Presentation
Incidental finding during cardiac workup
Patient Data
Branching fat density lesion within the distal left upper lobe bronchus and extending into the proximal lingular bronchi, causing downstream collapse. No enhancement. Punctate calcification adjacent to the lesion likely within the bronchial wall. When compared to prior imaging a small lobulated fat density lesion was within this same location, and it has now enlarged. Lingular collapse appears longstanding, noting that there is compensatory bronchial artery dilatation.
Incidental right top pulmonary vein (normal variant)
Same lesion 7 years prior is noticeably smaller.
Bilateral lower lobe subsegmental PEs
Case Discussion
Patient subsequently underwent a PET CT which did not demonstrate any avidity within the lesion.
Bronchoscopy subsequently performed, and the lesion was removed.
MICROSCOPIC
Polypectomy - lingula lobe: Sections of the endobronchial tumor show a polypoid piece of bronchial tissue with expansion of the subepithelial stroma by mature adipose tissue. The epithelial surface is partly denuded but appears intact with no cleft-like invaginations seen. No cartilage or chrondroid matrix is present. There is no atypical features and no mitoses are seen. Separate fragments of unremarkable bronchial mucosa, adipose tissue and blood/fibrin are also present. Seromucinous glands are seen and are focally present within a separate small fragment of adipose tissue. There is no significant inflammation. No cellular infiltrate is seen and there is no evidence of malignancy.
Features are in keeping with an endobronchial lipoma.
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