Review of smooth muscle tumours of the lower respiratory tract

Endoscopic submucosal dissection of endobronchial leiomyoma with a hybrid knife in an adolescent patient: a case report

Endobronchial leiomyomas are uncommon benign tracheobronchial tumors. Bronchoscopic intervention is a safe and effective strategy for patients with contraindications for surgery or refusal to undergo surgery. Endoscopic submucosal dissection (ESD) is widely used to treat early gastrointestinal tumors. The novel hybrid knife is useful during ESD owing to functions of submucosal injections, lesion dissection and hemostasis, and makes ESD more convenient. Here, we report a case of a benign leiomyoma at the orifice of RB7 in an adolescent boy. The diagnosis was confirmed based on bronchoscopic and pathological findings. The patient was successfully treated with combined electrocautery snare and cryoresection, ESD using a hybrid knife and the wound was managed with argon plasma coagulation. The postoperative course was satisfactory, with a good general condition and no severe respiratory symptoms. This is, to our knowledge, the first reported case of ESD using a hybrid knife to treat an endobronchial leiomyoma in an adolescent patient.

Tracheal leiomyoma imitating refractory asthma: A case report

INTRODUCTION AND IMPORTANCE

Tracheal leiomyoma is an extremely rare benign tumor. It mostly presents in the third decade of life and mostly affects men. Herein, we describe a patient with tracheal leiomyoma which was treated as asthma for 2 years before definite diagnosis.

CASE PRESENTATION

A 41-year-old female with a history of asthma was referred due to dyspnea and refractory cough. On bronchoscopic examination, a tumoral lesion was found in the distal trachea with near total obstruction and histopathologic examination of the bronchoscopic biopsy was inconclusive. The tumor was surgically resected. On the follow-up bronchoscopic examination, the trachea was normal and symptoms were relieved. Histopathologic results were compatible with Leiomyoma.

CLINICAL DISCUSSION

Airway leiomyoma is commonly misdiagnosed as asthma or bronchitis long before a definitive diagnosis. Fiberoptic bronchoscopy is the modality of choice for direct visualization of intraluminal lesions and tissue sampling. Surgical resection is the gold standard approach. The best surgical approach is not clearly determined to date and both endoscopic procedures and surgical resection have been utilized for treatment in case reports.

CONCLUSION

Usually there is a long interval between onset of clinical symptoms and a definite diagnosis. In the case of refractory signs and symptoms to medical treatment, alternative diagnosis should always be considered.

Tracheobronchial Inflammatory Myofibroblastoma

Clinicopathologic findings in three cases of inflammatory myofibroblastomas (so-called inflammatory pseudotumors) of the trachea and bronchi are reported. In all cases the myofibroblastic nature of the spindle cell proliferation was revealed using electron microscopic and immunohistochemical methods. In two of these cases, in which the lesions were incompletely excised to conserve the wall of the airways and the normal lungs, several recurrences over a period of many years were successfully managed endoscopically. These potentially recurring and locally invasive myofibroblastic lesions should be treated as low-grade neoplasms rather than reactive processes. However, if complete excision is not feasible, lung-sparing management is warranted because myofibroblastomas progress slowly and recurrences can be readily detected by bron choscopy. Int J Surg Pathol 2(2):93-98, 1994.

Leiomyoma of the trachea

Primary tracheal tumors are rare. Approximately 1% of them are leiomyoma. Given the rarity of these lesions, optimal management has not been defined. Bronchoscopic, local surgical excision and partial tracheal resection have all been described. One report of recurrence after resection has been published. The incidence of recurrence following local excision is unknown. We report a case of an incidental tracheal leiomyoma diagnosed and treated with a combined approach.

Primary Smooth Muscle Tumor of the Pleura: A Clinicopathological Case Report with Ultrastructural Observations and a Review of the Literature

Primary smooth muscle tumor of the pleura is exceptionally rare. The authors describe a primary smooth muscle tumor of the pleura that was discovered incidentally on chest X-ray in a 73-year-old man. Magnetic resonance imaging demonstrated a 12 x 18 x 15-cm pleura-based mass arising from the posterior mediastinum. Computerized tomography (CT) guided needle cores from the pleura showed a primary smooth muscle tumor of undetermined malignant potential. Further excision of the whole tumor showed an intimate relation to pleura, and the diagnosis of leiomyosarcoma was made. The clinical, radiological, histopathological, immunohistochemical, and ultrastuctural findings were consistent with a primary smooth muscle tumor of the pleura. This is the seventh case in the literature of a primary smooth muscle tumor of the pleura, which, to the best of the authors' knowledge, is the first such case of the pleura to be diagnosed on CT-guided needle biopsy. In conclusion, this method of investigation is recommended since it is minimally invasive but has a rewarding yield in providing the most likely diagnosis, predicting prognosis, and management planning.

Leiomyosarcoma of the main bronchus in a girl: a long-time survivor with multiple lung metastases

Primary leiomyosarcoma of the respiratory tract is a very rare malignancy, especially in childhood, with only 15 cases in patients under 16 years old having been reported. In the present case, the survival period from the onset of symptoms has been over 7 years, despite incomplete resection. Based on the 15 published cases, the prognosis is poorer when the tumor is unresected or incompletely resected, but under favorable circumstances, prolonged survival is possible.

Epithelial and soft tissue tumors of the tracheobronchial tree

This article provides a broad overview of tumors that can involve the tracheobronchial tree. For the most part, the clinical, radiographic, and endoscopic presentation of these rare tumors does not differ significantly from the more common tumors of the lung. Appropriate classification of many tracheobronchial tumors ultimately requires complete sampling and a thorough microscopic evaluation. The introduction of ancillary diagnostic techniques such as immunohistochemistry and molecular analysis will continue to refine tumor classification.

Smooth muscle tumor of the pleura. A case report and review of the literature

Smooth muscle tumors of the serosal membranes are extremely rare and have received little attention in the literature. To the best of our knowledge, only 1 published series of 5 pleural smooth muscle neoplasms has been published to date. We describe a primary pleural neoplasm with smooth muscle differentiation documented by light microscopy, immunohistochemistry, and electron microscopy. This tumor originated in the parietal pleura in a 32-year-old white man and was diagnosed incidentally by chest radiography; the diagnosis was confirmed by magnetic resonance imaging and biopsy. Four years later, the tumor was noted to have increased in size and disseminated into the chest wall as a separate circumscribed mass located in the pectoral muscle. Both masses were resected and diagnosed as smooth muscle tumors. We conclude that smooth muscle tumor of the pleura is a well-defined entity with a low, but definite malignant potential; therefore, we recommend complete resection and long-term follow-up for all patients.

A Dumon stent inserted for bronchial stenosis causing a left bronchopericardial fistula: report of a case

We present herein the case of a 59-year-old man in whom a Dumon stent, inserted as treatment for stenosis of the left main bronchus, caused a left bronchopericardial fistula. The patient initially presented with severe dyspnea caused by main bronchial stenosis of unknown origin for which a Dumon stent was inserted at a local hospital. The Dumon stent migrated to the endobronchus through the stenosis of the left main bronchus a few days later, and his dyspnea remained unresolved. He was subsequently referred to our department 6 months later, where a left pneumonectomy under supportive cardiopulmonary bypass through the femoral artery and vein was performed, and a postoperative pathological diagnosis of bronchial leiomyosarcoma was made. For this rare group of malignant tumors, early diagnosis permits complete surgical resection of the mass and offers the best prognosis. Excision of the tumor should be performed under cardiopulmonary bypass through the femoral vessels when a risk of sudden rupture of the pulmonary artery or vein exists for any reason.

Smooth muscle tumours presenting as pleural neoplasms

Five smooth muscle tumours presenting as pleural neoplasma are presented. The patients were three women and two men aged between 21 and 69 years (mean = 45 years). Clinically, one patient presented with chest pain, one with empyema and the other three were asymptomatic. Two of the tumours were located in the left side of the chest cavity and three in the right side. In four cases, the lesions presented as solitary pleural-based masses that varied in size from 10-18 cm in greatest dimension: in two of these cases, involvement of the diaphragm was present in addition to the pleural involvement. In one case, the tumour was seen to totally encase the right lung simulating the growth pattern of malignant mesothelioma. Histologically, three cases displayed an atypical spindle cell proliferation with marked cellular pleomorphism, mitoses and areas of hemorrhage and necrosis. The other two cases were characterized by a bland-appearing smooth muscle proliferation of uncertain malignant potential composed of elongated cells with a moderate amount of eosinophilic cytoplasm and cigar-shaped nuclei, lacking significant nuclear pleomorphism or mitotic activity. Immunohistochemical studies showed strong positivity for alpha-smooth muscle actin in all cases, and for desmin in four of five cases, and a focal positive reaction for keratin in one case. Ultrastructural examination in one of the high-grade tumours showed features of smooth muscle differentiation. Three of the patients were treated by complete surgical excision while, in the other two patients, the lesions were incompletely resected.(ABSTRACT TRUNCATED AT 250 WORDS)

Benign tumors of the tracheobronchial tree. Endoscopic characteristics and role of laser resection

We conducted a review of all the bronchoscopies performed at our institutions for benign tumors from 1980 to 1991 to determine the endoscopic characteristics of these lesions. We reviewed the charts, the endoscopic characteristics from our video records, and finally the pathologic findings of these cases. We tried to identify the effectiveness of laser resections in each group. Of a total of 3,937 patients, 185 (4.7%) were benign tumors. On these patients, 317 procedures were carried out. There were 3 myoblastomas, 53 papillomas, 1 adenoma, 8 chondromas, 4 fibromas, 45 hamartomas, 15 hamartochondromas, 6 lipomas, 19 angiomas, 5 leiomyomas, 4 schwannomas, 1 neurofibroma, and 21 amyloidomas. Results of laser resection were "very good" in 115 (62%) and "good" in 70 (38%). Complications were minimal: two mediastinal emphysemas, one pneumothorax, and one anesthesia-related cardiac arrest leading to the single death in this series. In general, benign tumors of the proximal endobronchial tree responded well to laser resection when their endoscopic appearance is recognized and prognosis known. Even when recurrent, repeated procedures can be performed easily with good results. This series is probably the largest in the world's literature about endoscopic recognition and the role of laser resection in patients presenting with benign endobronchial tumors.

Complete endobronchial obstruction and left non-aerated hemithorax caused by a leiomyoma: report of a case

Presented herein is the case of a 27-year-old man in whom an endobronchial tumor was found causing complete obstruction of the left main bronchus. The tumor was successfully removed by performing sleeve resection of the left main bronchus without pulmonary resection, immediately following which the left lung became reinflated. Subsequent histological study of the resected tumor confirmed that it was a leiomyoma, a type of benign tumor that is rarely found in the lung.

Leiomyosarcoma of the base of the tongue treated with radiotherapy: a case report

Soft tissue sarcomas of the oral cavity are uncommon malignancies; those of smooth-muscle origin are extremely rare. The world literature reveals about 80 leiomyomas and 26 cases of leiomyosarcoma. Only 4 of the cases with leiomyosarcoma occurred in the tongue. This report of leiomyosarcoma of the base and dorsum of the tongue adds 1 case which was primarily treated with irradiation and achieved an excellent response. A 1.5-year follow-up after radiation-therapy is included and a review of the literature is presented.

Leiomyoma of the bronchus treated by endoscopic resection

Leiomyoma of the bronchus is a rare benign tumor. The type of surgical resection depends on the location of the tumor and secondary lung destruction, although most surgical treatment has required thoracotomy. Two Korean women who had pedunculated masses in the left main bronchus and in the right lower lobe bronchus were successfully treated by endoscopic resection. Their postoperative courses were uneventful. They are well 19 months and 10 months, respectively, after resection.

Primary leiomyosarcoma of the lung presenting with a persistent pneumothorax

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