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J Thorac Cardiovasc Surg 2008;135:954-955
© 2008 The American Association for Thoracic Surgery

Brief Communication

Hemoptysis caused by an endobronchial lipoma

University of Torino Italy, Department of Thoracic Surgery, Torino, Italy

Received for publication August 31, 2006; revisions received October 7, 2007; accepted for publication October 19, 2007.

^_* Address for reprints: Pier Luigi Filosso, MD, University of Torino Italy, San Giovanni Battista Hospital, Department of Thoracic Surgery, Via Genova, 3, 10126 Torino, Italy. (Email: pierluigifilosso{at}tiscali.it).

Benign tumors of the lung and endobronchial tree are uncommon and need to be differentiated from malignant lesions. Among benign lesions, endobronchial lipoma (EL) is extremely uncommon, accounting for only 0.1% to 0.5% of all bronchial tumors. We present a case in which an EL caused hemoptysis, bronchial obstruction, and distal pulmonary fibrosis. Surgical resection with a right lower lobectomy was accomplished.

Clinical Summary

A 62-year-old man who smoked heavily had hemoptysis sporadically for 3 years. Six months before admission he had cough and shortness of breath, which was treated as asthma. Finally, he was admitted to our department because of increasing hemoptysis with fever and purulent secretions.

A chest radiograph demonstrated a right lower pulmonary infiltrate. Thoracic computed tomographic scan showed damage to the right lower lobe and a fat density mass in the right lower bronchus ( Figure 1). A bronchoscopic study confirmed a smooth round polypoid endobronchial lesion in the right lower bronchus ( Figure 2); histologic and cytolologic studies (biopsy and brushing) found no neoplastic cells. Bronchoscopic resection was not considered feasible because it was impossible to clearly identify the tumor's endobronchial origin. A right thoracotomy was thus performed.

View larger version (144K): [in this window] [in a new window]   Figure 1. Thoracic computed tomographic scan (particular) with a right lower endobronchial lesion.

View larger version (124K): [in this window] [in a new window]   Figure 2. Bronchoscopic view of the lesion.

Pathologic examination showed mature adipose tissue growing in the submucosal layer, completely covered with ciliate respiratory epithelium. A diagnosis of endobronchial lipoma was made. The resected lung tissue showed important inflammatory infiltrates, pus, and fibrotic areas.

The postoperative course was characterized by fever and purulent bronchial secretions for 6 days, controlled with broad-spectrum antibiothics.

Discussion

We present an uncommon case of EL in which surgical resection of the tumor was accomplished with a right lower lobectomy because of the pulmonary damage following long-term obstructive pneumonia.

ELs are rare benign tumors of the bronchial tree; only 80 cases have been previously reported in the English literature. Most ELs arise in the submucosal layer of the bronchus; fatty tissue is normally found in both the mucosa and the tissue external to the cartilage. Almost two thirds of the tumors occur in the right side, and they are usually located in the main-stem or lobar bronchi.^1-3 Smoking and obesity are significant risk factors for EL development.⁴ Cough, hemoptysis, and shortness of breath are common symptoms,^4,5 and patients are often misdiagnosed and treated for asthma for many years, as was our patient.

Owing to the endobronchial tumor growth, irreversible changes in distal pulmonary parenchyma often occur: atelectasis, overinfection, pneumonia, and fibrosis are frequently observed. Bronchoscopy is necessary to identify and locate the lesion and to differentiate it from a malignant tumor. Differential pathologic diagnosis between bronchial carcinoid and lipoma is often difficult because of the paucity of tissue sampling at biopsy. The tumor's surface is usually paler in the lipoma and more friable in the carcinoid. EL sometimes coexists with lung cancer, especially in patients who have smoked heavily.¹

Bronchoscopic resection should be considered the first choice of treatment for EL; Muraoka and associates² report that no patient presented with bronchial tumor recurrence after EL bronchoscopic resection. Tumor surgical resection is preferred in some cases: (1) extrabronchial growth or subpleural lipomatous disease; (2) expected technical difficulties during the bronchoscopic resection; (3) possible malignant tumor coexisting with EL; and (4) peripheral irreversible lung parenchyma changes after long-term atelectasis or pneumonia.

In conclusion, EL is a rare benign endobronchial tumor that can be safely resected by a bronchoscopic procedure. Surgery is recommanded when the distal lung parenchyma is damaged by an obstructive pneumonia or fibrosis.

References

1. Kamiyoshihara M, Sakata K, Otani Y, Kawashima O, Takahashi T, Morishita Y. Endobronchial lipoma accompained with primary lung cancer: report of a case. SurgToday 2002;32:402-405.
   
2. Muraoka M, Oka T, Akamine S, Nagayasu T, Iseki M, Suyama N, et al. Endobronchial lipoma. Chest 2003;123:293-296.[Medline]
   
3. Jensen MS, Petersen AH. Bronchial lipoma: three cases and review of the literature. Scand J Thorac Cardiovasc Surg 1970;4:131-134.[Medline]
   
4. Schraufnagel DE, Morin JE, Wang NS. Endobronchial lipoma. Chest 1979;75:97-99.[Medline]
   
5. Politis J, Funahashi A, Gehlsen JA, DeCock D, Stengel BF, Choi H. Intrathoracic lipomas: report of three cases and review of the literature with the emphasis on endobronchial lipoma. J Thorac Cardiovasc Surg 1979;77:550-556.[Abstract]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pier Luigi Filosso Roberto Giobbe Enrico Ruffini Alberto Oliaro Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Filosso, P. L. Articles by Oliaro, A. Search for Related Content PubMed Articles by Filosso, P. L. Articles by Oliaro, A. Related Collections Trachea and bronchi