The clinical, radiological, and bronchoscopic findings and outcomes in patients with benign tracheobronchial tumors

Abstract

Purpose: We evaluated the characteristics of and treatment outcomes in patients with benign tracheobronchial tumors.

Materials and methods: We reviewed the records of patients with benign tracheobronchial tumors who underwent bronchoscopic intervention with mechanical removal and Nd: YAG laser cauterization, and evaluated the characteristics and treatment outcomes of 55 patients with hamartomas, leiomyomas, papillomas, typical carcinoids, or schwannomas seen between April 1999 and July 2012.

Results: The most common tumors were hamartoma (n=24), leiomyoma (n=16), papilloma (n=7), typical carcinoid (n=5), and schwannoma (n=3). Forty-one patients (75%) had symptoms. On chest computed tomography, 35 patients (64%) had round or ovoid lesions, accompanied by atelectasis (n=26, 47%) or obstructive pneumonia (n=17, 31%). Fatty components (n=9, 16%) and calcifications (n=7, 13%) were observed only in hamartomas, leiomyomas, and typical carcinoids. At bronchoscopy, the typical findings were categorized according to tumor shape, surface, color, and visible vessels. Fifty (91%) patients underwent complete resection. Forty patients (73%) achieved successful bronchoscopic removal defined as complete resection without complications or recurrence. Recurrences occurred in four papillomas, one leiomyoma, and one typical carcinoid. The proportions of tumor types (p=0.029) differed between the successful and unsuccessful removal groups, and a pedunculated base (p<0.001) and no spontaneous bleeding (p=0.037) were more frequent in the successful removal group.

Conclusion: We described clinical, radiological, and typical bronchoscopic findings in patients with benign tracheobronchial tumors; these findings might help to differentiate such tumors. Bronchoscopic intervention was a useful treatment modality, and tumor type, pedunculated base, and vascularity may influence successful tumor removal.

Keywords: Benign tracheobronchial tumors; bronchoscopy; intervention.

Fig. 1

Bronchoscopic examination of a hamartoma shows a round shape, smooth and rough surface, pinkish color, and no visible vessels on the tumor surface. Spontaneous bleeding was absent (A). Chest computed tomography shows a 25-mm calcified ovoid nodule at the distal bronchus intermedius and atelectasis of the right middle lobe (B).

Fig. 2

Bronchoscopic examination of a leiomyoma reveals a round shape, smooth surface, pinkish color, and visible vessels on the tumor surface. Spontaneous bleeding was rarely observed (A). Chest computed tomography shows a 5.5-mm polypoid nodule at the membranous portion of the distal trachea (B).

Fig. 3

Bronchoscopic examination of a papilloma shows a polypoid shape, lobulated surface, whitish color, and no visible vessels on the tumor surface. Spontaneous bleeding was absent (A). Chest computed tomography reveals a 15-mm lobulated lesion at the anterior wall of the upper trachea (B).

Fig. 4

Bronchoscopic examination of a typical carcinoid shows a round shape, lobulated surface, pinkish color, visible vessels on the tumor surface. Spontaneous bleeding was frequent (A). Chest computed tomography shows a 20-mm round nodule at the right bronchus intermedius (B).

Fig. 5

Bronchoscopic examination of a schwannoma reveals a round shape, smooth surface, whitish color, and no visible vessels on the tumor surface. Spontaneous bleeding was absent (A). Chest computed tomography shows a 21-mm oval nodule occupying the proximal portion of the left main bronchus, leading to left lung atelectasis (B).