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• W4387247966 abstract "SESSION TITLE: Procedures Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Primary tumors of the trachea are rare accounting for only 0.1% of tumors (1) that are often initially misdiagnosed as asthma or chronic obstructive pulmonary disease among other airway diseases (2). Lipomas in the airway are even rarer accounting for less than 1% of all bronchial tumors with less than 50 cases reported in 2011-2021, grow slowly, often undiagnosed until the onset of obstructive symptoms such as recurring cases of pneumonia, dyspnea, dysphagia, cough, and even chest pain (3,4). We present a rare case of airway lipoma with near-complete obstruction of the left mainstem bronchus on bronchoscopy. CASE PRESENTATION: A 45-year-old male smoker with a past medical history of hyperlipidemia (total cholesterol 234, triglyceride 145, HDL 47, VLDL 26, LDL 161 not on a statin), obesity (BMI 28.91) underwent CT coronary artery calcium scoring screening (score 0) and was found to have an 11 mm endobronchial nodule in the left mainstem bronchus. A CT scan was pursued which showed an 11 x 9 mm polypoid lesion with low-density internal contents at the left mainstem bronchus. Considering the size and patient's smoking history a bronchoscopy was performed. On bronchoscopy, there was evidence of a pedunculated mass in the left mainstem bronchus arising from the medial wall causing 80% obstruction approximately 0.5 cm from the carina (Figure 1). Argon plasma coagulation (APC) was used to cauterize the mass and then a snare was used to cut the base with subsequent removal with a basket. APC was then further used for tumor destruction at the base (Figure 2). The scope was then withdrawn and an EBUS bronchoscope was introduced. A small station 4R node was visualized measuring 2 mm x 3 mm. A total of 3 Fine-needle aspirations were performed using Olympus 22-gauge needle. No station 7 or 4L were visualized. The pathology of these aspirations was significant for benign pulmonary lipoma/hamartoma without evidence of malignancy from lymph node samples. Surveillance was scheduled with a repeat bronchoscopy in 6 months. DISCUSSION: Rare airway tumors such as lipomas are often diagnosed incidentally due to their slow progressive nature and present with a myriad of symptoms with different degrees of severity. Due to the lack of epidemiological data and clinical studies, it is difficult to determine the actual prevalence and associated risk factors among other pathological associations. Some previous studies have implicated some commonalities with our patient, such as smoking, obesity, Men> women, and presentation in the fifth and sixth decade of life (2). Differentiation from other malignant airway tumors and lipomas is incredibly challenging yet of utmost importance considering tumor malignant potential impacts the overall survival, surveillance intervals, and modality of treatment including excision and re-excision (2). No clear guidelines exist regarding the management of airway lipomas, but treatment has shifted toward bronchoscopy management with 72.2% of cases managed biomicroscopically compared to less than 30% in 2003 (5). CONCLUSIONS: Considering the malignant potential and myriad of serious life-limiting symptoms a prompt biopsy and resection are necessary for timely identification and differentiation regardless of symptoms on initial presentation. REFERENCE #1: Macchiarini P. Primary tracheal tumours. Lancet Oncol. 2006 Jan;7(1):83-91. doi: 10.1016/S1470-2045(05)70541-6. PMID: 16389188. REFERENCE #2: Saoud, Marwan, Monali Patil, Samjot Singh Dhillon, Saraswati Pokharel, Anthony Picone, Mark Hennon, Sai Yendamuri, & Kassem Harris. Rare airway tumors: an update on current diagnostic and management strategies. Journal of Thoracic Disease [Online], 8.8 (2016): 1922-1934. Web. 3 Oct. 2022 REFERENCE #3: Azhar W, Zaidi F, Hannan A. Whistling Lipoma: Bronchial Obstruction Caused by a Lipoma. Cureus. 2020 Mar 3;12(3):e7167. doi: 10.7759/cureus.7167. PMID: 32257709; PMCID: PMC7117604. DISCLOSURES: No relevant relationships by Dania Afzal No relevant relationships by Muhammad Arif No relevant relationships by Abid Khokar No relevant relationships by Ali Moradi No relevant relationships by Deepika Razia" @default.
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• W4387247966 date "2023-10-01" @default.
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• W4387247966 title "NEAR COMPLETE OBSTRUCTION OF LEFT MAINSTEM BRONCHUS FROM A RARE AIRWAY LIPOMA IN AN ASYMPTOMATIC PATIENT" @default.
• W4387247966 doi "https://doi.org/10.1016/j.chest.2023.07.3508" @default.
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