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Goussard P, Eber E, Venkatakrishna SSB, Janson J, Schubert PT, Ebert L, Verster J, Basson M, Gie A, Andronikou S. Cryoprobe for Endoscopic Enucleation in Children with Pulmonary Tuberculosis: Effective but Not Without Danger - Case Report and Review of Literature. Respiration 2024; 103:513-520. [PMID: 38684142 DOI: 10.1159/000539076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Tuberculosis (TB) in children under 15 years often results in airway compression, with bronchus intermedius (BI) being the most common site. Endoscopic enucleations can be used to remove lymph nodes and establish an airway in severe cases. Both rigid and flexible bronchoscopy are suitable, with alligator forceps being preferred for its ability to extract tissue. Recent studies have also explored cryoprobe enucleation. CASE PRESENTATION An HIV-positive boy with persistent symptoms after 9 months of TB treatment was diagnosed based on his mother's and sister's Xpert MTB/RIF positive status. He was started on 4-drug TB treatment, but the child remained clinically symptomatic with abnormal chest X-ray and unconfirmed TB. Bronchoscopy was performed, revealing complete obstruction of BI due to caseating granulomas causing collapse of the right middle and lower lobes. Cryotherapy was used to recanalize the airway, and follow-up bronchoscopy confirmed patent BI. CONCLUSION While cryotherapy was effective in the restoration of airway patency in this case, there is a lack of knowledge about its use in children.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Pawel Tomasz Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lars Ebert
- Image Forensics, Zurich Forensic Science Institute, Zurich, Switzerland
| | - Janette Verster
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and Forensic Pathology Service, Cape Town, South Africa
| | - Marthinus Basson
- Department of Industrial Engineering, Faculty of Engineering, Stellenbosch University, Cape Town, South Africa
| | - Andre Gie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ji J, Zhong H, Ren X, He T, Xie G, Wang X. Bronchoscopic treatment of multiple bronchial myelolipomas: a case report and literature review. BMC Pulm Med 2023; 23:317. [PMID: 37653374 PMCID: PMC10472584 DOI: 10.1186/s12890-023-02608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Extra-adrenal myelolipoma is an unusual entity, and endobronchial myelolipoma is rarer, which is often ignored by clinicians, delaying the disease and affecting the prognosis. CASE PRESENTATION A 71-year-old man with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus, with recurrent fever, cough, and expectoration for more than 2 weeks experienced relief in cough, phlegm reduction, and glycemic control with anti-inflammatory treatment. Further examination revealed that new growths obstructing all lobar bronchi impaired flexible bronchoscope entry. In order to relieve the patient's symptoms, under general anesthesia, we performed liquid nitrogen cryobiopsy at multiple bronchial openings, and then used argon plasma coagulation (APC) to achieve hemostasis. The pathological diagnosis was bronchial myelolipoma. The largest volume of the resected tissue was a mass measuring 0.6 cm × 0.4 cm × 0.3 cm at the bronchial opening of the upper lobe of the left lung. The patient's condition was stable and the symptoms were partially relieved after surgery. No recurrence was observed during the 12-month follow-up, although the long-term treatment efficacy is unknown. CONCLUSION Pathological biopsy is key to the diagnosis of endobronchial myelolipoma, and the development of the endobronchial myelolipomas may have been associated with long-term poor control of steroid levels in this patient.
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Affiliation(s)
- Jiali Ji
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Hongqin Zhong
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Xian Ren
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Ting He
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Guijuan Xie
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China
| | - Xun Wang
- Department of Respiratory and Critical Care Medicine, Wuxi Second People's Hospital, Jiangsu, China.
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Operated pulmonary inflammatory myofibroblastic tumors: Our experience with 17 cases. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:101-108. [PMID: 35444850 PMCID: PMC8990154 DOI: 10.5606/tgkdc.dergisi.2022.21263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background
In this study, we aimed to evaluate the clinicopathological features of pulmonary inflammatory myofibroblastic tumor cases operated in our clinic.
Methods
A total of 17 inflammatory myofibroblastic tumor patients (5 males, 12 females; median age: 46 years) who were operated in our clinic between February 2000 and July 2019 were included. Data including sex, age, symptoms, accompanying diseases, tumor localization, tumor diameter, endobronchial extension, maximum standard uptake value of the tumors, surgery type, recurrence, and survival data were analyzed.
Results
Two patients were diagnosed preoperatively and two patients were diagnosed during surgery using frozen-section method before resection. Three (17.7%) patients underwent pneumonectomy, five (29.4%) patients lobectomy, three (17.7%) patients segmentectomy, five (29.4%) patients wedge resection, and one (5.8%) patient bronchial sleeve resection. All patients had complete resection with negative margins. None of them had lymph node metastasis. Median follow-up was 122 (range, 8 to 245 months) months. None of the patients received adjuvant therapy, there was no tumor recurrence or tumor-related death.
Conclusion
It is difficult to make a preoperative diagnosis of inflammatory myofibroblastic tumor patients. Systematic lymph node dissection is not required in diagnosed patients. Complete resection is the most important prognostic factor, and it is critical to achieve this with the smallest resection possible.
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Gupta S, Goyal P, Yang Y, Fitzgerald W. Tracheal Inflammatory Myofibroblastoma: A Rare Tumor of the Trachea. Cureus 2019; 11:e4484. [PMID: 31259102 PMCID: PMC6581385 DOI: 10.7759/cureus.4484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs), also known as inflammatory pseudotumor are rarely reported in the trachea. Although initially considered benign, with the recent evidence of local recurrence after surgical resection, cases of metastatic spread, and advance in cytogenetic analysis, they are now categorized as tumors with malignant potential. Correct histological diagnosis is of utmost importance, as they closely resemble other benign and malignant spindle cell tumors with myofibroblasts predominance. Treatment remains challenging taking into account the location involving the airway. Here, we describe a case of tracheal IMF in an apparently healthy young adult presenting with recurrent hemoptysis.
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Affiliation(s)
- Sonali Gupta
- Internal Medicine, St. Vincent's Medical Center, Bridgeport, USA
| | - Pradeep Goyal
- Radiology, St. Vincent's Medical Center, Bridgeport, USA
| | - Yifeng Yang
- Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA
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Reddy S, Swamy R, Irugu DVK, Ramji KVV. Transtracheal endoscopic-assisted resection of a rare inflammatory myofibroblastic tumour in adult trachea: a case report. ACTA ACUST UNITED AC 2018; 38:170-173. [PMID: 29967553 DOI: 10.14639/0392-100x-1278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/25/2016] [Indexed: 11/23/2022]
Abstract
SUMMARY Inflammatory myofibroblastic tumours (IMTs) are rare and clinically benign in childhood, and malignant in adults. The aetiology of IMTs is not clear, and recent studies report it as true neoplasm rather than a reactive or inflammatory lesion. IMTs can involve any part of the body, but are usually common in lungs. These are rarely seen in adults and tracheal involvement is also rare in both adults and children. We describe an 18-year-old woman who presented with respiratory difficulty to the emergency department. On clinical examination, the patient had complete absence of breath sounds on the right side of the chest. CT of the chest and virtual bronchoscopy revealed a polypoidal soft tissue mass lesion involving the carina with occlusion of right main bronchus. Endoscopic-assisted resection was performed under general anaesthesia and the final pathological diagnosis was tracheal IMT.
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Affiliation(s)
- S Reddy
- Department of Otorhinolaryngology & Head and Neck Surgery, Govt ENT Hospital, Osmania Medical College, Hyderabad, India
| | - R Swamy
- Department of Otorhinolaryngology & Head and Neck Surgery, Govt ENT Hospital, Osmania Medical College, Hyderabad, India
| | - D V Kumar Irugu
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - K V V Ramji
- Department of Otorhinolaryngology & Head and Neck Surgery, Govt ENT Hospital, Osmania Medical College, Hyderabad, India
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Saoud M, Patil M, Dhillon SS, Pokharel S, Picone A, Hennon M, Yendamuri S, Harris K. Rare airway tumors: an update on current diagnostic and management strategies. J Thorac Dis 2016; 8:1922-34. [PMID: 27621844 DOI: 10.21037/jtd.2016.07.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Marwan Saoud
- Department of Medicine, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA
| | - Monali Patil
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA
| | - Samjot Singh Dhillon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA;; Department of Medicine, Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Saraswati Pokharel
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA;; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA;; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kassem Harris
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA;; Department of Medicine, Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, New York, USA
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