Endobronchial Smooth Muscle Tumors: A Series of Five Cases Highlighting Pitfalls in Diagnosis
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Background: Primary endobronchial smooth muscle tumors (SMTs), which are extremely rare, include endobronchial leiomyomas and leiomyosarcomas. Clinically, SMTs present with signs and symptoms of bronchial obstruction, and lack specific radiological findings. Thus, histopathological examination is required for accurate diagnosis as well as for tumor grading. We examined the histomorphological and immunohistochemical features of endobronchial SMTs and highlighted pitfalls in diagnosis, particularly when using small biopsies. Methods: Cases of primary endobronchial SMTs diagnosed at our Institute over the last 6 years (2012–2017) were retrieved from the departmental archives. Histopathological features and immunohistochemistry performed for establishing the diagnosis were reviewed. Results: Five cases of SMTs occurring in endobronchial locations were identified. These included three cases of leiomyoma, and two cases of leiomyosarcoma. The age distribution of patients ranged from 13 to 65 years. Leiomyomas showed more consistent staining with smooth muscle markers (smooth muscle actin, desmin, and smooth muscle myosin heavy chain), while tumors of higher grade showed variable, focal staining, leading to erroneous diagnosis, especially on small biopsies. Conclusions: The diagnosis of endobronchial SMTs relies on histopathological examination, for both confirmation of smooth muscle lineage and determination of the malignant potential of the lesion. Appropriate immunohistochemical panels including more than one marker of smooth muscle differentiation are extremely valuable for differential diagnosis from morphological mimics, which is necessary for instituting appropriate management.
Abstract
Background: Primary endobronchial smooth muscle tumors (SMTs), which are extremely rare, include endobronchial leiomyomas and leiomyosarcomas. Clinically, SMTs present with signs and symptoms of bronchial obstruction, and lack specific radiological findings. Thus, histopathological examination is required for accurate diagnosis as well as for tumor grading. We examined the histomorphological and immunohistochemical features of endobronchial SMTs and highlighted pitfalls in diagnosis, particularly when using small biopsies. Methods: Cases of primary endobronchial SMTs diagnosed at our Institute over the last 6 years (2012–2017) were retrieved from the departmental archives. Histopathological features and immunohistochemistry performed for establishing the diagnosis were reviewed. Results: Five cases of SMTs occurring in endobronchial locations were identified. These included three cases of leiomyoma, and two cases of leiomyosarcoma. The age distribution of patients ranged from 13 to 65 years. Leiomyomas showed more consistent staining with smooth muscle markers (smooth muscle actin, desmin, and smooth muscle myosin heavy chain), while tumors of higher grade showed variable, focal staining, leading to erroneous diagnosis, especially on small biopsies. Conclusions: The diagnosis of endobronchial SMTs relies on histopathological examination, for both confirmation of smooth muscle lineage and determination of the malignant potential of the lesion. Appropriate immunohistochemical panels including more than one marker of smooth muscle differentiation are extremely valuable for differential diagnosis from morphological mimics, which is necessary for instituting appropriate management.
참고문헌 (17)
- Dacic S, "WHO classification of tumours of lung, pleura, thymus and heart", pp.132~133 (2015), IARC Press
- Swarnakar R, "Endobronchial leiomyoma: a rare and innocent tumour of the bronchial tree", Lung India, 30, pp.57~60 (2013)[DOI]
- Elouazzani H, "Primary endobronchial leiomyosarcoma of the lung: clinical, gross and microscopic findings of two cases", J Clin Imaging Sci, 2, pp.35~ (2012)[DOI]
- Cardenas-Garcia J, "Bronchial leiomyoma, a case report and review of literature", Respir Med Case Rep, 12, pp.59~62 (2014)
- Purgina B, "AIDS-related EBV-associated smooth muscle tumors: a review of 64 published cases", Patholog Res Int, 2011, pp.561548~ (2011)
- Awasthi A, "Primary endobronchial myxoid leiomyoma in a child: an unusual case report and review of literature", Indian J Pathol Microbiol, 59, pp.87~89 (2016)
- Litzky L, "Epithelial and soft tissue tumors of the tracheobronchial tree", Chest Surg Clin N Am, 13, pp.1~40 (2003)[DOI]
- Lee MC, "Surgical treatment of endobronchial leiomyosarcoma with right main bronchus total obstruction: a case report", Ann Thorac Cardiovasc Surg, 14, pp.105~108 (2008)
- Kim YK, "Airway leiomyoma: imaging findings and histopathologic comparisons in 13 patients", AJR Am J Roentgenol, 189, pp.393~399 (2007)[DOI]
- Dmello D, "Endobronchial leiomyoma: case report and literature review", J Bronchology Interv Pulmonol, 16, pp.49~51 (2009)[DOI]
- Moran CA, "Diagnostic histopathology of tumors", pp.207~245 (2013), Churchill Livingstone
- Vaz AP, "Primary endobronchial leiomyoma: endoscopic laser resection", Rev Port Pneumol, 17, pp.228~231 (2011)[DOI]
- Kwon YS, "Clinical characteristics and efficacy of bronchoscopic intervention for tracheobronchial leiomyoma", Respirology, 13, pp.908~912 (2008)[DOI]
- Harris PF, "Leiomyoma of the larynx and trachea: case reports", South Med J, 60, pp.1223~1227 (1967)[DOI]
- Lee SH, "Primary endobronchial leiomyosarcoma: diagnosis following expectoration of tumor fragment", Respiration, 68, pp.99~102 (2001)[DOI]
- Attanoos RL, "Primary sarcomas of the lung: a clinicopathological and immunohistochemical study of 14 cases", Histopathology, 29, pp.29~36 (1996)[DOI]
- Janssen JP, "Primary sarcoma of the lung: a clinical study with long-term followup", Ann Thorac Surg, 58, pp.1151~1155 (1994)[DOI]