대한흉부영상의학회 Weekly Chest Cases

Case No : 764 Date 2012-06-20

Courtesy of Kyeho Lee, Yoo Jin Hong, Byoung Wook Choi / Severance Hospital, Yonsei University College of Medicine
Age/Sex 66 / M
Chief ComplaintDyspnea (onset; 2 days), Heavy smoker

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Figure 1

Diagnosis With Brief Discussion

Diagnosis: Primary endobronchial leiomyosarcoma
Radiologic Findings: On pre contrast and (Fig.1) and post contrast images (Fig 2,3) an irregular well enhancing mass in right main bronchus is noted. Right main bronchus is completely obstructed by endobronchial mass. Atelectasis of right lung with right pleural effusion are also noted.
On chest PA view, total atelectasis of right lung is noted and an obstructing mass shadow is observed in right main bronchus.
Brief Review: Diagnosis was confirmed by bronchoscopic biopsy.
Primary endobronchial leiomyosarcoma is an uncommon malignancy of the lung. Leiomyosarcoma is somewhat more common than leiomyoma and is more common in men than women with a ratio of 2.5 to 1. Leiomyosarcomas are thought to arise from smooth muscles tissues in bronchus and pulmonary vascular structures. Endobronchial leiomyosarcomas are often symptomatic, complaining cough, dyspnea, hemoptysis or chest pain. Unlike other carcinoma of the lung, leiomyosarcoma is not associated with cigarette smoking or other potential inhalant carcinogens.
Radiographic findings consists of sharply defined lobulated pulmonary mass or atelectasis due to bronchial obstruction. Endobronchial mass may be observed on CT scans but definitive diagnosis can only be made by excision biopsy.
Prognosis is not well known because of the rarity of this neoplasm. According to reports, children and adolescents show more favorable prognosis than adults. Some reports describe that endobronchial tumors are less aggressive than parenchymal neoplasm, largely because the former tend to be smaller and diagnosed earlier. Surgical resection is the treatment of choice. Pulmonary leiomyosarcomas appears relatively resistant to adjunctive therapy, such as chemotherapy or radiotherapy. In a review of literatures, radical surgical resection produce a 5 year survival rate of 45~50%.
References: 1. Leslie KO, Wick MR. Practical pulmonary pathology: A diagnostic approach. 2nd ed.Elsevier Saunders 2011: 457-460
2. Takeda F, Yamagiwa I, Ohizumi H, Shiono S. Leiomyosarcoma of the main bronchus in a girl: a long-time survivor with multiple lung metastases. Pediatr Pulmonol 2004;37(4):368-74
3. Lee MC, Hsu CP, Hsia JY. Surgical treatment of endobronchial leiomyosarcoma with right main bronchus total obstruction: A case report. Ann Thorac Cardiovasc Surg. 2008;14(2):105-8
Keywords: bronchus, malignant tumor,

No. of Applicants : 91

▶ Correct Answer as Differential Diagnosis : 5/91, 5.5%

- China Medical University , Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Alswaida- zaid alsherity hospital , Syria jehad alakabani

▶ Semi-Correct Answer : 14/91, 15.4%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- XiangYa hospital , China Xia Yu
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Private sector , Greece Vasilios Tzilas
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Chonnam National University Hospital , Korea (South) Jung hyun Kim
- IRSA , France, Metropolitan BIGOT
- Fortis hospital , India Shaleen Rana
- All India Institute of medical sciences , India Justin Moses
- Korea university anam hospital , Korea (South) Sung-Hye You

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 764 Date 2012-06-20

Discussion

No. of Applicants : 91