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Lung Cancer |

Endobronchial Leiomyoma in a Patient Presenting With Chronic Cough After Treatment for Pneumonia

Zhou Zhang, MD; Vincent Chan, MD; Luis Moreta-Sainz, MD
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Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA


Chest. 2014;146(4_MeetingAbstracts):660A. doi:10.1378/chest.1994681
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Abstract

SESSION TITLE: Cancer 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: Endobronchial leiomyoma is a rare benign tumor of the lung. We describe an adult male found to have endobronchial leiomyoma presenting with chronic cough.

CASE PRESENTATION: A 54 year-old male from the Philippines presented with 6 months of persistent cough following antibiotic treatment for right lower lobe pneumonia. Due to persistent symptoms and a 10 pack-year smoking history, a chest CT was performed to rule out malignancy, revealing a right lower lobe endobronchial lesion. The patient underwent bronchoscopy, where a near-obstructing avascular lesion was found in the right lower lobe bronchus with extension into the bronchus intermedius. Pathology demonstrated nodular smooth muscle tissue consistent with leiomyoma.

DISCUSSION: Primary pulmonary leiomyoma is a rare benign tumor accounting for less than 2% of all benign lung tumors. Of these, endobronchial leiomyomas make up one-third of reported cases with approximately 100 patients identified in literature. Patients typically present in the fourth decade of life with a female predominance. Endobronchial leiomyoma is thought to arise from smooth muscle within the bronchial tree, and histologically, tissue stains are positive for smooth muscle actin low mitotic activity. Although these lesions are benign, they demonstrate potential for complication. Clinical symptoms often vary with the degree of bronchial obstruction, which include cough, dyspnea, wheezing, hemoptysis, and recurrent pneumonia. Radiographic findings range from atelectasis to more discrete consolidations and lobar collapse. Given the benign nature of this entity, prognosis is favorable, and treatment often hinges on control of symptoms related to obstruction. While surgical resection has demonstrated favorable long-term outcomes, recent literature suggests nonsurgical bronchoscopic removal techniques including APC, snare removal, and forceps extirpation may be performed with similar outcomes. In situations where lesions are large, wide based, or located in distal airway or lung parenchyma, surgical options including lobectomy or pneumonectomy are often necessary to achieve complete resection.

CONCLUSIONS: After a multi-disciplinary discussion of various treatments, our patient elected to pursue non-surgical tumor resection. Argon plasma coagulation and snare removal were performed with adequate tumor debulking and overall improvement of clinical symptoms.

Reference #1: Park JS et al. Primary leiomyoma of the trachea, bronchus, and pulmonary parenchyma - a single-institutional experience. European Journal of Cardio-Thoracic Surgery. 41: 41-45. 2012

DISCLOSURE: The following authors have nothing to disclose: Zhou Zhang, Vincent Chan, Luis Moreta-Sainz

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