SESSION TYPE: Bronchology Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: The inflammatory myofibroblastic tumor is seen to occur in all locations. We describe a case of inflammatory myofibroblastic tumor involving the trachea and bronchus. Only six cases have been reported in the literature so far involving the airway.(1) This is the first time Autofluorescence bronchoscopy (AFB) has been used to delineate the tumor for surgical planning and for surveillance of tumor recurrence.
CASE PRESENTATION: A 37 year old man presented with a seven month history of recurrent respiratory infections treated with antibiotics and occasional expectoration of blood tinged sputum. On examination he was short of breath with an oxygen saturation of ninety one percent on four liters of oxygen. He was transferred to our hospital from an outside facility for further management after a CAT scan of the chest showed a large right endobronchial mass with lymphadenopathy(Fig.1). Bronchoscopy showed a mass obstructing the right main bronchus, which was resected. Histopathological examination showed a spindle cell neoplasm with positive P53 immunoreactivity consistent with inflammatory myofibroblastic tumor(Fig.2).AFB was done a month later to plan for definite surgical repair and evaluate tumor margins. A small endobronchial lesion at the proximal right main bronchus was debrided. Bronchovascular margins were negative for neoplasm, carinal margins were positive for inflammatory myofibroblastic tumor. He then underwent a right thoracotomy with extended right upper lobe sleeve resection and included a carinal resection. Surveillance AFBs did not show any recurrence.
DISCUSSION: Myofibroblastic tumors have a potential for local invasion and recurrence and tumors with positive p53 immunoreactivity are associated with a more aggressive course. Definitive treatment is complete resection of the lesion with tumor free margins. AFB can be used for follow up and progression of disease. The ability of AFB to detect the difference between normal and neoplastic tissue is based on the differences between fluorophores and carrier molecules.
CONCLUSIONS: AFB has been proven to be useful in early detection of premalignant lesions of the lung.(2) In this case it has been useful in assessing the extent and margins of the tumor and in follow up for early detection of recurrence.
1) Browne M, Abramson LP, Chou PM, Acton R, Holinger LD, Reynolds M. Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the neck infiltrating the trachea. J Pediatr Surg. 2004;39(10):e1-4
2) Shibuya K, Fujisawa T, Hoshino H, et al. Fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy. Lung Cancer 2001; 32:19-25
DISCLOSURE: The following authors have nothing to disclose: Nithya Menon, Mohan Ashok Kumar, Richard Sue
No Product/Research Disclosure InformationInternal Medicine, St. Joseph's Hospital, Phoenix, AZ