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A solitary bronchial papilloma with unusual endoscopic presentation: case study and literature review.

Paganin F, Prevot M, Noel JB, Frejeville M, Arvin-Berod C, Bourdin A - BMC Pulm Med (2009)

Bottom Line: Routine examination was normal.No enhanced coloration was noticed.In situ HPV hybridization was negative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de Pneumologie, GHSR, St Pierre, France. f.paganin@wanadoo.fr

ABSTRACT

Background: Solitary endobronchial papillomas (SEP) are rare tumors and most of them are described by case report. A misdiagnosis is common with viral related papillomas. A histopathological classification has recently permitted a major advancement in the understanding of the disease.

Case presentation: We report a case of a mixed bronchial papilloma with an unusual endoscopic presentation. The literature was extensively reviewed to ascertain the unusual characteristics of the current case. A 39-year of age male was referred to our institution for the investigation of a slight hemoptysis. Routine examination was normal. A fibroscopy revealed an unusual feature of the right main bronchus. The lesion was a plane, non-bleeding, non-glistering sub-mucosal proliferation. No enhanced coloration was noticed. Biopsies revealed a mixed solitary bronchial papilloma. In situ HPV hybridization was negative. Endoscopic treatment (electrocautery) was effective with no relapse.

Conclusion: This lesion contrasts with the data of the literature where papilloma were described as wart-like lesions or cauliflower tumors, with symptoms generally related to bronchial obstruction. We advise chest physicians to be cautious with unusually small swollen lesions of the bronchi that may reveal a solitary bronchial papilloma. Endoscopic imaging can significantly contribute to the difficult diagnosis of SEP by pulmonary physicians and endoscopists.

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Related in: MedlinePlus

Mixed solitary bronchial papilloma. At this magnification, fibrovascular cores are lined by squamous and glandular epithelium. Hematoxylin-eosin stain; magnification × 100.
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Figure 2: Mixed solitary bronchial papilloma. At this magnification, fibrovascular cores are lined by squamous and glandular epithelium. Hematoxylin-eosin stain; magnification × 100.

Mentions: A 39-year old man was referred to our institution for investigation of recent cough. He experienced a unique slightly bloody sputum. He was a mild current smoker (less than 15 packs/year). There were no baseline abnormal conditions, and physical examination was unremarkable. The chest-X-Ray was normal. The bronchoscopy revealed a swollen lesion at the internal proximal part of the main right bronchus (figure 1). Endoscopic findings were uncommon. The entire lesion measured less than 1 cm2. It was a plane, non-bleeding, non-glistering sub-mucosal lesion. No enhanced coloration appeared. The tumor was soft and biopsies were easy despite the tangential localization in the bronchus. Histopathological examination revealed a mixed papilloma. It was an endobronchial polypoid lesion, 2.5 cm long and 0.2 cm wide, made of thin fibrovascular cores with moderate lymphoplasmocytic infiltrates, and lined by squamous and glandular epithelium. Pseudo-stratified ciliated and non ciliated, cuboidal to columnar cells, with rare mucinfilled cells were mixed with acanthotic and focally keratinizing squamous epithelium. Squamous atypia, ranging from mild to severe dysplasia could be seen, but viral cytopathic changes were not reported. No glandular atypia nor necrosis were seen (figure 2). In situ HPV hybridization was negative.


A solitary bronchial papilloma with unusual endoscopic presentation: case study and literature review.

Paganin F, Prevot M, Noel JB, Frejeville M, Arvin-Berod C, Bourdin A - BMC Pulm Med (2009)

Mixed solitary bronchial papilloma. At this magnification, fibrovascular cores are lined by squamous and glandular epithelium. Hematoxylin-eosin stain; magnification × 100.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734747&req=5

Figure 2: Mixed solitary bronchial papilloma. At this magnification, fibrovascular cores are lined by squamous and glandular epithelium. Hematoxylin-eosin stain; magnification × 100.
Mentions: A 39-year old man was referred to our institution for investigation of recent cough. He experienced a unique slightly bloody sputum. He was a mild current smoker (less than 15 packs/year). There were no baseline abnormal conditions, and physical examination was unremarkable. The chest-X-Ray was normal. The bronchoscopy revealed a swollen lesion at the internal proximal part of the main right bronchus (figure 1). Endoscopic findings were uncommon. The entire lesion measured less than 1 cm2. It was a plane, non-bleeding, non-glistering sub-mucosal lesion. No enhanced coloration appeared. The tumor was soft and biopsies were easy despite the tangential localization in the bronchus. Histopathological examination revealed a mixed papilloma. It was an endobronchial polypoid lesion, 2.5 cm long and 0.2 cm wide, made of thin fibrovascular cores with moderate lymphoplasmocytic infiltrates, and lined by squamous and glandular epithelium. Pseudo-stratified ciliated and non ciliated, cuboidal to columnar cells, with rare mucinfilled cells were mixed with acanthotic and focally keratinizing squamous epithelium. Squamous atypia, ranging from mild to severe dysplasia could be seen, but viral cytopathic changes were not reported. No glandular atypia nor necrosis were seen (figure 2). In situ HPV hybridization was negative.

Bottom Line: Routine examination was normal.No enhanced coloration was noticed.In situ HPV hybridization was negative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de Pneumologie, GHSR, St Pierre, France. f.paganin@wanadoo.fr

ABSTRACT

Background: Solitary endobronchial papillomas (SEP) are rare tumors and most of them are described by case report. A misdiagnosis is common with viral related papillomas. A histopathological classification has recently permitted a major advancement in the understanding of the disease.

Case presentation: We report a case of a mixed bronchial papilloma with an unusual endoscopic presentation. The literature was extensively reviewed to ascertain the unusual characteristics of the current case. A 39-year of age male was referred to our institution for the investigation of a slight hemoptysis. Routine examination was normal. A fibroscopy revealed an unusual feature of the right main bronchus. The lesion was a plane, non-bleeding, non-glistering sub-mucosal proliferation. No enhanced coloration was noticed. Biopsies revealed a mixed solitary bronchial papilloma. In situ HPV hybridization was negative. Endoscopic treatment (electrocautery) was effective with no relapse.

Conclusion: This lesion contrasts with the data of the literature where papilloma were described as wart-like lesions or cauliflower tumors, with symptoms generally related to bronchial obstruction. We advise chest physicians to be cautious with unusually small swollen lesions of the bronchi that may reveal a solitary bronchial papilloma. Endoscopic imaging can significantly contribute to the difficult diagnosis of SEP by pulmonary physicians and endoscopists.

Show MeSH
Related in: MedlinePlus