Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 27  |  Issue : 2  |  Page : 57-59

Endobronchial lipoma: A rare indication for a lobectomy


1 Department of Thoracic Surgery, Christian Medical College, Vellore, Tamil Nadu, India; Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Thoracic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication23-May-2019

Correspondence Address:
Dr. Osemobor Kennedy
Department of Surgery, University of Benin Teaching Hospital, Benin City

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njss.njss_20_17

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  Abstract 


Endobronchial lipomas are rare benign tumors of the respiratory tract. We describe a 61-year-old male with a history of recurrent pneumonia and hemoptysis whose computed tomography scan revealed a destroyed left lower lobe of lung caused by an endobronchial tumor. A bronchoscopic biopsy was suggestive of a lipoma. He underwent a left lower lobectomy since there was irreversible damage to the lower lobe beyond the obstruction. With this report, we stress the importance of early diagnosis of such tumors which could have made an endobronchial resection possible without resorting to a lung resection, thus preserving lung function.

Keywords: Endobronchial lipoma, endobronchial resection, lobectomy


How to cite this article:
Kennedy O, Roy GB, Gupta M. Endobronchial lipoma: A rare indication for a lobectomy. Niger J Surg Sci 2017;27:57-9

How to cite this URL:
Kennedy O, Roy GB, Gupta M. Endobronchial lipoma: A rare indication for a lobectomy. Niger J Surg Sci [serial online] 2017 [cited 2019 Dec 13];27:57-9. Available from: http://www.njssjournal.org/text.asp?2017/27/2/57/258802




  Introduction Top


Lipomas are benign tumors containing mature fat, derived from mesenchymal tissue. They may be found wherever there is fatty tissue and are usually encapsulated. Most of them are small and slow growing. When present in rare locations such as the breast,[1] endobronchial tree[2] or brain,[3] they often pose diagnostic dilemma and cause delay in diagnosis.[1],[2],[3]

We present the case of a patient with recurrent pneumonia and hemoptysis secondary to an endobronchial lipoma in the left lower lobe bronchus. The endobronchial obstruction had destroyed the left lower lobe, necessitating a lobectomy. With early diagnosis, endobronchial resection to preserving lung parenchyma would have been the treatment of choice.


  Case Report Top


A 61-year-old Indian male who presented with a history of a recurrent cough, fever, and hemoptysis of 2 years duration. He had been treated earlier for pulmonary tuberculosis.

On examination, there were reduced breath sounds over the left lower chest. The chest X-ray done showed collapse of the left lower lobe with an elevated left hemidiaphragm [Figure 1]. Computed tomography of the thorax [Figure 2] showed an endobronchial lesion of fat attenuation inside the left lower lobe bronchus just distal to the origin of the segment 6 bronchus. There was collapse and destruction of the basal segments. The right mainstem bronchus was normal.
Figure 1: Chest X-ray showing collapse of the left lower lobe with elevation of the left hemidiaphragm

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Figure 2: Coronal and axial cuts, respectively, showing an endobronchial lesion of fat attenuation inside the left lower lobe bronchus (red arrow) with collapse of the basal segments

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Fiberoptic bronchoscopy showed a yellow soft tumor completely occluding the origin of the left lower lobe bronchus [Figure 3]. Attempted endobronchial excision of the tumor was incomplete since the tumor was extending deep into the basal segmental bronchi.
Figure 3: Mass occluding the origin of the left lower lobe bronchus on bronchoscopy

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He underwent a left lower lobectomy through a posterolateral thoracotomy. Intraoperatively, the basal segments of the left lower lobes were noted to be consolidated.

Macroscopic examination of the resected specimen revealed the tumor extending into the basal segmental bronchi [Figure 4]. Microscopic examination of the tumor showed a well-circumscribed tumor composed of sheets of mature adipocytes with entrapped lobules of mucus glands [Figure 5]a and [Figure 5]b.
Figure 4: Cut section of the resected left lower lobe showing tumor involving the segmental and sub segmental bronchi (arrows)

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Figure 5: (a) Photomicrograph showing wall of bronchus (black arrow) with a well-circumscribed tumor composed of sheets of mature adipocytes tumor (red arrow) beneath the respiratory epithelium (H and E, ×4). (b) Photomicrograph showing tumor (black star) composed of mature adipocytes (H and E, ×10)

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Postoperative course and outpatient follow-ups were uneventful.


  Discussion Top


Endobronchial lipoma is a rare benign tumor.[4],[5],[6] Benign lung tumors constitute <3% of lung tumors,[7] and endobronchial lipoma constitute <0.1% of all lung tumors.[8] Most published cases are in Asian males between the ages of 50–70 years.[5],[6],[7],[8] Similar demographics were noticed in this patient.

In a review of 64 cases reported in 2003, Masashi et al.[2] documented 62.5% of cases had lipoma occurrence in the right main stem. All patients had resection of lipoma of some form with 37.5% of having lobectomies. The indication for lobectomy in their series where technically difficult endoscopic resection and extraluminal growth of the tumor. The patient we presented had the neoplasm on the left and had lobectomy due to an inadequate endoscopic resection.

Clinically, it is difficult to differentiate a benign endobronchial lipoma from other malignant lung lesions, as their symptoms and complications are alike.[4] Hemoptysis and repeated lower respiratory tract infections can occur as a result of infection caused by obstruction, as seen in this patient. All these are clinical features common to any endobronchial neoplasm, such as bronchial carcinoid and mucoepidermoid carcinoma.[4]

Endobronchial resection is the treatment of choice if the presentation is early. The outcome is very good after endoscopic resections.[2],[5],[6],[7]

In the presence of destroyed distal parenchyma, suspected high-grade malignancy or inadequate endobronchial resection, a lobectomy will be warranted.[2],[4],[5],[6] like in this case, there was radiologic evidence of destroyed lung and endoscopic resection was inadequate which necessitated a lobectomy.


  Conclusion Top


Endobronchial lipoma is a rare entity, unlike the lipoma in other areas of the body. Endobronchial resection is the treatment of choice if the lesion is diagnosed early. Delayed recognition with a resultant destroyed distal parenchyma may warrant pulmonary resection. Video-assisted thoracoscopic lobectomy will be ideal if available.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nwashilli NJ, Ugiagbe EE. Lipoma of the breast: An uncommon occurrence. Niger J Surg Sci 2016;26:12-4.  Back to cited text no. 1
  [Full text]  
2.
Muraoka M, Oka T, Akamine S, Nagayasu T, Iseki M, Suyama N, et al. Endobronchial lipoma: Review of 64 cases reported in Japan. Chest 2003;123:293-6.  Back to cited text no. 2
    
3.
Yilmaz MB, Genc A, Egemen E, Yilmaz S, Tekiner A. Pericallosal lipomas: A series of 10 cases with clinical and radiological features. Turk Neurosurg 2016;26:364-8.  Back to cited text no. 3
    
4.
Cao D, Sun Y, Yang S. Endobronchial lipoma: An unusual cause of bronchial obstruction. Case Rep Med 2011;2011:939808.  Back to cited text no. 4
    
5.
Surani S, Allen K, Surani S, Varon J. Endobronchial lipomatous polyp: A rare benign tumor of the lung. Case Rep Pulmonol 2014;2014:240834.  Back to cited text no. 5
    
6.
Wang H, Du Z, Li A, Song J. Surgical treatment of an endobronchial lipoma obstructing the right upper bronchus: Imaging features with pathological correlation. Pak J Med Sci 2013;29:1447-9.  Back to cited text no. 6
    
7.
Shah H, Garbe L, Nussbaum E, Dumon JF, Chiodera PL, Cavaliere S, et al. Benign tumors of the tracheobronchial tree. Endoscopic characteristics and role of laser resection. Chest 1995;107:1744-51.  Back to cited text no. 7
    
8.
Guibert N, Mhanna L, Droneau S, Plat G, Didier A, Mazieres J, et al. Techniques of endoscopic airway tumor treatment. J Thorac Dis 2016;8:3343-60.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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