SESSION TITLE: Cancer Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: The inflammatory myofibroblastic tumor (IMT), also referred to as plasma cell granuloma, fibrous histiocytoma, fibroxanthoma, or inflammatory pseudotumor, is a rare neoplasm that may present clinically with symptoms related to airflow obstruction. We describe a case of a young woman who presents with history of cough, wheezing, and progressively worsening dyspnea, found to have an obstructing endotracheal mass.
CASE PRESENTATION: A 40 year old non-smoking Hispanic female presented to clinic with complaint of cough, wheezing, and progressively worsening dyspnea for five months. Past medical history was significant for diabetes mellitus, hypertension, and cough-variant asthma diagnosed in September 2012. She was referred to the Emergency Department for further evaluation. Lung exam revealed bilateral expiratory wheezing that was louder at mid-chest. Computed tomography of her chest confirmed a large endobronchial mass in the most distal trachea, involving the carina, nearly occluding the right mainstem bronchus and bronchus intermedius, and extending into the origin of the right upper lobe, right middle lobe, and right lower lobe bronchi. Bronchoscopy revealed a large endotracheal mass with near occlusion of both mainstem bronchi, therefore, biopsies were not obtained. Patient was referred to cardiothoracic surgery for biopsy and resection. She underwent thoracotomy and the right mainstem bronchus was opened and the tumor extirpated. A modified sleeve resection of the right bronchus was performed due to tumor extension into the right upper lobe bronchus. Histological examination showed marked plasma cell infiltrate, clusters of small lymphocytes, histiocytes, and spindle cells, consistent with inflammatory pseudotumor.
DISCUSSION: We present a case of IMT mimicking asthma. The IMT is rare and accounts for 0.04% to 0.7% of all lung tumors. It may present with symptoms of airflow obstruction. We recommend early referral to cardiothoracic surgery for resection as prognosis is excellent with low morbidity.
CONCLUSIONS: Physicians should be aware of atypical causes of airflow obstruction in patients who remain refractory to treatment of asthma. Our patient followed up in clinic 10 days after surgery without complications or symptoms.
Reference #1: Andrade FM, Abou-Mourad OM, Judice LF, Carvalho-Filho A, Schau B, Carvalho A. Endotracheal inflammatory pseudotumor: The role of interventional bronchoscopy. Ann Thorac Surg 2010;90:36-37.
Reference #2: Gaissert HA, Grillo HC, Shadmehr MB, Wright CD, Gokhale M, Wain JC, Mathisen DJ. Uncommon primary tracheal tumors. Ann Thorac Surg 2006;82:268-73.
Reference #3: Cerfolio RJ, Matthews TC. Resection of the entire left mainstem bronchus for an inflammatory pseudotumor. Ann Thorac Surg 2005;79:2127-8.
DISCLOSURE: The following authors have nothing to disclose: Edris Alderwish, Arindam Ghatak, George Apergis, Gregory Brevetti, Muhammad Cheema, Spiro Demetis, Mel Ona, Ali El Atat
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