Endobronchial hamartoma

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

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.

[Endobronchial hamartochondroma]

INTRODUCTION

Endobronchial hamartochondroma is a form of rare benign tumour. Compared to those that occur in the lung parenchyma, the endobronchial form can potentially be managed by relatively conservative treatment involving per-endoscopic resection.

COMMENT

A 61-year-old patient had a dry cough and chest pain for 3 months. Their clinical examination was normal, but thoracic CT scan showed lingular collapse. Bronchoscopy revealed the presence of a multilobar tumour occluding the orifice of the lingula bronchus. Bronchial biopsies were consistent with the diagnosis of a hamartochondroma. Before the destruction of any of the left upper lobe parenchyma, the tumor was resected surgically and the patient had an uneventful postoperative course.

CONCLUSION

Endobronchial hamartochondroma support must be rapid to avoid irreversible parenchymal consequences downstream obstruction involving an often mutilating surgery. Essentially endoscopic treatment should be the most conservative possible.

Tumors and tumorlike conditions of the large airways

OBJECTIVE

Large-airway tumors and tumorlike conditions are uncommon, but a systematic approach aids in narrowing the differential diagnosis. In this article, we describe an approach to dealing with large-airway lesions and discuss their imaging characteristics and clinical presentations.

CONCLUSION

We have found it useful to separate these entities into groups on the basis of the distribution pattern (focal vs diffuse) and location (trachea vs bronchi).

Argon plasma coagulation and electrosurgery for benign endobronchial tumors

BACKGROUND

Benign endobronchial tumors are a rare entity capable of causing significant symptoms. Endobronchial tumor destruction has the potential for relieving symptoms while sparing the patient from invasive surgical resection. Although Nd:YAG laser has been successfully used, other less costly approaches such as argon plasma coagulation (APC) and electrocautery, may be effective alternatives for the bronchoscopic treatment of benign endobronchial tumors.

METHODS

A retrospective medical chart review was conducted at a single academic center in the United States from the period of January 2005 through December 2011 to collect a minimum of 10 cases for review. Eligibility criteria included diagnosis of a benign endobronchial tumor and age over 18 years. Our institution's pathology database was searched by specific benign tumor and the results were further refined based on an endobronchial location. The bronchoscopic procedure log was also searched and identified procedures were cross referenced with the medical record to confirm eligibility.

RESULTS

Ten patients with pathologically confirmed benign endobronchial tumors were identified. All patients achieved tumor regression with APC in combination with electrocautery or cryotherapy. Majority of the procedures (75%) were performed with flexible bronchoscopy and 55% were performed under moderate sedation.

CONCLUSIONS

APC is an effective method for tumor devitalization and reduction in tumor size, making it a viable and less costly therapeutic option for the treatment of benign endobronchial tumors.

Endobronchial hamartoma

Pulmonary hamartoma is a benign lung neoplasm and it comprises 6% of solitary pulmonary nodules. Two clinical types have been defined according to its location: intraparenchymal (90%) and endobronchial (10%). We report on a case of endobronchial hamartoma resected with electrocautery by a flexible bronchoscope (FB). A 57-year-old male patient was admitted to our clinic because of worsening dyspnea. The patient had been smoking 1 pack per day for 37 years. A solid smooth lesion with calcification, located in the distal part of the left main bronchus and partially obstructing the lumen of bronchus, was detected at computerized tomography. A mass lesion that moved with coughing was observed during FB. The polypoid mass was arising from the anterior wall of the left main bronchus. Punch biopsies were taken from the polypoid lesion and a diagnosis of bronchial papilloma was made after histopathologic examination. The patient underwent endobronchial electrosurgery and the lesion was excised using FB. Pathologic evaluation revealed it to be a cartilagenous hamartoma. In conclusion, endobronchial hamartomas are benign neoplasms of the tracheobronchial tree. Endoscopic treatment with flexible bronchoscopic electrocautery is safe and less invasive in experienced hands. Therefore, it should be considered as the primary treatment approach in selected cases.

An unusual bronchial obstruction in a fit young man

We describe the case of a previously well young man who presented acutely to hospital with a history of progressive chest symptoms and systemic upset. At admission, clinical evidence of left upper lobe collapse on respiratory examination and chest x-ray gave rise to significant clinical concern. Initial assessment by CT suggested a possible aspirated foreign body in the left upper lobe bronchus with distal left upper lobe collapse. Subsequent rigid bronchoscopy identified a solid abnormality totally occluding the left upper lobe bronchus, which did not appear to be a foreign body. The patient became progressively more unwell with clinical signs of chest sepsis and failed to settle with medical therapy. A decision was made to undertake a lobectomy to remove the collapsed lobe and obstructing endobronchial lesion. Histology confirmed that the cause of bronchial obstruction was a mesenchymoma (pulmonary hamartoma).

Endobronchial hamartoma causing massive hemoptysis

Endobronchial hamartoma is an unusual clinical entity and infrequently causes hemoptysis. This brief report extends the sparse available experience with endobronchial hamartoma causing hemoptysis by presenting, to our knowledge, only the third such patient reported to have massive hemoptysis complicating an endobronchial hamartoma.

Minimally invasive bronchoscopic resection of benign tumors of the bronchi

OBJECTIVE

Primary benign tumors of the trachea and main bronchi are uncommon. Interventional bronchoscopy allows the diagnosis and the treatment of some of these lesions.

METHODS

We reviewed four cases endoscopically treated at our institution.

RESULTS

Two patients had hamartoma, and two patients had endobronchial lipoma. In all of the cases, the interventional technique for the resection was the use of a polypectomy snare and electrocautery. The only complication reported was one episode of bronchospasm.

CONCLUSIONS

Minimally invasive bronchoscopic resection is a safe, effective method for treating selected benign tumors of the main airway and has a low complication rate.

Clinical and Radiological Manifestations of Primary Tracheobronchial Tumours: A Single Centre Experience

Introduction: Tracheobronchial tumours usually cause an airway obstruction and secondary pulmonary infections. Although rare, they are an important differential diagnosis as they may mimic other conditions and diseases. This paper aims to analyse clinical, radiological and histological characteristics of the patients with tracheobronchial tumours diagnosed for a period of 7 years. Materials and Methods: In this retrospective, observational study, we carefully reviewed 65 patients who were diagnosed with tracheal and endobronchial tumours, and performed statistical analysis on the results. Results: Among these 65 patients (36 men and 29 women) with a mean age of 48.8 years (range, 15 to 75), 50 had malignant tumours while 15 had benign ones. The most common symptoms were cough, chest pain and haemoptysis. Cough was a more frequent symptom in patients with benign tumours (P <0.0014). Only 2 patients were asymptomatic. Tumours were predominantly localised in the large airways (46 in large bronchi and 2 in trachea). The most common radiological manifestation of malignant tumours was tumour mass (46%) followed by atelectasis. One third benign tumour caused atelectasis, while tumour mass and consolidation were found in 3 patients each. Computerised tomography revealed endoluminal tumour mass in 29.2% of the cases, which was more frequently found in benign than malignant tumours (47% vs 24%, respectively). On bronchoscopy, tumours were visible in 73% and 70% benign and malignant cases respectively. Conclusion: Tracheobronchial tumours should be ruled as a possible diagnosis in patients with cough, haemoptysis, dyspnoea and chest pain. The imaging techniques and histological examination of the tissue would subsequently lead to correct diagnosis and proper treatment can be administered. Key words: Bronchus, Computerised tomography, Trachea, Tumour, X-ray

Endobronchial lipomatous hamartoma: an incidental finding in a patient with atrial fibrillation-a case report

Introduction. Lung hamartomas are the most common benign tumors of the lung. Typically, they are located in the peripheral lung, while an endobronchial localisation is rare. Case Presentation. We present a case with the rare diagnosis of an endobronchial hamartoma as incidental finding in a 69-year-old male, caucasian patient with atrial fibrillation. At first admission, the patient's exertional dyspnea was caused by atrial fibrillation. Relapse of exertional dyspnea in the absence of arrhythmia was due to postobstructive pneumonia caused by an endobronchial hamartoma. Conclusion. Endobronchial tumors such as endobronchial lipoma or hamartoma should be considered as potential causes of exertional dyspnea and thus as differential diagnosis of atrial fibrillation. Although endobronchial hamartomas are benign, resection is recommended to prevent postobstructive lung damage.

Endoscopic cryosurgical resection of pulmonary hamartoma with flexible bronchoscopy

Pulmonary hamartoma is one of the most common benign lung tumors. Well-known conventional methods of treatment for lung hamartomas include VATS enucleation or wedge resection, bronchoplasty, and others. Here we present a case of endobronchial hamartoma that was successfully treated with cryosurgery by flexible bronchoscopy.

Giant endobronchial hamartoma resected by fiberoptic bronchoscopy electrosurgical snaring

Less than 1% of lung neoplasms are represented by benign tumors. Among these, hamartomas are the most common with an incidence between 0.025% and 0.32%. In relation to the localization, hamartomas are divided into intraparenchymal and endobronchial.

Clinical manifestation of an endobronchial hamartoma (EH) results from tracheobronchial obstruction or bleeding. Usually, EH localizes in large diameter bronchus. Endoscopic removal is usually recommended. Bronchotomy or parenchimal resection through thoracotomy should be reserved only for cases where the hamatoma cannot be approached through endoscopy, or when irreversible lung functional impairment occurred after prolonged airflow obstruction. Generally, when endoscopic approach is used, this is through rigid bronchoscopy, laser photocoagulation or mechanical resection. Here we present a giant EH occasionally diagnosed and treated by fiberoptic bronchoscopy electrosurgical snaring.

Laser resection of endobronchial hamartoma via fiberoptic bronchoscopy

Endobronchial hamartoma is a rare benign tumor of lung that may present with symptoms of airway obstruction with wheezing, stridor, recurrent pneumonia or atelectasis. We report a case of a patient with endobronchial hamartoma, recurrent pneumonia, who presented to us with sputum smear and culture positive pulmonary tuberculosis. He was treated with antitubercular treatment and endobronchial hamartoma was resected completely by diode laser through fiberoptic bronchoscope.

A hamartoma located in the trachea

Hamartoma is rarely found to be localized in the trachea. In the literature, only about ten cases have been reported. A 52-year-old male who was being treated for asthma for 15 years applied to our hospital with a progressive dyspnea complaint. During his physical examination, stridor was heard, after which a computed tomography of his chest revealed a tracheal mass. Fiberoptic bronchoscopy revealed a mass which obstructed 80% of the tracheal lumen attached to the posterior tracheal wall with a broad base. The mass was removed surgically with segmentary resection of the trachea. histopathological examination of the lesion indicated that it was a hamartoma. Hamartomas can localize in the trachea very rarely, causing serious obstruction.

[Clinical characteristics of resected bronchial hamartoma. Study of seven cases]

INTRODUCTION

Endobronchial hamartoma is a benign tumour derived from peribronchial mesenchymal tissue. It is a form of intrapulmonary hamartoma and can cause irreversible pulmonary destruction due to bronchial obstruction. Early diagnosis and treatment is very important and endoscopic treatment is usually the first choice. In cases in which prolonged bronchial obstruction has produced irreversible lung destruction surgical, resection of the tumour is necessary. The aim of this study is to describe the clinicopathological characteristics of resected endobronchial hamartoma.

PATIENTS AND METHODS

Seven cases of endobronchial hamartoma, diagnosed in our institution between January 1995 and December 2009, were reviewed retrospectively.

RESULTS

The patient population consisted of four males and three females with mean age of 53.7 years (41-68 years). The most frequent clinical presentation was obstructive pneumonia. Endoscopy and imaging showed an endobronchial mass in most cases. Surgical treatment consisted of atypical resection in one case, lobectomy in five cases and pneumonectomy in one case. Tumour size ranged between 0.5 and 3.5 cm. The diagnosis was confirmed in all cases by histological examination. The outcome was favorable in all cases.

CONCLUSION

Endoscopic techniques are effective for the diagnosis and treatment of endobronchial hamartochondroma. Treatment should be prompt to prevent irreversible lung damage due to chronic obstruction and suppuration, in which case, pulmonary resection may be necessary.

Extrapulmonary hamartoma

We describe a rare case of extrapulmonary hamartoma. A 65-year-old man underwent video-assisted thoracic surgery to obtain a histological diagnosis of a tumor with an irregular shape in the subpleural region of the right apical segment. Thoracoscopy showed a chondromatous tumor in the extrapleural region. The tumor resection was uneventful. Pathology study showed a hamartoma outside the visceral pleura.

Endobronchial fibroleiomyomatous hamartoma: a diagnostic pitfall

A 46 year-old man was found to have a polypoidal growth in the lumen of the right main bronchus. Fiberoptic bronchoscope-guided biopsy of the mass on two occasions showed acute-on-chronic inflammation. The origin of the polyp was the right upper lobe bronchus; and upper lobectomy with adequate resection margin was done. Histopathology examination of the polyp showed features compatible with benign fibroleiomyomatous hamartoma. True fibroleiomyomatous hamartoma arising primarily in the lung is rare and presents as a pulmonary parenchymal lesion. the endobronchial variant of this tumor is extremely uncommon and not well documented in the literature. A preoperative diagnosis is difficult, and a high index of suspicion is required for diagnosing this benign neoplasm.

Imaging of tumors of the trachea and central bronchi

Tumors of the trachea and central bronchi can be benign or malignant. Clinical presentation may be confusing, particularly in benign tumors that can be misdiagnosed as asthma or chronic bronchitis. Chest radiography has many limitations and is often considered unremarkable in patients with tumors of the central airways; therefore, multidetector CT (MDCT) has become the most useful noninvasive method for diagnosing and assessing the central airways. The purpose of this article is to provide a review of imaging of the tumors of the trachea and central bronchi. We emphasize the crucial role of MDCT and postprocessing techniques in assessing neoplasms of the central airways.

Endobronchial lipomatous hamartoma with mediastinal extension

Endobronchial hamartoma is a special form of pulmonary hamartoma. We report a histologically proven case of an endobronchial lipomatous hamartoma with extrabronchial-mediastinal extension in a 64-year-old patient, and we describe the computed tomography and magnetic resonance imaging findings. To our knowledge, this is the first reported case of an endobronchial hamartoma extending into the mediastinum.

Benign thoracic disease in the elderly

The spectrum of benign thoracic disease in the elderly includes structural abnormalities, infectious disease and their complications, benign neoplastic growths, and autoimmune disease. Differences in physiologic reserve in this population make diagnosis difficult, as elderly patients may not present in the classic fashion, as well as complicate treatment. Benign thoracic disease in the elderly can pose a challenging clinical problem. Older patients with comorbid diseases may have poor tolerance of unnecessary surgical interventions. However, benign disorders of the chest associated with symptoms attributable to effusion or obstruction of airways can limit quality of life. Minimally invasive techniques (eg, video-assisted thoracoscopic surgery) can limit the morbidity associated with intervention. Additionally, prompt intervention may spare the patient more invasive treatments. For example, early effusions can be managed with simple drainage rather than thoracotomy and decortication. With respect to suspected benign thoracic lesions in the elderly, guiding principles for management include avoiding unnecessary interventions while not overlooking potential malignancies. Close surveillance of progressive symptoms, ensuring no radiographic change in the size of the lesion over 2 years, and use of positron-emission tomography remain the diagnostic keys to accurate management.

Bronchoscopic features and bronchoscopic intervention for endobronchial hamartoma

BACKGROUND AND OBJECTIVE

Bronchoscopic resection of endobronchial hamartomas has been reported to have a favourable outcome. This study describes the bronchoscopic features of endobronchial hamartoma and reports the clinical outcome of bronchoscopic intervention.

METHODS

A retrospective analysis was conducted of patients with histologically proven endobronchial hamartomas, diagnosed in the 10-year period 1999-2009 to elucidate the clinical, radiological and bronchoscopic features of hamartoma and to describe the clinical outcomes.

RESULTS

Seventeen of the 135 patients with pulmonary hamartomas were diagnosed as having endobronchial hamartomas. CXR was abnormal in 11 of the 17 patients. On chest CT (n = 16), the median diameter of the lesion was 15.6 mm. Calcification and areas of focal fat in the lesion, the diagnostic CT findings of pulmonary hamartoma, were found in two of 16 (12.5%) patients. At bronchoscopy (n = 16), all tumours had a mass appearance and most were smooth surfaced round masses (50.0%) with 18.8% having a 'stalk'. Bronchoscopic forceps biopsies were performed in 13 patients, which resulted in five patients (38.5%) being diagnosed with endobronchial hamartoma. Fifteen patients were treated with rigid or flexible bronchoscopic resection, one had lobectomy, and one had no intervention. No procedure-related mortalities or late complications developed.

CONCLUSIONS

Bronchoscopic intervention appears to be a safe and effective method to resect endobronchial hamartomas.

Imaging of tumors of the trachea and central bronchi

Tumors of the trachea and central bronchi can be benign or malignant. Clinical presentation may be confusing, particularly in benign tumors that can be misdiagnosed as asthma or chronic bronchitis. Chest radiography has many limitations and is often considered unremarkable in patients with tumors of the central airways; therefore, multidetector CT (MDCT) has become the most useful noninvasive method for diagnosing and assessing the central airways. The purpose of this article is to provide a review of imaging of the tumors of the trachea and central bronchi. We emphasize the crucial role of MDCT and postprocessing techniques in assessing neoplasms of the central airways.

Mucoid impactions: finger-in-glove sign and other CT and radiographic features

Mucoid impaction is a relatively common finding at chest radiography and computed tomography (CT). Both congenital and acquired abnormalities may cause mucoid impaction of the large airways that often manifests as tubular opacities known as the finger-in-glove sign. The congenital conditions in which this sign most often appears are segmental bronchial atresia and cystic fibrosis. The sign also may be observed in many acquired conditions, include inflammatory and infectious diseases (allergic bronchopulmonary aspergillosis, broncholithiasis, and foreign body aspiration), benign neoplastic processes (bronchial hamartoma, lipoma, and papillomatosis), and malignancies (bronchogenic carcinoma, carcinoid tumor, and metastases). To point to the correct diagnosis, the radiologist must be familiar with the key radiographic and CT features that enable differentiation among the various likely causes. CT is more useful than chest radiography for differentiating between mucoid impaction and other disease processes, such as arteriovenous malformation, and for directing further diagnostic evaluation. In addition, knowledge of the patient's medical history, clinical symptoms and signs, and predisposing factors is important.

Hamartoma pulmonar como diagnóstico diferencial de metástase de carcinoma de mama: relato de caso

Relata-se o caso de uma paciente de 60 anos, em menopausa há 14 anos, com presença de nódulo pulmonar à radiografia de tórax diagnosticado no seguimento pós-operatório por neoplasia de mama. A paciente tinha história de mastectomia e linfadenectomia axilar ipsilateral por carcinoma ductal invasivo de mama, assim como de hormonioterapia, quimioterapia e radioterapia adjuvante. Após nodulectomia por vídeotoracoscopia, o exame de congelação mostrou tratar-se de um hamartoma pulmonar. Estudos recentes demonstram que 75% dos pacientes que se submeteram a cirurgia por nódulos pulmonares após mastectomia curativa de câncer de mama apresentaram metástases pulmonares, 11,5% apresentaram câncer primário de pulmão e 13,5% apresentaram lesões benignas, dentre as quais o hamartoma.

Central airway obstruction caused by a peripheral hamartoma

We report the first case of a hamartoma, arising from peripheral lung tissue, which extended proximally over several decades to occlude the large airways. The patient's symptoms were originally attributed to asthma and the correct diagnosis was only made when she developed life-threatening airway obstruction. The endobronchial component of the hamartoma was debulked with urgent laser therapy, while the peripheral base of the tumour was resected by elective right middle lobectomy.

Multiple central endobronchial chondroid hamartoma

Benign neoplasm of the lung is rare, and pulmonary hamartoma is the most common form of benign neoplasm of the lung. Most pulmonary hamartomas are parenchymal hamartomas, and endobronchial hamartomas are very rare and usually occur as a single mass. We report a case of a 55-year-old man presenting with multiple endobronchial chondroid hamartomas that had not been confirmed preoperatively. The patient received bilobectomy, and the postoperative course was uneventful. There was no evidence of recurrence or complications during the 6-month follow-up period. Reports of multiple endobronchial chondroid hamartomas are rare in the literature, and the awareness of this form of benign disease is important in the differential diagnosis of pulmonary neoplasms.

Transverse Bronchoplasty of the Membranous Wall After Resection of an Endobronchial Hamartoma

Lung hamartomas are rare benign tumors of the bronchi. Their management consists of bronchoscopic excision or removal through a thoracotomy and bronchotomy whenever there is a large tumor totally obstructing the bronchial lumen. As a lung-sparing procedure is usually the aim, various bronchoplastic techniques have been described, providing a functional lumen of the repaired bronchus. We describe a simple technique that can be safely undertaken to preserve a satisfactory diameter of the bronchus or trachea and prevent a stenosis at the site of repair.

Giant pulmonary hamartoma

Pulmonary hamartomas are usually an incidental finding and range in size from 1 cm to 8 cm in diameter in various series. We report a case of a massive pulmonary hamartoma (size 25.5 x 17.5 x 6.5 cm and weighing 1134 g) in a 61 year old male who presented with a short history of breathlessness. The tumour was arising from the medial border of the right lung and occupying most of the right chest extending in to the anterior mediastinum. The tumour was compressing the right lung and there was no evidence of infiltration into the surrounding structures. It was successfully treated by surgical resection and final histology was pulmonary hamartoma with predominantly adipose and leiomyomatous differentiation.

Rapidly growing endobronchial hamartoma with bone marrow tissue

A 29-year-old woman presented with a 4 x 3.5 cm circumscribed mass located in the left upper lobe, which had not been detected in a chest roentgenogram that was taken 3 years prior. Bone scintigraphy using technetium-99m methylene diphosphonate revealed an increased uptake of the isotope in the mass, indicating increased osteoplastic activity. She underwent surgical resection of the mass and the pathologic diagnosis was endobronchially located pulmonary hamartoma, which contained bone marrow tissue. An extremely rare case of pulmonary hamartoma showing rapid growth and involving bone marrow tissue is presented.

The role of endoscopic surgery for completely obstructive endobronchial benign tumor

BACKGROUND

The improving techniques of therapeutic bronchoscopy have been replacing conventional surgery for resecting endobronchial benign tumor. However, there could be some limitation for performing bronchoscopic intervention for the patients with complete bronchial obstruction. To evaluate the role of endoscopic surgery for completely obstructive endobronchial benign tumor, we retrospectively reviewed the medical records of 7 patients who underwent bronchoscopic resection due to completely obstructive benign tumor.

METHODS

Rigid bronchoscopy was performed under general anesthesia. After the stalk of tumor was identified with using a 1 mm biopsy forceps as a probe, a Nd-YAG laser was used to coagulate the stalk of tumor. The tumor was then removed.

RESULTS

Bronchoscopic resection was successful in 6 out of 7 patients. The histological diagnoses were 3 leiomyomas, 3 harmatomas and 1 lipoma. There was no mortality in our study. Pneumomediastinum developed in 1 patient, and this patient was treated with 3 days of oxygen therapy. In 5 out of the 6 successful patients, there was no recurrence for a median of 35 months. In 1 patient, leiomyoma recurred after 17 months, and this was treated by pneumonectomy.

CONCLUSIONS

Endoscopic surgery could be applied to the patients with completely obstructive endobronchial benign tumor.

Resection of endobronchial hamartoma by bronchoplasty and transbronchial endoscopic surgery

Endobronchial hamartoma is a rare, benign tumor usually associated with pneumonitis and atelectasis caused by obstruction. Lobectomy is sometimes performed even if the tumor is benign. Transbronchial endoscopic surgery is usually performed for patients with a small endobronchial hamartoma. We report our treatment of a large hamartoma completely obstructing the patient's left main bronchus. The tumor was partially resected, and that remaining was resected by transbronchial endoscopic surgery. No finding of recurrence of the endobronchial hamartoma was detected by endoscopy or biopsy for 3 years. A combination of bronchoplasty and transbronchial endoscopic surgery benefits patients with large endobronchial hamartoma by preserving the lung parenchyma.

Surgical treatment of other bronchial tumors

Bronchial gland tumors (bronchial carcinoids, adenoid cystic carcinoma, mucoepidermoid carcinoma are the most common), benign tumors and other rare primary malignant neoplasms present as endobronchial tumors. This article discusses the surgical treatment of each of these tumors individually.