Purpose:To report the computed tomography (CT) findings and short-term follow-up of a patient with malignant bronchial glomus tumor. Methods and Results:The glomus body is an organ found in the skin and thought to be involved in blood flow and temperature regulation. Neoplasms of the glomus body are usually benign and usually affect the palm, wrist, forearm, and foot. Glomus tumors are rarely found in the tracheobronchial tree.The histopathological diagnosis of glomus tumors can occasionally be difficult. The lesion may resemble carcinoid tumor histopathologically, although immunohistochemical stains and ultrastructural studies, if obtained, are diagnostic. We encountered a patient with a malignant glomus tumor occluding the left mainstem bronchus. The lesion showed intense enhancement on CT, closely resembling a carcinoid tumor. Virtual bronchoscopic imaging showed complete occlusion of the left lower lobe bronchus. The lesion was biopsied with flexible bronchoscopy and partially resected with rigid bronchoscopy and laser therapy. Follow-up CT showed reduction in tumor size.
Solitary fibrous tumor of the pleura (SFTP) is a rare primary pleural neoplasm that most commonly arises from visceral pleural surfaces. SFTPs consist of spindle cells embedded within variable amounts of connective tissue, and may stain positive for vimentin and antibodies to CD 34. Grossly, SFTPs often are attached to pleural surfaces via a pedicle. Most SFTPs are benign, although malignant degeneration may occur in approximately 40% of lesions. Histopathologically, malignancy is favored when high mitotic counts (greater than 4 -10 per high power fields), pleomorphism, high cellularity with crowding and overlapping nuclei, tumor giant cells, necrosis, and hemorrhage are encountered. Chest radiography may show a peripheral mass that may show characteristics suggestive of an extraparenchymal location: obtuse angles with the chest wall associated with a circumscribed border on one side of the lesion and a fading margin on the other side. Cross sectional imaging findings of SFTP include a variable sized mass in contact with the chest wall or diaphragm that shows enhancement following intravenous contrast administration. Calcification and effusion are uncommon. Magnetic resonance imaging may show decreased T1 and T2 signal, consistent with the fibrous nature of the lesion. The treatment of choice for SFTP is wide surgical resection.
Relapsing polychondritis is a rare inflammatory disorder of cartilaginous and proteoglycan-rich tissues, commonly affecting the nasal and auricular cartilages, joints, tracheobronchial cartilage, cardiovascular system, as well as a number of other organ systems. The etiology of relapsing polychondritis is unknown, but an immune-mediated mechanism may be responsible. The diagnosis of relapsing polychondritis requires evidence of recurrent inflammation of the major organ systems affected by the disease such as the ears, eyes, nose, and airways with or without confirmation of cartilage inflammation on biopsy. The diagnosis of relapsing polychondritis may also be enabled by the demonstration of thoracic computed tomography findings characteristic of the disorder, including thickening and increased attenuation of the anterior two thirds of the trachea and bronchi, with sparing of the posterior one third of these structures, with or without stenosis. Excessive airway collapse on expiratory imaging or imaging performed during a forced vital capacity maneuver is characteristic of this disease.
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