Abstract
BackgroundSolitary 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 PresentationWe 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.ConclusionThis 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.
Highlights
Solitary endobronchial papillomas (SEP) are rare tumors and most of them are described by case report
A major advancement was achieved in 1999 with a large histopathological review that led to a classification of the different sub-types related to solitary papilloma [1]
Surgical resection was the gold standard, but SEP being considered as benign tumors, endobronchial treatment was successfully used (YAG Laser, electrocautery)
Summary
The analysis of several case reports revealed abnormal shadows on chest-XRays for 6 patients [14,15,16,17,18,19] and no abnormalities for 1 [4] In his series of 13 patients, Flieder found 3/5 radiographic abnormalities for solitary squamous papillomas, 2/3 for glandular papillomas and 4/5 for mixed papillomas [1]. In 1965, Drennan and Douglas described a solitary papilloma of the bronchus (2 × 1.5 cm), but did not find any bronchoscopic abnormalities [18] This was surprising as the chest-X-Ray localized the tumor at the origin of the left lower lobe. SEP: Solitary endobronchial papillomas; CEA: carcino embryonary antigen; SCC: squamous cell carcinoma; HPV: human papilloma virus; COPD: chronic obstructive pulmonary disease; CT-scan: computed tomography scanner
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