Endobronchial granular cell tumor mimicking asthma

The article presents a 22 year old female being treated as a case of asthma without any benefit, whom was ultimately found to have an endobronchial growth which on biopsy revealed Granular Cell Tumor. Pulmonary Granular Cell Tumors are very rare benign tumors as less than 80 cases has been described since 1938, when it was first described.

Bronchogenic Carcinoma: Endoscopy versus Histopathology

Introduction: Lung cancer is the malignancy with the highest mortality (1.76 million deaths per year, 18.4% of the total) worldwide, being the only one whose incidence of death has progressively increased despite improved and more aggressive therapy in recent years. Early diagnosis plays an important role in increasing survival in lung cancer patients. Fiber Optic Bronchoscopy (FOB) is currently considered the first method for evaluating the tracheobronchial tree in patients with suspected lung cancer. Even though histopathological examination of bronchial biopsy specimen remains the confirmatory or the gold standard test, morphological appearance along with side and site of the lesion is also important in the diagnosis. Aim: To compare the bronchoscopic presentations of bronchogenic carcinoma in relation to side, site and morphology with histopathology. Materials and Methods: This descriptive cross-sectional study was conducted prospectively in the Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. It included 122 patients suspected clinico-radiologically and bronchoscopically with lung cancer and admitted to the hospital during the period from March 2018 to May 2019. FOB findings were noted carefully with regard to side, site and type of the lesion. One hundred and two patients were pathologically diagnosed with primary lung cancer. The bronchoscopic findings were correlated with histopathology. Statistical analysis were done using the chi-square test using the software IBM Statistical Package for the Social Sciences (SPSS) Statistics, Version 25.0. Results: A total of 102 patients (90 males and 12 females) with primary lung cancer were included in the study; most of them were in the sixth decade of life. The main anatomical site of bronchogenic carcinoma were; main bronchi (n=36, 35.29%), followed by lobar bronchi (n=28, 27.45%). Most common morphologic presentation was endobronchial growth (n=86, 84.31%) and for all the endobronchial growths, Squamous Cell Carcinoma (SQCC) was the most common histopathological diagnosis i.e., 32 cases out of 86 (37.21%). For Adenocarcinoma (AC), non-specific morphological finding was the most common (7 out of 13, 53.85%) rather than endobronchial growth (6 out of 13, 46.15%). External compression was the most common among the non-specific findings of AC (n=3 out of 13, 23.08%). Conclusion: Bronchoscopic appearance was associated to histological type. Both SQCC and Small Cell Carcinoma (SCC) were more in the central airways and endoscopically had the presentation of intraluminal growth commonly. ACs were more in the peripheral airways and endoscopically had non-specific findings more than endoscopic growth.

Bronchoscopy and fine needle aspiration cytology aided diagnosis of suspected lung malignancy- A prospective observational study

Background: Flexible bronchoscopy is the main modality of diagnosing lung malignancy as per the location of lesion in our setup. Accurate diagnosis and categorization into various types is vital for its prognostic and management point of view. Objectives: The study was conducted to find out yield of bronchoscopy and FNAC in suspected lung lesion and to know the various subtypes of bronchogenic carcinoma. Methodology: The study was conducted in Kathmandu Medical College Teaching Hospital from December 2016 to May 2018. This was a prospective observational study conducted in 90 radiological suspected lung lesions. Radiological, bronchoscopy, histopathological and cytopathological findings were analyzed and evaluated. Data were recorded on a pre-designed proforma and entered into Statistical Package for the Social Sciences version 20. Results: Among 90 suspected lung lesions who underwent contrast enhanced computed tomography, chest mass lesion was seen in 57(63.3%) subjects, nodular in 8 (8.9%), consolidation in 7 (7.8%), fibrosis in 7 (7.8%), collapse in 6 (6.7%) and pleural effusion in 3 (3. 3%).The most common malignancy was squamous cell carcinoma (53.48%). Lung malignancy was more common among endobronchial growth. The tendency of lesion to be malignant however tended to be significant at right upper lobe (p=0.02). When the suspected lesion was mass, the occurrence of malignancy was significantly higher (p<0.05). Conclusion: The diagnostic yield increases with presence of right upper lesion with endobronchial growth. When the lung lesion presents as mass, the yield of having malignancy is also higher.

A retrospective study of brochoscopic profile of patients in a tertiary care centre

Background: The purpose of this study was to find out the demographic profiles, indications, bronchoscopic findings and diagnosis of the patients who underwent bronchoscopic examination.Methods: A retrospective analysis of 200 consecutive fiber-optic bronchoscopies was performed at RMCH from June 2015 to June 2017 to find out the demographic and clinical profile of the patients who underwent this procedure. The instrument Olympus video bronchoscope was used for the procedure.Results: Among total of 200 patients, 131 (65.5%) were males and 69 (34.5%) patients were females. 150 (75%) patients were smokers and 50 (25%) patients were non- smokers. Cough was the most common presenting symptom in 180 (90%) of the patients followed by breathlessness 138 (69%), chest pain 114 (57%), hemoptysis 80 (40%), fever 66 (33%). The most common finding is endobronchial growth in 119 (59.5%) followed by nonspecific inflammation 40 (20%), inconclusive 21 (10.5%), normal 12 (6%), suspected growth 8 (4%).Out of 200 patient biopsy was done in 65 patients (32.5%) and most common histopathological diagnosis was malignancy 42 (64.61%), pulmonary tuberculosis 10 (15.38%), Infective pathology 9 (13.8%), inconclusive 4 (6.1%).Conclusions:Bronchoscopy is a safe and useful tool for making the diagnosis of a variety of pulmonary diseases. Endobronchial growth and malignancy were the commonest findings on bronchoscopy and histopathological examination respectively. Moreover, we would like to emphasize the importance of attempting biopsy from the abnormal segment of the lung even when bronchoscopy does not show frank mucosal growth.

Radiological and Bronchoscopic Findings for the Better Yield of Tissue Diagnosis in Lung Malignancy

Introduction: In flexible bronchoscopy, absence of endobronchial abnormality blinds the bronchoscopist towards the location of the lung lesion. Guided techniques for bronchoscopy are not available in Nepal. Hence, diagnostic yield is very low. There is need to find the factors to improve yield. This study evaluates the radiological and bronchoscopic findings that can help in histo-pathological yield.Methods: This retrospective study included 557 bronchoscopies done for the evaluation of lung malignancy. Radiological, bronchoscopic and histo-pathological abnormalities were classified and evaluated. The study aimed at finding the radiological and bronchoscopic factors commonly associated with positive yield in histopathology.Results: Among 557 subjects, 490 had abnormal chest X-ray. Mass lesion was seen in 252(45.24%), cavity in 19(3.41%), collapse in 93(16.69%), consolidation in 81(14.54%), pleural effusion in 28(5.02%) and fibrosis in 17(3.05%) subjects. Total of 314(56.37%) abnormal bronchoscopies included: endobronchial growth 200(35.9%), narrowing 66(11.84%), obstruction 107(19.27%) and ulcer 16(2.8%). Histopathology was positive in 198(35.54%) including 179 (32.13%) lung malignancies. The diagnostic yield for getting positive histopathology for the study population was 35.54%, for mass lesion was 40.47% and for abnormal bronchoscopy was 54.78%. Significant correlation was identified among mass lesion, endobronchial abnormality and positive histo-pathology. Central mass lesion, collapse and consolidation showed significant association with lung malignancy. Significant association was also identified between histo-pathology and endobronchial growth, obstruction and ulcer. Conclusions: The diagnostic yield increases with positive endobronchial abnormality. Presence of central lung lesion, collapse and consolidation favour positive yield of histo-pathology. Endobronchial growth, obstruction and ulcer are likely to yield malignant histopathology reports.

Radiological and bronchoscopic findings for the better yield of tissue diagnosis in lung malignancy

Introduction In flexible bronchoscopy, absence of endobronchial abnormality blinds thebronchoscopist towards the location of the lung lesion. Guided techniques for bronchoscopy are not available in Nepal. Hence, diagnostic yield is very low.There is need to find the factors to improve yield. This study evaluates the radiological and bronchoscopic findings that can help in histo-pathological yield.MethodThis retrospective study included 557 bronchoscopies done for the evaluation of lung malignancy. Radiological, bronchoscopic and histo-pathological abnormalities were classified and evaluated. The study aimed at finding the radiological and bronchoscopic factors commonly associated with positive yield in histopathology.Results &nbsp;Among 557 subjects, 490 had abnormal chest X-ray. Mass lesion was seen in 252(45.24%), cavity in 19(3.41%), collapse in 93(16.69%), consolidation in 81(14.54%), pleural effusion in 28(5.02%) and fibrosis in 17(3.05%) subjects. Total of 314(56.37%) abnormal bronchoscopies included: endobronchial growth 200(35.9%), narrowing 66(11.84%), obstruction107(19.27%) and ulcer 16(2.8%). Histopathology was positive in 198(35.54%) including 179(32.13%) lung malignancies. The diagnostic yield for getting positive histopathology for the study population was 35.54%, for mass lesion was 40.47% and for abnormal bronchoscopy was 54.78%. Significant correlation was identified among mass lesion, endobronchial abnormality and positive histo-pathology. Central mass lesion, collapse and consolidation showed significant association with lung malignancy. Significant association was also identified between histo-pathology and endobronchial growth, obstruction andulcer. &nbsp;ConclusionThe diagnostic yield increases with positive endobronchial abnormality. Presence of central lung lesion, collapse and consolidation favour positive yield of histo-pathology. Endobronchial growth, obstruction and ulcer are likely to yield malignant histopathology reports.