An unusual endobronchial lesion: expanding the differential diagnosis

Leonard, Robert H.; Schultz, Charles J.; Hadique, Sarah

doi:10.1002/rcr2.429

Cited by 4 publications

(5 citation statements)

References 18 publications

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“… 22 The lesions can be completely intrapulmonary or pleuropulmonary, rarely endobronchial, and the size ranges between 7 and 10 cm, larger than carcinoma. 23 24 25 This larger size at presentation could be attributed to the late occurrence of bronchovascular infiltration and, hence, late onset of symptoms. 22 26 Most masses in SS show circumscribed or lobulated margins, heterogeneous contrast enhancement, and areas of necrosis.…”

Section: Discussionmentioning

confidence: 99%

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Mohan,

Dhamija,

Bakhshi

et al. 2024

Indian J Radiol Imaging

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Background Primary lung sarcoma (PLS) differs in management protocols and prognosis from the more common primary lung carcinoma (PLC). It becomes imperative to raise a high index of suspicion on radiological and pathological features. Purpose The aim of this study is to highlight the variable imaging appearances of PLS compared with PLC, which impacts radiologic - pathologic correlation. Materials and Methods A retrospective observational study of 68 patients with biopsy-proven lung tumors who underwent baseline imaging at our tertiary care cancer hospital was conducted between January 2018 and March 2022. The patient details and imaging parameters of the mass on contrast-enhanced computed tomography (CECT) were recorded and analyzed for patients with PLS and compared with PLC. Follow-up imaging was available in 9/12 PLS and 52/56 PLC patients. Results Among 12 patients with PLS, 5 patients had synovial sarcoma on histopathology. PLS was seen in patients with a mean age of 40.8 years; the mass showed a mean size of 13.2 cm, lower lobe (75%), parahilar (75%), hilar involvement (41.7%), oval shape (41.7%), circumscribed (25%) or lobulated (75%) margins, lower mean postcontrast attenuation of 57.3 HU, fissural extension (50%), calcification (50%), and no organ metastasis other than to the lung. PLC (56 patients) was seen in the elderly with a mean age of 54.8 years; the mass showed a mean size of 5.7 cm, irregular shape (83.9%), spiculated margins (73.2%), higher mean postcontrast attenuation (77.3 HU), chest wall infiltration (30.4%), and distant metastasis (58.9%) at baseline imaging. A statistically significant difference (p < 0.05) was seen between sarcoma and carcinoma in the mean age, size, site, shape, margins, postcontrast attenuation, presence of calcifications, fissural extension, and distant metastasis. Conclusion The distinct imaging features of sarcoma help in differentiating it from carcinoma. This can also be used to corroborate with histopathology to achieve concordance and guide clinicians on further approach.

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Section: Discussionmentioning

confidence: 99%

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Mohan,

Dhamija,

Bakhshi

et al. 2024

Indian J Radiol Imaging

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“…La localización del SSPP es pleural, parenquimatosa o endobronquial; esta última de presentación extremadamente rara, con solo nueve casos descritos en la literatura, en pacientes entre los 34 y 73 años. (Ver tabla 1) (6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Discussionunclassified

Sarcoma Sinovial Primario Pulmonar: Un Caso Inusual en Pediatría

V.¹,

B.²,

P.³

et al. 2021

Neumol Pediatr

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El sarcoma sinovial primario de pulmón (SSPP) localizado en bronquio, es una entidad no reportada en la edad pediátrica. Se presenta el caso de un niño de siete años con antecedente de aparentes neumonías recurrentes derechas de siete meses de evolución; en la evaluación por neumología pediátrica se destaca en las radiografías de tórax, la presencia de atelectasias recurrentes en lóbulo medio e inferior derecho, por lo que se realiza broncoscopia, donde se observa una masa obstruyendo el 100% de la luz del bronquio fuente derecho y se sospecha tumor carcinoide. Se realiza extirpación de masa endobronquial con fines diagnósticos y terapéuticos, incluyendo resección segmentaria bronquial y anastomosis término-terminal. El respectivo análisis inmunohistoquímico muestra hallazgos sugestivos de sarcoma sinovial monofásico. Se descarta compromiso tumoral extrapulmonar, por lo que se diagnostica como tumor primario de bronquio. Se administraron 7 ciclos de quimioterapia y 31 sesiones de radioterapia. Actualmente en control, sin evidencia de metástasis, tumores residuales o recidivas.

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“…Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) is an exceptionally rare subtype of endobronchial tumor that has rarely been described in medical literature. These tumors are part of the group of primary endobronchial neoplasms, which account for 0.6% of all lung neoplasms [ 1 ]. Because of their low incidence, the clinical presentation and management of ALT/WDL remain poorly defined, and most of the available knowledge is derived from cases of endobronchial lipomas.…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Obstruction: A Case of Well-Differentiated Liposarcoma

Martinez Trevino,

Sohail,

Mijares-Rojas

et al. 2024

Cureus

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Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) is a rare subtype of endobronchial tumor that has been rarely reported in medical literature. Due to its low incidence, distinguishing it from endobronchial lipoma poses a significant diagnostic challenge, necessitating histopathologic and cytogenetic analysis. As of today, the treatment and surveillance protocols for these neoplasms remain poorly defined, often resulting in their misclassification and treatment as endobronchial lipomas. We present a case involving a 72-year-old male who presented with worsening dyspnea and cough. Diagnostic imaging revealed an endobronchial lesion obstructing the left main bronchus. The patient underwent a flexible bronchoscopy that identified a polypoid mass causing significant obstruction, which was subsequently resected via cryoablation. Histopathology confirmed ALT/WDL, supported by genetic analysis revealing chromosomal alterations. Following the intervention, symptoms resolved, with no recurrence on follow-up imaging. Differentiating ALT/WDL from endobronchial lipomas is necessary not only because it influences treatment decisions but also because it can significantly affect the prognosis of patients diagnosed with ALT/WDL. In this case, we emphasize the importance of considering ALT/WDL in the differential diagnosis of endobronchial tumors and highlight the use of flexible bronchoscopy as a viable substitute for rigid bronchoscopy, serving not only as a diagnostic tool but also as a therapeutic method.

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An unusual endobronchial lesion: expanding the differential diagnosis

Cited by 4 publications

References 18 publications

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Sarcoma Sinovial Primario Pulmonar: Un Caso Inusual en Pediatría

Endobronchial Obstruction: A Case of Well-Differentiated Liposarcoma

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