Tuberc Respir Dis.  2007 Jul;63(1):94-99. 10.4046/trd.2007.63.1.94.

A Case of Spontaneously Regressed Endobronchial Sarcoma after Obstructive Pneumonia

• Park SH
• Jeon YJ
• Kwon KY
• Han SB

• KMID: 1877324
• DOI: http://doi.org/10.4046/trd.2007.63.1.94

Abstract

The spontaneous regression (SR) of cancer is defined as the complete disappearance of a malignant disease without adequate treatment. SR is a very rare biological event, particularly in a pulmonary sarcoma. We report the first documented case of an endobronchial sarcoma that regressed spontaneously in Korea. We encountered a rare case of a 72-year-old woman with an undiagnosed intrapelvic cystic mass, who presented with a smooth surfaced endobronchial tumor obstructing the orifice of the right lower lobe bronchus on a bronchoscopic examination. She had a prior history cervical cancer and adenocarcinoma in the right middle lobe lateral segment of her lung for which she had undergone radiation therapy. The tumor was diagnosed as an endobronchial sarcoma by the histopathology findings and immunohistochemistry. It was unclear if the tumor was a primary sarcoma of the lung or a metastatic lesion of an intrapelvic cystic mass because she refused a diagnostic exploratory laparotomy. Two months later, obstructive pneumonia of the right lower lobe with parapneumonic effusion developed with fever above 38.5degrees C for 10 days. After recovering from pneumonia, she was followed up regularly in the outpatient clinic without any specific treatment. One year later after treating the obstructive pneumonia, the follow-up bronchoscopy revealed complete SR of endobronchial sarcoma. It is believed that the obstructive pneumonia accompanied by fever above 38.5degrees C for 10 days might have played a role in this SR.

Keyword

Spontaneous regression; Endobronchial sarcoma; Pneumonia

MeSH Terms

Adenocarcinoma
Aged
Ambulatory Care Facilities
Bronchi
Bronchoscopy
Female
Fever
Follow-Up Studies
Humans
Immunohistochemistry
Korea
Laparotomy
Lung
Pneumonia*
Sarcoma*
Uterine Cervical Neoplasms

Figure

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  Figure 1 Bronchoscope shows a smooth surfaced polypoid endobronchial tumor which obstructs totally the bronchial lumen of right lower lobe bronchus.

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  Figure 2 On admission, chest radiograph shows diffuse homogenous radiopaque hazziness over the right middle and lower lung fields.

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  Figure 3 (A) Histopathologic finding of tissue section shows malignant spindle cell proliferation with myxoid background. There are scattered neutrophilic infiltrates and numerous vague vascular structures with some extravasated red blood cells. (H&E stain, ×40) (B) The tumor cells revealed elongated and spindle shape with frequent typical or atypical mitotic figures and microscopic foci of necrosis. (H&E stain, ×400) (C) The majority of tumor cells show strong and diffuse positive reaction for vimentin. (vimentin stain, ×400)

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  Figure 4 Histopathologic comparison of malignant tumors. Cervical cancer, squamous cell carcinoma (A; H&E stain, ×400), right middle lobe lateral segment adenocarcinoma (B; H&E stain, ×400), right lower lobe endobronchial sarcoma (C; H&E stain, ×400) and right middle lobe endobronchial squamous cell carcinoma (D; H&E stain, ×400)

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  Figure 5 Complete regression of the previous endobronchial sarcoma was noticed on the follow-up bronchoscopy at one year later after pneumonia. A hyperemic mulberry shaped mass was newly showed on the diverged portion of right middle lobe bronchus and right lower lobe bronchus.

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