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| CASE REPORT |
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| Year : 2023 | Volume
: 6
| Issue : 1 | Page : 26-28 |
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Endobronchial leiomyoma
Vyshnavi Rajeev, L Sundararajan, Sheba Jacob, Rajiv Santhosham
Department of Pulmonology, Apollo Main Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 17-Jan-2023 |
| Date of Decision | 20-Feb-2023 |
| Date of Acceptance | 21-Feb-2023 |
| Date of Web Publication | 29-Apr-2023 |
Correspondence Address:
Dr. Vyshnavi Rajeev
Apollo Main Hospital, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/japt.japt_1_23
Leiomyomas are rare benign tumors of the lung. They arise from the smooth muscle cells of the bronchial wall and the interstitium or from the smooth muscles of the arterioles. Symptoms are chiefly based on the degree to which bronchial obstruction occurs. Bronchoscopic intervention or lung sparing surgical resection are the treatments of choice. In leiomyomas that are accessible by bronchoscopy and confined to airway, bronchoscopic resection appears to be safe and effective. This case is being reported because of the rarity of this condition and the need to recognise the role for endobronchial intervention, thereby, avoiding major surgical procedures with the attendant risk of morbidity due to surgery.
Keywords: Bronchoscopy basket, diathermy knife, endobronchial leiomyoma
How to cite this article:
Rajeev V, Sundararajan L, Jacob S, Santhosham R. Endobronchial leiomyoma. J Assoc Pulmonologist Tamilnadu 2023;6:26-8 |
How to cite this URL:
Rajeev V, Sundararajan L, Jacob S, Santhosham R. Endobronchial leiomyoma. J Assoc Pulmonologist Tamilnadu [serial online] 2023 [cited 2023 May 29];6:26-8. Available from: https://www.japt.in//text.asp?2023/6/1/26/375454 |
| Introduction | |  |
Leiomyomas are rare benign tumors of the lung. Symptoms are chiefly based on the degree to which bronchial obstruction occurs. Bronchoscopic intervention or lung sparing surgical resection is the treatment of choice. Here, we present a case of endobronchial leiomyoma treated with Bronchoscopic snaring.
| Case Report | | |
A 59-year-old man presented to the outpatient department with a history of cough with mucoid expectoration for the past 2 months with no other complaints.
He was a nonsmoker with a past history of anti-tubercular treatment for pulmonary tuberculosis 20 years back and on regular treatment for diabetes and hypertension.
On physical examination, he was moderately built, afebrile, and maintained optimal saturation with room air and his chest was clear on auscultation.
Chest X-ray [Figure 1] showed right lower zone homogeneous opacity obscuring the right heart border. | Figure 1: Chest X-ray showing Right lower zone (RLZ) homogeneous opacity obscuring right heart border
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- Radiology
- Bronchoscopy
- Management
- Discussion.
Radiology
CT chest axial view [Figure 2] and [Figure 3] and coronal view [Figure 4] and [Figure 5] shows intraluminal lesion in the right intermediate bronchus with the segmental collapse of the right lower lobe. | Figure 2: Computed tomography chest axial view showing intraluminal lesion in Right intermediate bronchus (RIB)
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 | Figure 3: Computed tomography chest axial view showing Right lower lobe (RLL) segmental collapse
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 | Figure 4: Computed tomography chest coronal view showing intraluminal lesion in Right intermediate bronchus (RIB)
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 | Figure 5: Computed tomography chest coronal view showing Right lower lobe (RLL) segmental collapse
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Bronchoscopy
Bronchoscopy showed polyploid lesion in the right intermediate bronchus occluding the right middle lobe and right lower lobe [Figure 6]. Bronchial wash, bronchial brush, and bronchial biopsy were taken. Bronchial wash was sent for Gene Xpert Mycobacterium tuberculosis, cytology, routine culture and sensitivity, acid-fast bacilli culture and sensitivity, and fungal culture and sensitivity. | Figure 6: Bronchoscopy image showing polyploid lesion in Right intermediate bronchus (RIB)
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Biopsy histopathological examination [Figure 7] revealed some nodular foci of smooth muscle composed of elongated spindle-shaped cells with oval-to-elongated nuclei, suggestive of endobronchial leiomyoma. | Figure 7: Histopathological examination showing smooth muscle composed of elongated spindle-shaped cells with oval-to-elongated nuclei
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Management
Various treatment options were discussed, and cardiothoracic vascular surgeon's opinion was obtained. It was decided to explore bronchoscopic removal in the first place and if not successful, then proceed with surgical removal. Bronchoscopy was done under general anesthesia and the pedunculated mass [Figure 8] was snared at the base and removed using bronchoscopy basket [Figure 9] and was sent for HPE. The tiny base was fulgurated using diathermy knife. Repeat HPE again confirmed the initial diagnosis of endobronchial leiomyoma.
Discussion
Leiomyomas are rare benign tumors of the lung accounting for 2% of all benign lung tumors.[1]
Bronchial leiomyomas are benign tumors which predominantly occur in the fourth decade of life with female preponderance. Bronchial leiomyomas are thought to arise from the smooth muscle cells of the bronchial wall and the interstitium or from the smooth muscles of the arterioles. Leiomyomas of the respiratory tract can be termed according to the site of occurrence, for example., tracheal, bronchial, and parenchyma based on the anatomical site of occurrence.[2]
Symptoms due to endobronchial leiomyomas are chiefly based on the degree to which bronchial obstruction occurs. The most common symptom is cough, followed by hemoptysis and wheeze.[3] Large endoluminal or compressing lesions may present with hemoptysis, atelectasis, consolidation, bronchiectasis, or postobstructive pneumonia. Pneumothorax resulting from air trapped behind an endobronchial leiomyoma has been reported.[1]
Bronchoscopic intervention or lung-sparing surgical resection is the treatment of choice. In leiomyomas that are accessible by bronchoscopy and confined to the airway, bronchoscopic resection appears to be safe and effective. This could also include debulking with thermal means including electrocautery, argon plasma coagulation, Nd: YAG laser, and cryotherapy probe.[4]
This case is being reported because of the rarity of this condition and the need to recognize the role for endobronchial intervention, thereby, avoiding major surgical procedures with the attendant risk of morbidity due to surgery.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
LS has received travel grant from Sun Pharma and honorarium from AstraZeneca for educational lectures.
| References | | |
| 1. | Fell CD, Tremblay A, Michaud GC, Urbanski SJ. Electrocauterization of an Endobronchial Leiomyoma. Journal of Bronchology 2005;12:181-3. |DOI: 10.1097/01.laboratory.0000172961.40016.91.  |
| 2. | Swarnakar R, Sinha S. Endobronchial leiomyoma: A rare and innocent tumour of the bronchial tree. Lung India 2013;30:57-60. [ PUBMED] [Full text] |
| 3. | Dmello D, Javed A, Espiritu J, Matuschak GM. Endobronchial leiomyoma: Case report and literature review. J Bronchology Interv Pulmonol 2009;16:49-51. |
| 4. | Sumner ET, Le PT, Quick BD. Endobronchial leiomyoma successfully respected with electrocautery snare. Am J Respiratory Crit Care Med 2022;205:A4162. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
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