Journal Information
Vol. 55. Issue 10.
Pages 535 (October 2019)
Clinical Image
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Lobular Capillary Hemangioma in Post-Pneumonectomy Bronchial Stump
Hemangioma lobular capilar en muñón bronquial posneumonectomía
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Blanca de Vega Sáncheza,c,d,
Corresponding author
blancadevegasanchez@gmail.com

Corresponding author.
, Carlos Disdier Vicentea, Henar Borrego Pintadob,e
a Unidad de Broncoscopias y Técnicas Pleurales, Servicio de Neumología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
c Grupo Emergente de Broncoscopias y Neumología Intervencionista (GEBRYN)
d Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
e Centro de Investigación en Red Enfermedades Respiratorias (CIBERES)
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We report the case of a 55-year-old man diagnosed with squamous cell carcinoma in the right upper lobe, preoperative pathological stage T3N0M0,1 who underwent right intrapericardial pneumonectomy (residual tumor measuring 4mm on resection border), and was treated with adjuvant chemotherapy and radiation therapy. After 5 months, the patient was referred to our clinic again, complaining of cough with whitish expectoration. Flexible bronchoscopy (FB) findings, not visible in the preoperative bronchoscopy, are shown in Fig. 1. Biopsies were obtained using Radial Jaw™ 4 2mm endoscopic forceps (Boston Scientific®), which were consistent with lobular capillary hemangioma in the bronchial stump (LCH). FB was scheduled for close endoscopic follow-up, and the patient showed no signs of malignancy or recurrent lesions, and no changes were found in the mucosa samples obtained over the following 3 years.

Fig. 1.

(A) Nodular lesion measuring 7.8mm in the post-pneumonectomy stump after visualization with conventional white light. (B) Endoscopic exploration with autofluorescence, with loss of the conventional appearance. (C) Optical coherence tomography showing an intact basal membrane. (D) Histological sample stained with hematoxylin eosin, 10× magnification, revealing the transition in the respiratory epithelium with a well delimited protuberance in the interior of the bronchial lumen with presence of angioblastic features and abundant leukocytes (polymorphonuclear subtypes), consistent with lobar capillary hemangioma.

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LCH is a highly unusual acquired vascular lesion of non-neoplastic etiology that occurs in the lumen of the trachea, generally causing cough and hemoptysis.2 Despite the absence of a well-defined etiology, some of the hypotheses proposed suggest an association with minor trauma, endotracheal intubation, local irritation, bacterial and viral infections, or hormonal imbalances.3 To our knowledge, this is the first report of LCH described in a post-pneumonectomy stump.

References
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P. Goldstraw, K. Chansky, J. Crowley, R. Rami-Porta, H. Asamura, W.E. Eberhardt, International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Advisory Boards and Participating Institutions, et al.
The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer.
J Thorac Oncol, 11 (2016), pp. 1433-1446
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Q. Xu, X. Yin, J. Sutedjo, J. Sun, L. Jiang, L. Lu.
Lobular capillary hemangioma of the trachea.
Arch Iran Med, 18 (2015), pp. 127-129
[3]
S.E. Mills, P.H. Cooper, R.E. Fechner.
Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma.
Am J Surg Pathol, 4 (1980), pp. 471-479

Please cite this article as: de Vega Sánchez B, Disdier Vicente C, Borrego Pintado H. Hemangioma lobular capilar en muñón bronquial posneumonectomía. Arch Bronconeumol. 2019;55:536.

Copyright © 2019. SEPAR
Archivos de Bronconeumología

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