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J Thorac Cardiovasc Surg 1996;111:1104-1105
© 1996 Mosby, Inc.

BRIEF COMMUNICATIONS

HEMOPTYSIS CAUSED BY AN ENDOBRONCHIAL LIPOMA

Murcia, Spain

From the Department of General Surgery, Virgen de la Arrixaca, University Hospital, University of Murcia, Murcia, Spain.

Received for publication May 8, 1995 Accepted for publication May 18, 1995. Benign tumors of the lung and endobronchial tree are uncommon processes that, because of their location, need to be differentiated from malignant tumors. When these tumors are endobronchial, bronchoscopy is an excellent method of diagnosis. We present a case in which an endobronchial lipoma in a patient with symptoms of coughing and hemoptysis was removed by rigid bronchoscopy.

A 68-year-old male patient who had no family medical history of interest, smoked approximately 20 cigarettes daily, and had a peptic ulcer was admitted to our hospital with a cough of several weeks' duration, accompanied by expectoration and episodes of hemoptysis. No other symptoms were reported. Neither general examination nor cardiopulmonary auscultation revealed pathologic findings.

Simple chest radiography disclosed condensation and atelectasis of the middle right lobe. The chest computed tomographic scan showed no mediastinal adenopathies. At bronchoscopy, a smooth, round, polypoid tumor, which was freely movable, apparently benign, and impossible to sample for biopsy, was seen within the lumen of the middle right lobe bronchus. Cytologic study from brushing revealed no neoplastic cells.

We subsequently performed a rigid bronchoscopy with the patient under general anesthesia. We took an initial biopsy sample and completely removed the tumor, which was pedunculated. Histologic examination of the resected piece showed a well-delimited, 7 mm diameter nodular proliferation. Although not clearly encapsulated, it was made up of mature adipose tissue with normal morphologic characteristics. The nodule was completely covered with ciliate respiratory epithelium of normal characteristics, nonulcerated and separated from proliferative adipocytes by a fibrous area with a slight subepithelial inflammatory infiltrate. Diagnosis of endobronchial lipoma was made (Fig. 1).

View larger version (129K): [in this window] [in a new window]   Fig. 1. Nodule of mature adipose tissue enveloped in ciliate respiratory epithelium and separated by a fibrous area with inflammatory infiltrate. (hematoxylin-eosin stain; original magnification x40.)

Benign pulmonary tumors are rare entities, and among them lipomas are the most uncommon. Of a total of 3502 pulmonary tumors, Jensen and Petersen ¹ reported only 65 cases of benign pulmonary tumors, only three of which were lipomas. The medical literature in the English language as of 1991 had reported only 54 cases of endobronchial and endotracheal lipoma.

Classically, endothoracic lipomas have been divided into endobronchial, parenchymatous, pleural, mediastinal, and cardiac. ³ The endobronchial type originates in the submucous adipose tissue of the bronchial tree, grows endoluminally, and usually manifests as a freely movable, pedunculated tumor with a narrow stem.

The clinical symptoms of endobronchial lipoma are fundamentally caused by obstruction of the airflow, with the possibility of distal atelecstasis, overinfections, and pneumonia. Although coughing has been reported as a clinical manifestation in 81%, hemoptysis was present in only 26%. ³ Differential diagnosis must be made with carcinoma and adenoma. Bronchoscopic diagnosis to differentiate endobronchial lipomas from adenomas can be difficult. The surface of the tumor, however, is paler in the lipoma and more friable in the adenoma. ⁴

These tumors can be managed by bronchoscopy, as in the case reported here, when practicable and the peduncle permits. If bronchoscopic management is not possible, we must resort to thoracotomy with bronchiotomy and removal of the tumor before the symptoms have led to irreversible distal complications.

Footnotes

J THORAC CARDIOVASC SURG 1996;111:1104-5

References

1. Jensen MS, Petersen AH. Bronchial lipoma: three cases and review of the literature. Scand J Thorac Cardiovasc Surg 1970;4:131-4.[Medline]
   
2. Matsuba K, Saito T, Ando K, Shirakusa T. Atypical lipoma of the lung. Thorax 1991;46:685.[Abstract/Free Full Text]
   
3. Politis J, Funahashi A, Gehlsen JA, DeCock D, Stengel BF, Choi H. Intrathoracic lipomas: report of three cases and review of the literature with emphasis on endobronchial lipoma. J Thorac Cardiovasc Surg 1979;77:550-6.[Abstract]
   
4. Bellin HJ, Libshitz HI, Patchefsky AS. Bronchial lipoma: report of two cases showing chondroitic metaplasia. Arch Pathol 1971;92:20-3.[Medline]
   

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