Carta al Director
A propósito del lipoma endobronquial
Talking about Endobronchial Lipoma
Juan José Guelbenzu Zazpe
, Elena Ramírez Gil, Ester Vilá Mayo
Corresponding author
Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Presenta una radiografía de tórax con imagen de aumento de densidad con formación redondeada paratraqueal derecha alta; la TAC torácica muestra una atelectasia parcial del lóbulo superior derecho; la broncoscopia mostró una lesión redondeada, sonrosada, vascularizada y de consistencia blanda en la entrada del bronquio de dicho lóbulo; la biopsia mostró mucosa bronquial con metaplasia, y la PET mostró captación patológica. Con el diagnóstico de lesión en el lóbulo superior derecho captante en la PET se decidió practicar una toracotomía con lobectomía superior derecha y linfadenectomía. El informe anatomopatológico fue de lipoma endobronquial con foco de metaplasia ósea, hemorragia alveolar, áreas de bronconeumonía y distorsión arquitectural de características obstructivas.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discusión</span><p id="par0010" class="elsevierStylePara elsevierViewall">El lipoma endobronquial es un tumor muy poco frecuente, representando el 0,1% de todos los tumores pulmonares<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. Generalmente están localizados en las primeras 3 divisiones del árbol traqueobronquial. Los síntomas más frecuentes son tos, expectoración, hemoptisis, fiebre y disnea, aunque un 25% de los casos pueden ser asintomáticos<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a>. Están formados por tejido adiposo maduro cubierto por epitelio bronquial normal o –como en nuestro caso- con metaplasia escamosa<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">4</span></a>. Cabe destacar la posible existencia en el seno del lipoma de tejido fibroso, glandular, áreas de cartílago o metaplasia ósea; para el patólogo, es importante realizar un diagnóstico diferencial con tumores lipomatosos atípicos y liposarcomas bien diferenciados<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">5</span></a>. El tratamiento de elección es la resección broncoscópica, contemplándose la toracotomía en casos de dificultad en el diagnóstico, destrucción parenquimatosa por atelectasia y neumonitis de larga evolución, crecimiento extrabronquial o imposibilidad técnica de resección por este medio<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>; sin embargo, y dada la posibilidad de recidiva a largo plazo, creemos recomendable realizar revisiones de los pacientes a los que se ha realizado resección broncoscópica.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discusión" ] 1 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipoma endobronquial: una causa infrecuente de obstrucción bronquial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Lirios Sacristán" 1 => "E. Fernández Robledo" 2 => "F. Peña Blas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2013.06.008" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2014" "volumen" => "50" "paginaInicial" => "78" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24119688" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipoma endobronquial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Marcote Valdivieso" 1 => "A. Baltasar Torrejón" 2 => "R. Bou Pérez" 3 => "J. Vierna García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir Esp" "fecha" => "1990" "volumen" => "4" "paginaInicial" => "460" "paginaFinal" => "464" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipoma endobronquial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Leon" 1 => "G. Estrada" 2 => "S. Alvarez" 3 => "C. Puzo" 4 => "R. Bordes" 5 => "R. Cornudella" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "1983" "volumen" => "19" "paginaInicial" => "217" "paginaFinal" => "219" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0015" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial lipoma: A series of three cases and the role of electrocautery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Huisman" 1 => "K.W. van Kralingen" 2 => "P.E. Postmus" 3 => "T.G. Sutedja" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "56302" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2000" "volumen" => "67" "paginaInicial" => "689" "paginaFinal" => "692" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11124655" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0020" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial lipomatous tumors: Clinicopathologic analysis of 12 cases with molecular cytogenetic evidence supporting classification as «lipoma»" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Boland" 1 => "K.J. Fritchie" 2 => "M.R. Erickson-Johnson" 3 => "A.M. Oliveira" 4 => "T.V. Colby" 5 => "A.L. Folpe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAS.0b013e3182a115c9" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "1715" "paginaFinal" => "1721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24121172" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endobronchial lipoma. Review of 64 cases reported in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Muraoka" 1 => "T. Oka" 2 => "S. Akamine" 3 => "T. Nagayasu" 4 => "M. Iseki" 5 => "N. Suyama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2003" "volumen" => "123" "paginaInicial" => "293" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12527636" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005100000005/v2_201504291226/S0300289614002245/v2_201504291226/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005100000005/v2_201504291226/S0300289614002245/v2_201504291226/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614002245?idApp=UINPBA00003Z" ]
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| 2015 December | 48 | 21 | 69 |
| 2015 November | 68 | 14 | 82 |
| 2015 October | 75 | 3 | 78 |
| 2015 September | 50 | 0 | 50 |
| 2015 August | 77 | 0 | 77 |
| 2015 July | 3 | 0 | 3 |
| 2015 June | 5 | 0 | 5 |
| 2015 May | 32 | 0 | 32 |
| 2015 April | 4 | 0 | 4 |
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