Multiple endo bronchial lipoma: a rare case report

Abstract

Background: Endobronchial lipoma is an extremely rare benign tumor, which is generally located in the first three subdivisions of the tracheobronchial tree. According to the existing literature, all endobronchial lipomas are single (one per patient). Here, we report a rare case in which the patient presented with two endobronchial lipomas in the same patient, and underwent a bronchoscopic tumor resection in the left main bronchus and the left lower bronchus. Both tumors were pathologically confirmed as endobronchial lipoma.

Case presentation: A 52-year-old Chinese man presented at the clinic reporting a mild cough with yellow color sputum and exertional dyspnea for 2 weeks. He was a heavy smoker (45 pack-years). Chest auscultation demonstrated faint wheezing in left lower lobe. Computed tomography (CT) revealed two low-density endobronchial masses located in the middle segment of the left main bronchus and the posterior basilar segmental bronchus of the left lower lobe. The neoplasms measured a CT-attenuation value of -70HU, -98HU in density with air trapping and atelectasis in the segmental bronchus of the left lower lobe. The patient underwent interventional bronchoscopic management to remove the neoplasms by using an electrosurgical snare, cryotherapy, and electrocautery. The locations of the neoplasms were confirmed at the left main bronchus and the superior segment of the left lower lobe during bronchoscopic intervention. Histopathological examination confirmed that both tissues were consistent with lipomas. After 18 months of follow-up, the patient was free of symptoms and CT revealed that bronchiectasia remained in the superior segment of the left lower lobe; however, no mass lesion was present in the left bronchus.

Conclusions: This case suggests that an endobronchial lipoma can present as multiple lesions, and both proximal and distal types can simultaneously occur in the same patient. Thus, these findings help us further understand the biology of endobronchial lipomas.

Keywords: Bronchoscopy; Case report; Endobronchial lipoma; Lipoma.

Fig. 1

CT showing a low-density mass obstructing the left main bronchus, the CT value is -70HU

Fig. 2

CT suggesting low-density mass obstructing the left lower lobe, the CT value is -98HU

Fig. 3

A spherical neoplasm growing in the left main bronchus with a smooth, soft, and red appearance

Fig. 4

Neoplasm located in left main bronchus, about 2.0 × 1.3 × 0.9 cm in size, with an oval polypoid shape

Fig. 5

The left lower lobe bronchus is blocked by a neoplasm. Its surface is smooth, soft, has a light-yellow appearance, and is dumbbell shaped

Fig. 6

Image of left main bronchial tumor after resection

Fig. 7

Five pieces of neoplasia tissues that have been removed from the left main bronchus and the lower left bronchus

Fig. 8

Image of the left lower lobe bronchial after tumor resection

Fig. 9

Histology of the neoplasm at low magnification demonstrating the pseudo-stratified ciliated columnar epithelium overlying the mature adipocytes and little fibrous tissue. The neoplasm in the left main bronchus is consistent with lipoma. Hematoxylin and eosin (HE) staining

Fig. 10

Histology of the neoplasm at low magnification demonstrating the pseudo-stratified ciliated columnar epithelium overlying mature adipocytes. The neoplasm in the left lower lobe is consistent with lipoma. HE staining

Fig. 11

CT revealing that the left main bronchus and the left lower lobe were unobstructed, and that the left lower lobe showed bronchiectasis

Fig. 12

CT revealing that the left main bronchus and the left lower lobe were unobstructed, and that the left lower lobe showed bronchiectasis