case_images: PMC10612437_01
case_images: CT showing an irregular mass with surrounding ground glass opacity in the right B4a (a). The lesion contents a focal area of homogenous fat attenuation (a) and multiple areas of associated mucoid impaction secondary to bronchial obstruction (b). Furthermore, a solid nodule was detected in the right B6b ( , c).
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case_images: Under the lung window setting, the CT scan demonstrated an irregular mass in the medial segment of the right middle lobe (B4a) with surrounding ground glass opacity; under the soft tissue window setting, the lesion showed obvious heterogeneous enhancement, and multiple linear low-attenuation areas implied internal mucoid impaction (size, 10-20 mm; CT attenuation value, -82.7 HU) [Figure 1(a)], which was then misdiagnosed as bronchial mucocele with inflammatory atelectasis [Figure 1(b)]. Besides, another solid nodule was detected in the right lower lobe (B6b) [Figure 1(c)]. Figures S1-S3). Figure 5 shows the diagnosis, treatment and prognosis evolution of the lesion in detail.
case_images: Bronchoscopy detected a yellowish multilobulated and smooth polypoid tumor located in the right B4a (a), and it was resected by endoscope bandaging and cryosurgery (b and c).
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case_images: The patient underwent further bronchoscopy, which revealed a smooth, multilobulated, yellowish polypoid tumor at the bronchial opening of the right lower lobe (B4a), which completely obstructed the bronchial lumen [Figure 2(a)]. Therefore, the clinician removed the tumor by endoscopic mucosal resection with a ligation device (EMR-L) and cryosurgery, and postoperative pathology confirmed that the B4a tumor was an endobronchial lipoma [Figure 2(b) and (c)]. Figures S1-S3). Figure 5 shows the diagnosis, treatment and prognosis evolution of the lesion in detail.
case_images: Histopathology revealed a large amount of mature adipose tissue accompanied by focal fibrous hyperplasia tissue, inflammatory cell infiltration, and mucus background (HE x10, a; HE x100, b). Immunohistochemical staining results (S-100 x100, c). The results of special staining are displayed. The mucoid degeneration zone is blue (AB x100, d).
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case_images: The histopathology revealed a large amount of mature adipose tissue accompanied with focal fibrous hyperplasia tissue, inflammatory cell infiltration, and mucus background in some areas [Figure 3(a) and (b)]. Immunohistochemical staining results were as follows: S-100(+), CD68(+), CD163(+), Ki-67(+, 1%), CD31 (+, vessel), CD34 (+, vessel); The special staining result was as follows: AB(+) [Figure 3(c) and (d)]. Figures S1-S3). Figure 5 shows the diagnosis, treatment and prognosis evolution of the lesion in detail.
case_images: Atelectasis basically disappeared (red  , a). Endobronchial lipoma was recurrent ( , b). The solid nodule in the right B6b was significantly enlarged (white  , a, c). CT showed the reappeared lipoma with slow enlargement ( , d) and a pathologically confirmed metastatic nodule in the right chest wall ( , e) during the 29 month follow-up. The solid nodule was pathologically proven to be SCC by puncture biopsies (HEx100, f).
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case_images: After 4 months of follow-up, we observed that the B6b solid nodule in the right lower lobe was significantly enlarged (from 5 to 12 mm in size) [Figure 4(a) and (c)] and the lipoma reappeared at the original location [Figure 4(b)]. At the follow-up of 29 months, the recurrent lipoma slowly increased in size [Figure 4(d)] and the extent of emphysema gradually increased, but more unfortunately, metastasis occurred in the right chest wall [Figure 4(e)], which was confirmed as SCC by needle biopsy [Figure 4(f)].
case_images: The diagram shows the diagnosis, treatment and prognosis evolution of endobronchial lipoma with SCC in this case.
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case_images: Figures S1-S3). Figure 5 shows the diagnosis, treatment and prognosis evolution of the lesion in detail.