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Endobronchial Lipoma*: Review of 64 Cases Reported in Japan FREE TO VIEW

Masashi Muraoka, MD; Tadayuki Oka, MD; Shinji Akamine, MD; Takeshi Nagayasu, MD; Masachika Iseki, PhD; Naofumi Suyama, MD; Hiroyoshi Ayabe, MD
Author and Funding Information

*From the First Department of Surgery (Drs. Muraoka, Oka, Akamine, Nagayasu, and Ayabe), and Department of Pathology, Institute of Tropical Medicine (Dr. Iseki), Nagasaki University School of Medicine; and Nagasaki Adult Disease Medical Center (Dr. Suyama), Nagasaki, Japan.

Correspondence to: Masashi Muraoka, MD, The First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8102, Japan; e-mail: ceb17760@hkg.odn.ne.jp



Chest. 2003;123(1):293-296. doi:10.1378/chest.123.1.293
Text Size: A A A
Published online

Background: Several recent studies discuss bronchoscopic techniques for treating endobronchial lipoma, an extremely rare benign tumor.

Objectives: To describe the epidemiology of endobronchial lipoma and to propose appropriate therapeutic policies for treating this tumor.

Methods: We reviewed 64 cases of endobronchial lipoma: 33 cases previously reported in 30 different articles, and 31 case reports presented at thoracic meetings in Japan.

Results: Of the 64 patients included in this study (50 male and 14 female; mean age, 60 years), 40 patients had endobronchial lipoma in the right lung and 23 patients had it in the left lung. The overwhelming majority of the tumors (n = 61) were found in the first three subdivisions of the tracheobronchial tree. Forty-eight patients (75%) were symptomatic, and their symptoms included cough, sputum, hemoptysis, elevated temperature, and dyspnea. Additionally, abnormal radiographic findings were reported for 51 patients (80%): 18 patients had atelectasis, 14 patients had infiltration or consolidation, 6 patients showed volume loss of the lung, and mass shadow was identified in 9 patients, and another abnormality including pleural effusion was found in 4 patients. Forty patients underwent surgical resection: 4 pneumonectomies, 24 lobectomies, 8 bilobectomies, and 4 resections by bronchotomy. Bronchoscopic resection was carried out in 17 cases: 7 cases by Nd-YAG laser, 5 cases by electrosurgical snaring forceps, and another 5 cases with a combined therapy using both procedures.

Conclusions: Bronchoscopic resection should be considered as the first choice of treatment for endobronchial lipoma; however, surgical therapy is indicated for patients who show the possibility of a complicated malignant tumor, who have destructive peripheral lung disease, who have extrabronchial growth, or who may have technical difficulties during the bronchoscopic procedure.

Figures in this Article

Endobronchial lipoma is an extremely rare benign tumor, with incidence reported to range from only 0.1 to 0.5% in all lung tumors.12 In 1971, Tsunohara et al3published the first report of a Japanese patient with endobronchial lipoma; since then, an additional 63 Japanese patients with lipoma have been reported,434 including the patient we report on here. Almost all of these studies consist of single case reports, although a few cases are described in detail. In this article, we present the case of our patient and review all previously reported cases of endobronchial lipomas in Japan, published between January 1971 and May 2001 in abstracts, case reports, and published articles. We examine the overall epidemiology of the disease and discuss appropriate therapeutic strategies.

A 56-year-old woman presented with cough and sputum of 2 months in duration. A chest radiograph revealed atelectasis of the left lower lobe, chest CT showed a fat density mass in the left basal bronchus, and MRI showed a mass with high intensity on T1-weighted images, originating from the subsegmental bronchus of left B6 (Fig 1 ). Bronchoscopy revealed a polypoid tumor in the left basal bronchus (Fig 2 ) and lipoma was suspected, based on histologic study of a transbronchial biopsy (TBB) specimen. It was deemed impossible to remove the tumor by bronchoscopic methods because of the technical difficulty involved in snaring due to the multidirectional growth of the tumor. Because of irreversible damage to the left lower lobe due to obstructive pneumonia, left lower lobectomy was performed to achieve complete resection of the tumor. Surgical specimens showed that the bronchial tumor originated from the entrance of the left basal bronchus and extended to the subsegmental branch of left B6 (Fig 3 ). Pathologically, mature adipose tissue growth in the bronchial submucosal layer and the tumor were diagnosed as an endobronchial lipoma.

Epidemiology

We conducted a retrospective analysis of 64 cases of endobronchial lipoma reported in Japan: 1 case included in the present study and 63 cases previously published in 30 different articles434 and 31 case reports presented at a variety of professional meetings in Japan. The patients identified with endobronchial tumors were 50 men and 14 women, with a mean age (± SD) of 60.0 ± 11.4 years. The locations of the tumors are shown in Table 1 , from which one case35 has been omitted because the patient had multiple bilateral tumors. Almost two thirds of the tumors occurred on the right side, and most were located in the first three subdivisions of the tracheobronchial tree. All lesions but three were visible by bronchoscope. No tracheal lipoma has been reported to date in Japan. The tumor sizes were described in 34 of the available reports, and they ranged from 3 to 65 mm (mean 20 ± 15 mm).13

Diagnosis

Forty-eight patients (75%) were symptomatic, showing the following symptoms: cough (n = 40), sputum (n = 18), hemoptysis (n = 7), elevated temperature (n = 10), and dyspnea (n = 6). Sixteen patients had no symptoms. In 15 of the 16 asymptomatic patients, the disease was detected through abnormal chest radiographic findings; diagnosis was made in one patient at autopsy.

Fifty-one patients (80%) had abnormal chest radiographic findings (Table 2 ), 8 patients had normal chest radiographic findings, and there were no descriptions of radiographic findings in five of the available studies. Most of the abnormal radiographic findings did not include a direct shadow of the tumor, and almost half of the shadows that were found were judged to be instances of consolidation or infiltration due to atelectasis and pneumonia of the distal lung.

In 1986, Matsumura et al8 first reported a lipoma identified by CT; in our review of the literature, we found CT data included in 22 cases. MRI has also recently been used to identify bronchial lipoma, and MRI data appear in all three cases considered in the present study, including that of our patient. The accuracy rate of diagnosis of bronchial lipoma by TBB is rather low, and new radiologic technologies such as CT and MRI are therefore highly useful diagnostic tools.

Bronchial lipoma was diagnosed in 20 patients (31%) by histologic study of the TBB specimen. However, bronchial lipoma was not so diagnosed in the remaining 44 patients: other benign bronchial tumors (hamartoma, adenoma, inflammatory polyp, or others) were diagnosed in 33 patients, lung cancers were diagnosed in 4 patients, indeterminate pulmonary nodules were diagnosed in 2 patients, and in 5 patients the tumor was not diagnosed preoperatively. Suzuki et al22 suggested that the submucosal growth of endobronchial lipoma leads to a low accuracy rate of diagnosis by TBB. Endobronchial lipoma is histologically benign in character; however, Simmers et al36 reported that recurrent obstructive pneumonia may induce sufficient nuclear atypia to suggest malignancy in endobronchial brush cytology of this tumor. Surgical treatment, including pulmonary resection, has been often performed because it is not always possible to diagnose the lesion as a benign tumor.

Etiology

Most endobronchial lipomas arise in the submucosal layer of the main or lobular bronchus, which shows fat tissue in the wall in histologic study. In three cases in Japan, the tumor arose in the subpleural pulmonary parenchyma, which is particularly rare given that these tumors generally arise in the subpleural fat tissue.

Some investigators claim that smoking and obesity are significant risk factors for endobronchial lipoma.2,22 The Brinkman smoking index (calculated by multiplying the number of cigarettes per day by the number of years the patient has smoked37) is included in 19 of the studies under consideration, and ranged from 0 to 1,360 (511 ± 439 = 25.6 ± 22 pack-years). Fourteen of these 19 patients (74%) were smokers. We expect that the average of the index and the rate of smoking would be rather high; however, it remains unclear why exactly heavy smokers have a particularly high incidence of this tumor. Body mass index was calculated for 20 patients, and ranged from 15.6 to 26.9 (22.8 ± 3.0). Five patients (25%) were considered obese, with body mass indexes > 25. We believe that the incidence of obesity is not significantly high among patients with bronchial lipoma.

Lung cancer accompanied lipoma in five patients,1516,26,32,38 most notably in one patient in whom squamous cell carcinoma coexisted with bronchial lipoma in the same tumor.16 Patients with bronchial lipoma may have some malignant potential related to smoking history, as is the case in lung cancer. Primary liposarcoma originating in the bronchus has not been reported to date in Japan; however, a single case of liposarcoma metastatic to the lung with endobronchial extension was reported in 1999.39

Therapeutic Procedure and Operative Indications

Surgical resection was performed for 40 patients, and the operative methods are shown in Table 3 . One investigator did not include the specific operative methods in his report.40 One patient underwent surgical resection after bronchoscopic therapy. Six patients underwent no resection: two patients who were treated by probe thoracotomy (thoracotomy without tumor resection due to extensive disease) and four patients with a diagnosis made at autopsy.

In 1984, Adachi et al41 reported the first case of endoscopic surgery for bronchial lipoma using a bronchial fiberscope. Since their report, 17 patients have undergone bronchoscopic treatment: 7 patients received Nd-YAG laser therapy, five tumors were removed by electrosurgical snaring forceps via flexible bronchoscope, and 5 patients received a combined therapy using both laser techniques and polypectomy snares. None of these 17 patients has reported any recurrence of the tumor after the bronchoscopic procedure. Nomori et al32 suggest that bronchoscopic snaring is superior to laser vaporization in several different ways.

Based on these cases, we believe that bronchoscopic resection should be considered the first choice of treatment for bronchial lipoma; nevertheless, surgical resection is indicated for some patients. The conditions under which surgical resection is preferred are the following: (1) difficulty of definite diagnosis and possible complicated malignant tumor, (2) peripheral destructive lung disease due to long-term atelectasis or pneumonia, (3) extrabronchial growth or subpleural lipomatous disease, or (4) expected technical difficulties during the bronchoscopic procedure due to multidirectional development of the tumor. To summarize, endobronchial lipoma is a rare benign bronchial tumor and bronchoscopic therapy is recommended as the first choice of treatment for this disease, although surgical resection may be necessary under certain conditions.

Abbreviation: TBB = transbronchial biopsy

Figure Jump LinkFigure 1. The finding of the lesion on MRI, showing a mass with high intensity on T1-weighted images, originating from the subsegmental bronchus of left B6.Grahic Jump Location
Figure Jump LinkFigure 2. The finding of the lesion in situ via the bronchoscope, revealing a polypoid tumor in the left basal bronchus, and lipoma was suspected, based on histologic study of a TBB specimen.Grahic Jump Location
Figure Jump LinkFigure 3. Macroscopic finding of the left lower lobe specimen, showing the bronchial tumor originated from the entrance of the left basal bronchus to the subsegmental branch of left B6. Obstructive pneumonia with mucus impaction in the segmental bronchus was shown in the peripheral lung.Grahic Jump Location
Table Graphic Jump Location
Table 1. Side and Site of the Tumor*
* 

Data are presented as No. One patient with multiple lesions in bilateral bronchi was omitted.

Table Graphic Jump Location
Table 2. Findings of Chest Radiography of the Patients With Endobronchial Lipoma
Table Graphic Jump Location
Table 3. Operative Procedure for Endobronchial Lipoma*
* 

One case did not provide specific operative method.

Jensen, MS, Petersen, AH (1970) Bronchial lipoma.Scand Thorac Cardiovasc Surg4,131-134. [CrossRef]
 
Schraufnagel, DE, Morin, JE, Wang, NS Endobronchial lipoma.Chest1979;75,97-99. [PubMed]
 
Tsunohara, A, Yokoyama, S, Hirono, T A case of endobronchial lipoma [abstract]. J Jpn Surg Soc. 1971;;72 ,.:276
 
Niinomi, F, Fujii, H, Yamazaki, J, et al Bronchial lipoma: a case report and literature review [in Japanese with English abstract].Kyobu Geka1973;26,257-261. [PubMed]
 
Ikeuchi, H, Yoshida, K, Oshibe, M, et al Lipoma of the lung: a case report [in Japanese with English abstract].Jpn J Chest Dis1977;36,922-924
 
Okada, S, Akematsu, T, Takeda, Z, et al A case of bronchial lipoma [in Japanese with English abstract]. Haigan. 1977;;17 ,.:147
 
Ishikawa, K, Touyama, M, Genga, K, et al A case report of lipoma of the lung [in Japanese with English abstract]. J Jpn Thorac Surg. 1980;;33 ,.:610
 
Matsumura, A, Monden, Y, Nakahara, K, et al A case report of endobronchial lipoma resected by fiberoptic bronchoscopy [in Japanese with English abstract].Haigan1986;26,433-438
 
Nakashima, Y, Tsuchiya, E Bronchial lipoma [in Japanese with English abstract].Jpn J Chest Dis1987;46,784-789
 
Tashiro, T, Ohtsuka, E, Nagai, H, et al Endoscopic electrosurgical resection of endobronchial lipoma [in Japanese with English abstract].J Jpn Soc Bronchol1987;8,748-753
 
Kamei, K, Kohiyama, R, Kanai, T, et al A case of endobronchial lipoma with peripheral organizing pneumonia [in Japanese with English abstract].Jpn J Thorac Dis1987;25,586-591
 
Yoshida, K, Uno, E, Tagaki, S A case of endobronchial lipoma [in Japanese with English abstract].J Jpn Soc Bronchol1988;10,301-305
 
Ishikawa, N, Asakuma, S, Kouji, R, et al A case of endobronchial lipoma [in Japanese].J Jpn Surg Assoc1988;43,1525-1528
 
Soejima, Y, Oshita, F, Sakamoto, A, et al Endobronchial lipoma treated with Nd-YAG laser [in Japanese with English abstract].J Jpn Soc Bronchol1989;11,64-69
 
Shikanai, T, Tazawa, M, Tomichi, N A case of endobronchial lipoma [in Japanese with English abstract].J Jpn Soc Bronchol1989;11,387-390
 
Watanabe, T, Tsutahara, S, Mizutani, Y, et al A combined case of squamous cell carcinoma and lipoma in the same tumor [in Japanese with English abstract]. J Jpn Soc Bronchol. 1989;;11 ,.:100
 
Iriki, A, Egawa, K, Hirotsu, Y, et al Endobronchial lipoma: report of a case and review of the literature in Japan [in Japanese with English abstract].Jpn J Chest Dis1990;49,916-920
 
Niimi, T, Kajita, M, Matsuda, A, et al A case report of endobronchial lipoma [in Japanese with English abstract].Jpn J Thorac Dis1990;28,519-524
 
Hayashi, Y, Maehara, T, Kouno, M, et al Bronchial lipoma treated with circumferential resection of the right upper bronchus: a case report [in Japanese with English abstract].J Jpn Assoc Chest Surg1991;5,73-78
 
Yamashiro, T, Okada, T, Tamiya, T Endobronchial lipoma: a case report [in Japanese with English abstract].J Jpn Assoc Chest Surg1991;5,169-177
 
Matsuba, T, Matsumoto, K, Fujiki, T, et al A case of endobronchial lipoma with distal organizing pneumonia.J Jpn Soc Bronchol1992;14,201-205
 
Suzuki, N, Takizawa, H, Yamaguchi, M, et al A case of asymptomatic endobronchial lipoma followed for 4 years [in Japanese with English abstract].Jpn J Thorac Dis1992;30,1879-1883
 
Nakano, M, Tsukasaki, M, Kinoshita, A, et al A case of bronchial lipoma treated by Nd-YAG laser surgery [in Japanese with English abstract].Jpn J Thorac Dis1993;31,1134-1139
 
Kimura, S, Sakata, A, Horiuchi, N, et al A case of endobronchial lipoma with dyspnea [in Japanese with English abstract].J Jpn Soc Bronchol1994;16,191-196
 
Hirai, T, Kamiyoshihara, M, Kawashima, O, et al Bronchial lipoma: a case report [in Japanese with English abstract].Kitakantouigaku1995;45,339-343
 
Yokozaki, M, Kodama, T, Yokose, T, et al Endobronchial lipoma: a report of three cases.Jpn J Clin Oncol1996;26,53-57. [PubMed]
 
Takiguchi, Y Bronchial lipoma removed with bronchoscopic snaring forceps [in Japanese with English abstract].Jpn J Thorac Dis1997;35,236-239
 
Okimoto, N, Fujita, K, Oba, H, et al A case of endobronchial lipoma detected by a chest CT [in Japanese with English abstract].Kokyu1997;16,1085-1088
 
Takagi, M, Akiba, T, Yamazaki, Y, et al A case of bronchial lipoma which was resected by bronchoscopic electrosurgical snaring and Nd-YAG laser therapy [in Japanese with English abstract].J Jpn Soc Bronchol1998;20,66-69
 
Saito, H, Nishihori, T, Kourakata, N, et al A case of bronchial lipoma with extrabronchial growth [in Japanese with English abstract].J Jpn Respir Soc1998;36,408-411
 
Hiyoshi, H, Iwanami, H, Narita, K, et al A case of endobronchial lipoma with organizing pneumonia of the right middle lobe [in Japanese with English abstract].J Jpn Soc Bronchol1998;20,519-522
 
Nomori, H, Horio, H, Suemasu, K Two-stage operation for endobronchial lipoma and lung cancer using bronchoscopy and thoracoscopy in an elderly patients with chronic obstructive pulmonary disease.Jpn J Thorac Cardiovasc Surg1999;47,567-569. [PubMed]
 
Ishiyama, T, Tsuchida, S A case of endobronchial lipoma with right upper atelectasis [in Japanese with English abstract].J Jpn Soc Bronchol2001;23,124-128
 
Tamura, K, Nakamura, A, Itoh, S Endoscopic removal of a bronchial lipoma with high-frequency electrosurgery [in Japanese with English abstract].J Jpn Soc Bronchol2001;23,545-549
 
Kokubu, K, Sudo, M, Bando, T, et al Multiple bronchial lipoma with Recklinghausen’s disease [abstract in Japanese]. J Jpn Soc Bronchol. 1989;;11(suppl) ,.:141
 
Simmers, TA, Jie, C, Sie, B Endobronchial lipoma posing as carcinoma.Neth J Med1997;51,143-145. [PubMed]
 
Brinkman, GL, Block, DL The prognosis in chronic bronchitis.JAMA1966;197,71-77
 
Nagashima, T, Fukui, T, Tsukamoto, R, et al A case of lung cancer complicated with bronchial lipoma [in Japanese]. Jpn J Thorac Dis. 1980;;18 ,.:550
 
Kanemitsu, S, Takao, M, Fujinaga, K, et al A case of liposarcoma metastatic to the lung with endobronchial extension [in Japanese with English abstract].J Jpn Soc Bronchol1999;21,462-466
 
Ando, T A case of endobronchial lipoma [in Japanese]. J Jpn Surg Assoc. 1981;;42 ,.:694
 
Adachi, S, Takada, Y, Watanabe, H, et al Endoscopic surgery for bronchial benign tumor [in Japanese]. J Jpn Soc Bronchol. 1984;;6 ,.:134
 

Figures

Figure Jump LinkFigure 1. The finding of the lesion on MRI, showing a mass with high intensity on T1-weighted images, originating from the subsegmental bronchus of left B6.Grahic Jump Location
Figure Jump LinkFigure 2. The finding of the lesion in situ via the bronchoscope, revealing a polypoid tumor in the left basal bronchus, and lipoma was suspected, based on histologic study of a TBB specimen.Grahic Jump Location
Figure Jump LinkFigure 3. Macroscopic finding of the left lower lobe specimen, showing the bronchial tumor originated from the entrance of the left basal bronchus to the subsegmental branch of left B6. Obstructive pneumonia with mucus impaction in the segmental bronchus was shown in the peripheral lung.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1. Side and Site of the Tumor*
* 

Data are presented as No. One patient with multiple lesions in bilateral bronchi was omitted.

Table Graphic Jump Location
Table 2. Findings of Chest Radiography of the Patients With Endobronchial Lipoma
Table Graphic Jump Location
Table 3. Operative Procedure for Endobronchial Lipoma*
* 

One case did not provide specific operative method.

References

Jensen, MS, Petersen, AH (1970) Bronchial lipoma.Scand Thorac Cardiovasc Surg4,131-134. [CrossRef]
 
Schraufnagel, DE, Morin, JE, Wang, NS Endobronchial lipoma.Chest1979;75,97-99. [PubMed]
 
Tsunohara, A, Yokoyama, S, Hirono, T A case of endobronchial lipoma [abstract]. J Jpn Surg Soc. 1971;;72 ,.:276
 
Niinomi, F, Fujii, H, Yamazaki, J, et al Bronchial lipoma: a case report and literature review [in Japanese with English abstract].Kyobu Geka1973;26,257-261. [PubMed]
 
Ikeuchi, H, Yoshida, K, Oshibe, M, et al Lipoma of the lung: a case report [in Japanese with English abstract].Jpn J Chest Dis1977;36,922-924
 
Okada, S, Akematsu, T, Takeda, Z, et al A case of bronchial lipoma [in Japanese with English abstract]. Haigan. 1977;;17 ,.:147
 
Ishikawa, K, Touyama, M, Genga, K, et al A case report of lipoma of the lung [in Japanese with English abstract]. J Jpn Thorac Surg. 1980;;33 ,.:610
 
Matsumura, A, Monden, Y, Nakahara, K, et al A case report of endobronchial lipoma resected by fiberoptic bronchoscopy [in Japanese with English abstract].Haigan1986;26,433-438
 
Nakashima, Y, Tsuchiya, E Bronchial lipoma [in Japanese with English abstract].Jpn J Chest Dis1987;46,784-789
 
Tashiro, T, Ohtsuka, E, Nagai, H, et al Endoscopic electrosurgical resection of endobronchial lipoma [in Japanese with English abstract].J Jpn Soc Bronchol1987;8,748-753
 
Kamei, K, Kohiyama, R, Kanai, T, et al A case of endobronchial lipoma with peripheral organizing pneumonia [in Japanese with English abstract].Jpn J Thorac Dis1987;25,586-591
 
Yoshida, K, Uno, E, Tagaki, S A case of endobronchial lipoma [in Japanese with English abstract].J Jpn Soc Bronchol1988;10,301-305
 
Ishikawa, N, Asakuma, S, Kouji, R, et al A case of endobronchial lipoma [in Japanese].J Jpn Surg Assoc1988;43,1525-1528
 
Soejima, Y, Oshita, F, Sakamoto, A, et al Endobronchial lipoma treated with Nd-YAG laser [in Japanese with English abstract].J Jpn Soc Bronchol1989;11,64-69
 
Shikanai, T, Tazawa, M, Tomichi, N A case of endobronchial lipoma [in Japanese with English abstract].J Jpn Soc Bronchol1989;11,387-390
 
Watanabe, T, Tsutahara, S, Mizutani, Y, et al A combined case of squamous cell carcinoma and lipoma in the same tumor [in Japanese with English abstract]. J Jpn Soc Bronchol. 1989;;11 ,.:100
 
Iriki, A, Egawa, K, Hirotsu, Y, et al Endobronchial lipoma: report of a case and review of the literature in Japan [in Japanese with English abstract].Jpn J Chest Dis1990;49,916-920
 
Niimi, T, Kajita, M, Matsuda, A, et al A case report of endobronchial lipoma [in Japanese with English abstract].Jpn J Thorac Dis1990;28,519-524
 
Hayashi, Y, Maehara, T, Kouno, M, et al Bronchial lipoma treated with circumferential resection of the right upper bronchus: a case report [in Japanese with English abstract].J Jpn Assoc Chest Surg1991;5,73-78
 
Yamashiro, T, Okada, T, Tamiya, T Endobronchial lipoma: a case report [in Japanese with English abstract].J Jpn Assoc Chest Surg1991;5,169-177
 
Matsuba, T, Matsumoto, K, Fujiki, T, et al A case of endobronchial lipoma with distal organizing pneumonia.J Jpn Soc Bronchol1992;14,201-205
 
Suzuki, N, Takizawa, H, Yamaguchi, M, et al A case of asymptomatic endobronchial lipoma followed for 4 years [in Japanese with English abstract].Jpn J Thorac Dis1992;30,1879-1883
 
Nakano, M, Tsukasaki, M, Kinoshita, A, et al A case of bronchial lipoma treated by Nd-YAG laser surgery [in Japanese with English abstract].Jpn J Thorac Dis1993;31,1134-1139
 
Kimura, S, Sakata, A, Horiuchi, N, et al A case of endobronchial lipoma with dyspnea [in Japanese with English abstract].J Jpn Soc Bronchol1994;16,191-196
 
Hirai, T, Kamiyoshihara, M, Kawashima, O, et al Bronchial lipoma: a case report [in Japanese with English abstract].Kitakantouigaku1995;45,339-343
 
Yokozaki, M, Kodama, T, Yokose, T, et al Endobronchial lipoma: a report of three cases.Jpn J Clin Oncol1996;26,53-57. [PubMed]
 
Takiguchi, Y Bronchial lipoma removed with bronchoscopic snaring forceps [in Japanese with English abstract].Jpn J Thorac Dis1997;35,236-239
 
Okimoto, N, Fujita, K, Oba, H, et al A case of endobronchial lipoma detected by a chest CT [in Japanese with English abstract].Kokyu1997;16,1085-1088
 
Takagi, M, Akiba, T, Yamazaki, Y, et al A case of bronchial lipoma which was resected by bronchoscopic electrosurgical snaring and Nd-YAG laser therapy [in Japanese with English abstract].J Jpn Soc Bronchol1998;20,66-69
 
Saito, H, Nishihori, T, Kourakata, N, et al A case of bronchial lipoma with extrabronchial growth [in Japanese with English abstract].J Jpn Respir Soc1998;36,408-411
 
Hiyoshi, H, Iwanami, H, Narita, K, et al A case of endobronchial lipoma with organizing pneumonia of the right middle lobe [in Japanese with English abstract].J Jpn Soc Bronchol1998;20,519-522
 
Nomori, H, Horio, H, Suemasu, K Two-stage operation for endobronchial lipoma and lung cancer using bronchoscopy and thoracoscopy in an elderly patients with chronic obstructive pulmonary disease.Jpn J Thorac Cardiovasc Surg1999;47,567-569. [PubMed]
 
Ishiyama, T, Tsuchida, S A case of endobronchial lipoma with right upper atelectasis [in Japanese with English abstract].J Jpn Soc Bronchol2001;23,124-128
 
Tamura, K, Nakamura, A, Itoh, S Endoscopic removal of a bronchial lipoma with high-frequency electrosurgery [in Japanese with English abstract].J Jpn Soc Bronchol2001;23,545-549
 
Kokubu, K, Sudo, M, Bando, T, et al Multiple bronchial lipoma with Recklinghausen’s disease [abstract in Japanese]. J Jpn Soc Bronchol. 1989;;11(suppl) ,.:141
 
Simmers, TA, Jie, C, Sie, B Endobronchial lipoma posing as carcinoma.Neth J Med1997;51,143-145. [PubMed]
 
Brinkman, GL, Block, DL The prognosis in chronic bronchitis.JAMA1966;197,71-77
 
Nagashima, T, Fukui, T, Tsukamoto, R, et al A case of lung cancer complicated with bronchial lipoma [in Japanese]. Jpn J Thorac Dis. 1980;;18 ,.:550
 
Kanemitsu, S, Takao, M, Fujinaga, K, et al A case of liposarcoma metastatic to the lung with endobronchial extension [in Japanese with English abstract].J Jpn Soc Bronchol1999;21,462-466
 
Ando, T A case of endobronchial lipoma [in Japanese]. J Jpn Surg Assoc. 1981;;42 ,.:694
 
Adachi, S, Takada, Y, Watanabe, H, et al Endoscopic surgery for bronchial benign tumor [in Japanese]. J Jpn Soc Bronchol. 1984;;6 ,.:134
 
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