Exceptional Case of Endobronchial Foreign Body Mimicking Primitive Lung Cancer

Cara, Andrea; Mazzella, Antonio; Spaggiari, Lorenzo

doi:10.1016/j.arbres.2022.01.012

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

It is a monthly journal in which all manuscripts are sent to peer-review and handled by the editor or an associate editor from the team and the final decision is made on the basis of the comments from the expert reviewers and the editors. The journal is published solely in English. All the published data is composed of novel manuscripts not previously published in any other journal and not being in consideration for publication in any other journal..

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52 years-old woman presented persistent cough and single-episode haemoptysis, no clinical history. CT-scan showed hypoplastic left lower lobe with 28mm×32mm PET positive (SUVmax=2.7) lesion obstructing bronchus. Bronchoscopy showed non-transitable bronchial obstruction and oedema of mucosa. Biopsies suggested well-differentiated neoplasm (adenoma/adenocarcinoma G1). Mutational panel showed presence of BRAF mutation. Bronchial-sleeve left lower lobectomy was programmed. Frozen-section bronchial margin resulted negative and a 2.5cm plastic screw was found in the basal pyramid. Histology showed a pattern of giant-cell chronic inflammation without neoplasm. No mutations of BRAF were found in the specimen. Patient didn’t recall foreign-body inhalation during youth. Inveterate foreign-body inhalation is a rare problem in adults and left lower bronchus localization relatively uncommon (14% of cases).1 In this case foreign-body caused chronic inflammation and consequent tissue reaction mimicking a malignant process. Furthermore, bronchial obstruction prevented normal lobar development causing hypoplasia. The absence of radiological findings suggesting foreign-body (non-metal screw) addressed an endobronchial lesion (NSCLC/carcinoid/hamartoma) and the endoscopic biopsy with BRAF mutation constituted a challenging element for correct preoperatory diagnosis. However surgical approach was also prompted by the hypoplastic lobe, towards preventing potential uncontrollable haemoptysis or recurrent pneumonia and would have been the correct approach even with a correct preoperatory diagnosis (Fig. 1).