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Pulmonary Procedures |

Rare Cause of Persistent Cough?

Kashif Ali Khan, MMSc; O'Connor Terry, MD; Marcus Kennedy, MD
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Cork University Hospital/University College Cork, Cork, Ireland


Chest. 2014;146(4_MeetingAbstracts):790A. doi:10.1378/chest.1993427
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Abstract

SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We present an uncommon cause in which rare endobronchial aetiology was found during the work-up of persistent cough in a smoker that was treated with a bronchoscopy therapy.

CASE PRESENTATION: A 62 year old woman presented to a tertiary care hospital with two months history of persistent cough. She was lifelong smoker with 40 pack year history. Her physical examination revealed high BMI and was otherwise normal.Her CT thorax (fig 1A) raised concerns of an endobronchial lesion in the proximal lingual. PET-CT did not report any FDG-avid lesion. A flexible bronchoscopy revealed polypoidal neoplasm of approximately 1cm, partially obstructing the lingular bronchus. Biopsies of the lesion confirmed the pathological diagnosis of Granular Cell Tumour (GCT). After discussion at our thoracic oncology meeting she subsequently had repeat flexible bronchoscopy and the endobronchial tumour was debulked with forceps and argon plasma coagulation. Her symptoms resolved completely and follow up CT and bronchoscopy are planned.

DISCUSSION: Endobronchial GCT are extremely rare, 2-6% occur in the lung, and of these, 90% are endobronchial with the predilection to upper lobes and at the bifurcation of the bronchi. GCT can be found incidentally or with symptoms of cough, shortness of breath, wheeze or haemoptysis. There are no distinguishing radiological features, nevertheless, GCT should be considered in the differential diagnosis of all bronchogenic growth. Histologically, GCTs are composed of large polygonal cells containing numerous eosinophilic granules. They resemble Schwann cells under electron microscopy and stain positive for S100 protein, suggesting that they originate from cells of the neural origin. Tracheobronchial GCTs are benign, slow growing neoplasm with lower risk of recurrence for smaller size lesion; thus, simple excision appears to be an effective therapy. However, the proper method of treatment remains controversial. Endobronchial therapy with electrosurgery and Nd-Yag laser has been reported with success especially in tumours <1cm1. The ablative therapy (fig B and C) applied in our case was argon plasma coagulation (APC) that has not been previously reported as a therapeutic strategy. In addition to immediate ablative effect, APC also produces delayed cytocidal effect of heat transmission. In our case, this approach was sufficient to provide complete symptomatic relief and tumour ablation. However, close bronchoscopic surveillance will be performed for early assessment of tumour recurrence.

CONCLUSIONS: GCT is a rare benign neoplasm of neuroectoderm in origin with good prognosis. Differentiation of the GCT from other bronchogenic growth, require histological diagnosis. Argon plasma coagulation can be used as an endobronchial ablative treatment with special emphasis on bronchoscopy for follow up due to the risk of recurrence.

Reference #1: Granular cell tumour of the bronchus:bronchoscopic and clinical features.Thorax 1986;41:927-931

DISCLOSURE: The following authors have nothing to disclose: Kashif Ali Khan, O'Connor Terry, Marcus Kennedy

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