelectasis and obstructive pneumonitis. Nonobstructive tumors present as sessile or pedunculated soft tissue nodules within the trachea or bronchi. In a review of the literature concerning leiomyomas, the mean age at the time of diagnosis was 39 years. As might be expected, the majority of patients have cough, hemoptysis, or dyspnea. Provided that the tumors can be adequately excised, the prognosis is good even in histologically malignant forms; both local recurrence and metastases are exceptional. Some of these cases were treated by pneumonectomy or lobectomy. However, pure endobronchial lesion were treated by sleeve operation. In the present case, a sleeve resection of the left main bronchus including the tumor and end-to-end anastomosis was performed.
References: 1. Fraser RS, M?ler NL, Colman N, Par?PD eds. Diagnosis of diseases of the chest. 4th ed. W.B. Sauders company 1999: 1331-1332.
2. Ayabe H, Tsuji H, Tagawa Y, Tomita M, Tsuda N, Chen J. Endobronchial leiomyoma: report of a case treated by bronchoplasty and a review of the literature. Surg Today 1995; 25:1057-1060
Keywords: Airway, Benign tumor,

No. of Applicants : 18

▶ Correct Answer : 16/18, 88.9%

- Bharat Scans, Chennai, India R G Gopinath
- Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
- Harasanshin hospital, Fukuoka, Japan Shunya Sunami
- Il-san Gospel Hospital, Korea Hoe Seok Jung
- Inha University Hospital, Korea Dong-Jae Shim
- Korea Cancer Center Hospital, Korea Donghee Park
- Nowon Eulji General Hospital, Korea Sang Hyun Park
- Ohio State University, Columbus, Ohio, USA Sumit Seth
- Ospedale di Jesi, Italy Giancarlo Passarini
- Planned Parenthood Federation of Korea Kyu Sung Kwack
- Pulmonologist, Korea Jae-Joon Yim
- Samsung Medical Center, Korea Hyowon Eun
- Samsung Medical Center, Korea Chin A Yi
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Sungji Hospital, Korea Jung Hee Kim
- University of Colorado Health Sciences Center, USA Stan Zipser

▶ Semi-Correct Answer : 2/18, 11.1%

- S. M. Grazie Hospital, Pozzuoli Naples, Italy Bianca Cusati
- Xray Clinic, Pune, India M D Rahalkar

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 236 Date 2002-05-04

Discussion

No. of Applicants : 18