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Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.

Josu Zameza Arano and Antonio Félix Conde Martín

Servicio de Anatomía Patológica
Hospital Can Misses
C/ Corona s/n Ibiza
07800 Baleares

Spain
Discussion in:
PATOLOGIA
PATOCITO
FOROPAT
 Clinical Information
Mujer de 41 años, fumadora, con lesión endobronquial polipoide de color rosado. Se realiza biopsia.

41 years old female, smoker, with endobronchial polypoid pink lesion. A biopsy is performed.
 Figures
Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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Imagen de Lesión endobronquial en mujer de 41 años / Endobronchial lesion in 41 y-o female.
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 Dicussion

 

The 4/11/05 0:16, Patricia Cabaleiro say:

Creo que podria tratarse de un TUMOR GLOMICO.

 

The 4/11/05 3:09, Gustavo Sales Barbosa say:

TUMOR GLÔMICO

 

The 4/11/05 8:58, Bayardo Flores say:

Aunque la posibilidad de un Tumor Glómico parece ser acertada, si bien una localización endobronquial es muy rara, quería proponer, para estimular la discusión, otra alternativa como puede ser un Hemangioma Esclerosante.

Saludos a todos.

 

The 4/11/05 9:30, jose mari arrinda yeregui say:

1ºcarcinoide (¿atipico?).

2 melanoma.

3 t.glomico.

opciones previas a la inmuno, que nos delimitara totalmente el caso supongo, deseo y espero.

 

The 4/11/05 9:40, Javier Gomez say:

De acuerdo con Josemari. Ante un tumor que respeta el epitelio bronquial, bien vascularizado con un patrón organoide, la primera posibilidad me parece un carcinoide. No se puede descartar otra posibilidad como es la metástasis endobronquial de otros tumores (es amiloide lo que señala una foto?) u otros tumores más raros como los ya mencionados.

 

The 4/11/05 9:49, JULIAN JOSE AHIJADO GONZALEZ say:

Las características histopatológicas parecen mostrar un TUMOR GLÓMICO. No obstante y debido a la rareza de este tipo de lesión en la vía bronquial, está indicada la realización de un estudio inmunohistoquímico de confirmación.

Un saludo a tod@s.

 

The 4/11/05 21:34, Kleber Simões say:

O padrão arquitetural algo organóide da lesão, com estas células de médio tamanho, exibindo núcleos arredondados a ovalados e homogêneos, com este eventual clareamento reminescente de pseudoinclusões nucleares e a distribuição perivascular das células tumorais fazem-me pensar como primeira hipoótese lesão na categoria dos TUMORES GLÔMICOS. Penso que pela proeminência do componente vascular (observação subjetiva minha), melhor considerá-lo como um GLOMANGIOMA.

Não obstante gostaria de deixar assinalado o diagnóstico diferencial com os TUMORES CARCINÓIDES, sendo de valor a imunohistoquímica para tal.

 

The 4/11/05 23:06, Romualdo Correia Lins Filho say:

Colegas do Foro

Apesar da localização incomum, acredito que todas as características microscópicas mostradas apontem para o diagnóstico de um TUMOR GLÔMICO.

Além do já referido, gostaria de lembrar a anfofilia citoplasmática e a presença de minúsculos espaços irregulares e fendiformes entre agregados de células neoplásicas como características adicionais favorecendo o diagnóstico de um tumor glômico.

Abraços a todos

Romualdo Lins

Caruaru - Pernambuco - Brasil

 

The 4/12/05 0:09, Oscar Marin say:

Glomangioma.

Carcinoide.

Tumor neuroendocrino.

 

The 4/12/05 0:53, Hernan Molina Kirsch say:

Carcinoide.

Lesion subepitelial con patron organoide de crecimiento.

No pense en glomus, pero hay que reconocer que presenta caracteristicas morfologicas. El fenotipo dara la respuesta.

Mod Pathol. 1998 Mar;11(3):253-8.

Primary pulmonary glomus tumor: a clinicopathologic and immunohistochemical study of two cases.

Koss MN, Hochholzer L, Moran CA.

We present two cases of glomus tumors arising within the lung parenchyma. The patients are a 40-year-old man and a 51-year-old man. Clinically, the two men were asymptomatic, and the pulmonary tumor was detected during a routine chest roentgenographic examination. Complete surgical resection of the pulmonary tumors was performed. Grossly, the tumors measured 1.1 and 1.5 cm. in greatest dimension; they were well circumscribed and subpleural. Neither tumor showed evidence of invasion of lung or pleura. Histologically, both tumors had pseudocapsules, lacked invasion of surrounding lung structures, and demonstrated the appearance of the solid/mucohyaline, or "glomus tumor proper" type of neoplasm. This included oval-to-round cells, with central uniform nuclei; variably eosinophilic-to-clear cytoplasm; and well-demarcated cell borders in close proximity to a rich vascular supply showing perivascular fibrosis. Immunohistochemically, both tumors showed diffuse, moderate-to-strong staining for vimentin, muscle-specific actin, and smooth muscle actin. One tumor also showed diffuse strong staining for desmin, whereas the other was negative. Follow-up information obtained from one of the patients revealed that he was alive and well 47 months after surgical resection. Our cases highlight the ubiquitous distribution of glomus tumor and its similar histologic appearance and immunohistochemical profile to soft tissue glomus tumors.

 

The 4/12/05 14:53, Túlio Souza say:

.

Concordo com os colegas que Tumor glômico é uma ótima pedida, porém não afastaria carcinoide apenas com o HE. Na minha opinião a imunohistoquímica é indispensável.

Túlio Souza

Salvador - Bahia - Brasil

.

 

The 4/14/05 14:30, Esther Contreras Valerio say:

Me parece un Tumor Glómico endobronquial, he visto descritos este tipo de tumores endobronquiales.

Saludos.

Esther

 

The 4/14/05 14:55, emilio mayayo say:

Esta vez me uno a la mayoria. Aunque raro debe ser un tumor glómico.

Saludos a todos.

Emilio.

 

The 4/14/05 16:36, Clóvis Klock say:

- Glomus Tumour

DD: Carcinoid tumor

Saludos

Clóvis Klock

Brazil

Refer:

Respirology. 2002 Dec;7(4):369-71.Pulmonary glomus tumour: a case initially diagnosed as carcinoid tumour.

Yilmaz A, Bayramgurler B, Aksoy F, Tuncer LY, Selvi A, Uzman O.

Department of Pulmonology, SSK Sureyyapasa Center for Chest Diseases and Thoracic Surgery, Istanbul, Turkey. elifim@rt.net.tr

Pulmonary glomus tumours are rare lesions, with few cases reported previously. Herein, we present the clinical and pathological features of a case of pulmonary glomus tumour. A 29-year-old female patient presented to our clinic complaining of cough, dyspnoea and left-sided chest pain. Computed tomography (CT) of the thorax revealed a nodular lesion causing obstruction of the left main bronchus. Fibreoptic bronchoscopy demonstrated a polypoid mass occluding the left main bronchus 10 mm distal to the main carina. Bronchoscopic biopsy was interpreted histologically as carcinoid tumour. Bronchotomy plus mass extirpation was performed with left thoracotomy. Microscopically, a tumoral structure composed of uniform cells with a round centrally located nucleolus and narrow eosinophilic cytoplasm was seen. Thin-walled vessels lined with endothelium were interspersed between tumoral structures. The cells were stained chromogranin and cytokeratin negative and strongly vimentin positive. The pathological diagnosis for the thoracotomy specimen was pulmonary glomus tumour. Follow-up chest CT was negative for recurrent tumour and the patient remains free of disease 17 months after surgery.

 

The 4/19/05 19:31, Luis Muñoz Fernández say:

Tumor glómico-glomangioma.
Post a comment
 Diagnostic
TUMOR CARCINOIDE TIPICO / TYPICAL CARCINOID TUMOR
 Author Comment
SEE BELOW FOR ENGLISH TRANSLATION
Como ha sido señalado repetidamente, el diagnóstico diferencial en este caso se plantea entre el (raro) tumor glómico bronquial y el tumor carcinoide. Se observan cordones de células cúbicas de escaso citoplasma y núcleos redondos de cromatina uniforme. El estroma muestra delicados vasos. Este patrón vascular, reflejado en algunas de las imágenes mostradas hace pensar en el tumor glómico.

El tumor glómico, aunque poco frecuente en vías aéreas, ha sido publicado tanto en tráquea como en bronquios como lesión de aspecto polipoide, que muestra características histológicas y ultraestructurales superponibles al tumor glómico de otras localizaciones 1 .

El diagnóstico diferencial definitivo viene dado fundamentalmente por la expresión inmunohistoquímica de cromogranina y sinaptofisina en el tumor carcinoide 2 , como de hecho ocurrió en nuestro caso.

En fin, una lástima. Nosotros también pensábamos estar ante un tumor glómico bronquial y nos hemos quedado con el carcinoide. Ya tendremos más suerte la próxima vez.

ENGLISH
As it has been repeatedly pointed out, differential diagnosis in this case is between the (rare) bronchial glomus tumor and carcinoid tumor. We see cords of cubical cells with scant cytoplasm and round nuclei with uniform chromatin. There are delicate vessels in the stroma. This vascular pattern , shown in some of the pictures raises the possibility of glomus tumor.

Glomus tumor, even little frequent in airways has been reported in trachea and lower respiratory tract. Its histological, immunohistochemical and ultrastructural features are similar to those of the glomus tumor in other locations 1 .

Definitive differential diagnosis is given by the expression of chromogranin and synaptophisin in carcinoid tumor 2 , as in fact occurs in this case.

A pity at last. We also thought that we had a glomus tumor but we only have a carcinoid tumor. Better luck next time.

 References
1 Garcia-Prats MD, Sotelo-Rodriguez MT, Ballestin C, Martinez-Gonzalez MA, Roca R, Alfaro J, De Miguel E
Glomus tumor of the trachea: report of a case with microscopic, ultrastructural and immunohistochemical examination and review of the literature.
Histopathology. 1991 Nov;19(5):459-464.

2 Carcinoid and other neuroendocrine tumors. Tumors of the lower respiratory tract.
Third series. Atlas of tumor Pathology vol 13.
Ed. Juan Rosai.
Wasington DC. 1995.
NOTE: This is a professional medical forum which object is not offer medical or helth consultation. Messages sent for this advices will not attend. Scientific information offered is supported by references and bibliography and authors are responsibles of their veracity. Participation is free.

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