Granular lonely dwelling myoblastoma is an uncommon benign tumor that causes pulmonary complications suitable to obstruction of the airways.
Granular lonely dwelling myoblastoma is an uncommon benign tumor that causes pulmonary complications suitable to obstruction of the airways. We report the first case of bronchial obstruction to be ascribed to granular cell tumor treated with Nd:YAG laser. The Nd:YAG laser appears to be an effective just discovered tool for relieving obstruction and, in any cases, preventing recurrence, and can be delivered with the use of a flexible bronchoscope
Granular enclosed space myoblastoma is a rare tumor of Schwann lonely dwelling origin that is almost always benign and appears primarily in the skin and tongue. Although unusual, there are several reports of tracheobronchial lesions. Pulmonary complications from these tumors are becoming to bronchial obstruction and usually instant as persistent or recurrent consolidation or atelectasis. Treatment has been predominantly by dint of surgical or endobronchial resection. We report the first case of bronchial obstruction suitable to a granular cell tumor treated with a Nd:YAG laser.
CASE REPORT
The patient was an 80-year-old white woman who had been in her usual state of health until 2 days prior to hospital admission when she unfolded of a productive cough, excitements chills, and right-sided pleuritic chest pain. She was seen on her private physician who place a right lower lobe infiltrate and pleural effusion onward the chest radiograph, and admitted her to the hospital for treatment of pneumonia. improvements were positive for Streptococcus pneumoniae and she was treated with intravenous penicillin for pneumococcal pneumonia. At the time of hospital discharge, she was asymptomatic without chest pain or pleurisy, and she was afebrile. The chest radiograph showed a mild residual pleural effusion and no resolution of the infiltrate.
She did well at domestic circle for a week and then increasing shortness of breath began to bring out Chest radiograph revealed a returning right pleural effusion and she was readmitted to the hospital for evaluation. The patient was afebrile moreover hypoxemic. Thoracentesis revealed a sterile exudate. Chest radiograph after drainage of the effusion still showed a compressed consolidated right lower lobe infiltrate (Fig 1) Flexible fiberoptic bronchoscopy was performed to evaluate the nature of the persistent infiltrate. This examination revealed a 3 x 4 mm soft mass, partially obstructing the right lower lobe bronchus. The mass was located upon the medial wall of the bronchus just below the middle lobe takeoff and opposite the opening to the superior section of the right lower lobe. The basilar portions distal to the mass were patent and normal in appearance. Biopsy specimens of the mass were taken further were nondiagnostic. This was followed from rigid bronchoscopy that revealed the same lesion. Biopsy specimens revealed the characteristic findings of a granular small cavity tumor--polygonal and spindle cells with granular eosinophilic cytoplasm and uniform-appearing hyperchromatic, centrally oriented nuclei. No other abnormalities were originate on either bronchoscopy.
After consideration of the patient's age, baseline function, and benign nature of the lesion, it was decided an attempt should be made to eliminate the obstruction at a nonsurgical method. The patient underwent another rigid bronchoscopy with resection of the tumor using a Nd:YAG laser. With a power setting of 30 W for 09 s the lesion was vaporized and glutted patency of the right lower lobe get backed after 86 pulses. The appearance of the lesion before and after laser therapy is shown in Figures 2 and 3 The patient tolerated the conduct without complications and was discharged hearth the next day. She has remained asymptomatic during the ensuing six month with no return on repeat bronchoscopy.
DISCUSSION
Granular small room myoblastoma is a rare tumor that was first described in 1926 by the agency of Abrikossoff[1] who believed the tumor was of myogenic origin. Although no definite confined apartment of origin has been clarified, most numerous authors believe that the tumor is of Schwann enclosed space origin.[2,3] Granular cell myoblastoma is infrequent in the tracheobronchial tree, with sole 67 cases reported in the most numerous recent review.[3] The lesions are equally distributed between the larger airways and the segmental bronchi. The in the greatest degree common symptoms are cough and chest pain, sometimes with agitation and night sweats. The radiograph mostly commonly shows persistent or intermittent consolidation and/or atelectasis.[3]
There is still one controversy about the method of treating granular confined apartment tumors. Resection, either surgical or bronchoscopically, is the greatest in quantity frequently utilized method. A number of surgical approaches have been used, including wedge bronchotomy, local excision with bronchoplasty, segmental resection, and lobectomy. Daniel et al[4] reviewed 55 cases in the literature, 32 of which had surgical resection and 13 underwent bronchoscopic removal. There were no returns in any of the patients undergoing surgical resection, on the other hand two died of surgical complications and ten were unavailable for follow-up Of the 13 patients whose tumors were remov bronchoscopically, 5 had documented returns and 2 were unavailable for follow-up When the size of the original tumor was greater than 8 mm in diameter, full-thickness extension from one side the bronchial wall was plant 100 percent of the time and was associated with return of tumor in each case. in succession the basis of these findings, Daniel et al[4] commended surgical resection for tumors greater than 8 mm in diameter or in the case of extensive destruction of distal tissue. Bronchoscopic resection was attract favor toed for tumors less than 8 mm or for larger tumors when palliation alone was clinically indicated.
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