With reference to the article “Endobronchial Lipoma: A Rare Cause of Bronchial Occlusion”,1 we report the case of a 64-year-old man with a previous diagnosis of severe obstructive sleep apnea-hypopnea syndrome receiving CPAP therapy, who presented with a clinical picture of long-standing productive cough. Increased density with upper right paratracheal rounded mass was observed on chest X-ray; chest computed tomography showed partial atelectasis of the right upper lobe (RUL); bronchoscopy showed a soft, rounded, pinkish, vascularized lesion in the entrance to the RUL; biopsy revealed metaplastic bronchial mucosa; and pathological contrast uptake was seen on positron emission tomography (PET). With a diagnosis of a RUL lesion with uptake on PET, a thoracotomy with upper right lobectomy and lymphadenectomy was performed. Pathology report revealed endobronchial lipoma with focal osseous metaplasia, alveolar hemorrhage, areas of bronchopneumonia and obstructive architectural distortion.
DiscussionEndobronchial lipoma is a very rare tumor, accounting for only 0.1% of all lung tumors.2 They are usually located in the first 3 divisions of the tracheobronchial tree. The most common symptoms are cough, expectoration, hemoptysis, fever and dyspnea, although 25% of cases may be asymptomatic.3 The lipoma consists of mature fatty tissue covered with normal bronchial epithelium or–as in our case–squamous metaplasia.4 Fibrous, glandular tissue, areas of cartilage or osseous metaplasia can also be found in the lipoma; pathologist must use differential diagnosis to rule out atypical lipomatous tumors and well-differentiated liposarcomas.5 Treatment of choice is bronchoscopic resection, while thoracotomy should be considered in difficult-to-diagnose cases, when there is parenchymal destruction due to atelectasis and long-standing pneumonitis, extrabronchial growth, or if bronchoscopy cannot be used for technical reasons.6 Nevertheless, in view of the possibility of long-term relapse, we recommend regular follow-up of patients undergoing bronchoscopic resection.
Please cite this article as: Guelbenzu Zazpe JJ, Ramírez Gil E, Vilá Mayo E. A propósito del lipoma endobronquial. Arch Bronconeumol. 2015;51:252–252.
