Yonsei Med J.  2014 Jan;55(1):84-91. 10.3349/ymj.2014.55.1.84.

The Clinical, Radiological, and Bronchoscopic Findings and Outcomes in Patients with Benign Tracheobronchial Tumors

• Jhun BW
• Lee KJ
• Jeon K
• Um SW
• Suh GY
• Chung MP
• Kwon OJ
• Kim H

• KMID: 1779890
• DOI: http://doi.org/10.3349/ymj.2014.55.1.84

Abstract

PURPOSE
We evaluated the characteristics of and treatment outcomes in patients with benign tracheobronchial tumors.
MATERIALS AND METHODS
We reviewed the records of patients with benign tracheobronchial tumors who underwent bronchoscopic intervention with mechanical removal and Nd: YAG laser cauterization, and evaluated the characteristics and treatment outcomes of 55 patients with hamartomas, leiomyomas, papillomas, typical carcinoids, or schwannomas seen between April 1999 and July 2012.
RESULTS
The most common tumors were hamartoma (n=24), leiomyoma (n=16), papilloma (n=7), typical carcinoid (n=5), and schwannoma (n=3). Forty-one patients (75%) had symptoms. On chest computed tomography, 35 patients (64%) had round or ovoid lesions, accompanied by atelectasis (n=26, 47%) or obstructive pneumonia (n=17, 31%). Fatty components (n=9, 16%) and calcifications (n=7, 13%) were observed only in hamartomas, leiomyomas, and typical carcinoids. At bronchoscopy, the typical findings were categorized according to tumor shape, surface, color, and visible vessels. Fifty (91%) patients underwent complete resection. Forty patients (73%) achieved successful bronchoscopic removal defined as complete resection without complications or recurrence. Recurrences occurred in four papillomas, one leiomyoma, and one typical carcinoid. The proportions of tumor types (p=0.029) differed between the successful and unsuccessful removal groups, and a pedunculated base (p<0.001) and no spontaneous bleeding (p=0.037) were more frequent in the successful removal group.
CONCLUSION
We described clinical, radiological, and typical bronchoscopic findings in patients with benign tracheobronchial tumors; these findings might help to differentiate such tumors. Bronchoscopic intervention was a useful treatment modality, and tumor type, pedunculated base, and vascularity may influence successful tumor removal.

Keyword

Benign tracheobronchial tumors; bronchoscopy; intervention

MeSH Terms

Adolescent
Adult
Aged
Bronchi/pathology/*surgery
Bronchoscopy
Carcinoid Tumor/pathology/surgery
Female
Hamartoma/pathology/surgery
Humans
Leiomyoma/pathology/surgery
Male
Middle Aged
Neurilemmoma/pathology/surgery
Papilloma/pathology/surgery
Young Adult

Figure

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  Fig. 1 Bronchoscopic examination of a hamartoma shows a round shape, smooth and rough surface, pinkish color, and no visible vessels on the tumor surface. Spontaneous bleeding was absent (A). Chest computed tomography shows a 25-mm calcified ovoid nodule at the distal bronchus intermedius and atelectasis of the right middle lobe (B).

• 

  Fig. 2 Bronchoscopic examination of a leiomyoma reveals a round shape, smooth surface, pinkish color, and visible vessels on the tumor surface. Spontaneous bleeding was rarely observed (A). Chest computed tomography shows a 5.5-mm polypoid nodule at the membranous portion of the distal trachea (B).

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  Fig. 3 Bronchoscopic examination of a papilloma shows a polypoid shape, lobulated surface, whitish color, and no visible vessels on the tumor surface. Spontaneous bleeding was absent (A). Chest computed tomography reveals a 15-mm lobulated lesion at the anterior wall of the upper trachea (B).

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  Fig. 4 Bronchoscopic examination of a typical carcinoid shows a round shape, lobulated surface, pinkish color, visible vessels on the tumor surface. Spontaneous bleeding was frequent (A). Chest computed tomography shows a 20-mm round nodule at the right bronchus intermedius (B).

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  Fig. 5 Bronchoscopic examination of a schwannoma reveals a round shape, smooth surface, whitish color, and no visible vessels on the tumor surface. Spontaneous bleeding was absent (A). Chest computed tomography shows a 21-mm oval nodule occupying the proximal portion of the left main bronchus, leading to left lung atelectasis (B).

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