Mehmet Unlu*, Pinar Cimen, Nuran Katgi and Salih Zeki Guclu

Izmir Training and Research Hospital for Thoracic Medicine and Surgery, Pulmonary Division,
Turkey

Case Report : Open Access

Tiara Larisa, S.Ked

16174114
Co-assisten RSUD Meuraxa Banda Aceh
-Ilmu Penyakit Paru-
 A variety of airway tumours are reported to manifest
with symptoms similar to those of asthma and may
cause delays in exact diagnosis because of the increase
in size at a slow rate.

Pulmonary endobronchial mesenchymoma is one

of the slow growing tumours which is associated
with symptoms or signs of airway obstruction
mimicking asthma.
So, patients with chronic symptoms suggestive of
asthma, poor response to asthma medications,
and frequent exacerbations should be evaluated
for endobronchial mesenchymoma.

Keywords

Asthma; Differential diagnosis;

Pulmonary mesenchymoma
 Pulmonary mesenchymomas are the most common
form of
benign lung tumours which accounts for approximately
8% of all
lung neoplasmsand, 77% of all benign lung tumor

The vast
majority of pulmonary mesenchymomas are
located peripherally
within the lungs (>90%) and only up to 10% of
such lesions represent
with endobronchial location
 However, because of this rare
endobronchial form of presentation patients
may be mis diagnosed as
asthma and may be tried to be
treatedmistakenly with bronchodilators
for a long time.

Here we describe a case of pulmonary

mesenchymoma mimicking
features of asthma and treated with asthma
medication for more than
ten years before admission to our clinic.
 She had never
A 51-year-old Her smoking history consumed illicit
female was 4 packs/year drugs and had
no allergies

progressive She had history of an RR = 22 x/i

increase
dyspnea and dry especially in shortness
BP = 110/70 mmHg
cough of breath and cough HR = 140 x/i

She had been Hb = 10,4 gr/dl

she had been
diagnosed with prescribed Leukocytes,trombocytes,and
asthma 12 years bronchodilators results of blood chemistry
ago were within normal limits
 Pathology report of the forceps Immunohistochemic
Erythrocyte biopsy was describing a studies showed
sedimentation = 10 mesenchymal tumour with a
polypoid growth pattern and
positivity to (EMA),
mm/h eosinophilic chondroid matrix but staining was
C-reactive protein = surrounded by negative for CD34
0.5 mg/dl respiratory epithelium And (NSE) .

Based on the clinical,

arterial blood (CT) of the thorax demonstrated a radiological and
gas analysis on room air mass lesion which was 40 mm in histopathological
revealed pH: 7.44 features, the patient was
diameter and surrounding the right
PaCO2: 36mmHg main bronchus and distal portion diagnosed as
endobronchial pulmonary
PaO2: of the right main pulmonary artery mesenchymoma
74mmHg

After surgery, all

Her chest radiograph symptoms of the
HCO3 revealed a homogenous and
-. 24mmol/L regularlyshaped patient disappeared
and she
SaO2: 96% which was dense shadow expanding
compatible superiorly and laterally from had no more need for
with mild hypoxemia the bronchodilators
hilum of the right lung
Figure 1: Chest radiographs of the patient. (a) On admission
(b) A year after discharge.
Figure 2: Thorax-CT (a) and PET-CT (b) images
of the patient on admission
Figure 3: Pathological view of the tumour cells. Positive
staining with vimentin, (left) and S-100 antibodies (right)
(100x)
Figure 4: Gross appearance of the
endobronchial mesenchymoma
 Pulmonary incidence of The histology
mesenchymomas between 0.025%– predominant
are the most 0.32% chondroid
common form of differentiation (80%),
according to with fibroblastic (12%),
benign lung different necropsy fatty (5%)
tumours studies and osseous (3%)

Conversely, in this case

a male predominance, was a female and had
they are smokers, only 14%
had no smoking no history of a heavy-
smoking
asymptomatic for a long
Mostly
time and usually the
they are less than
lesions are diagnosed
2.5-4 cm in diameter
incidentally

The presence of fat

Majority intraparenchymal
lesions (90%) and
endobronchial lesions
making up only about 10%
density and popcorn
like calcification ( 20-
30% )

Cavitation is not
radiological presentation seen
is a solitary pulmonary
nodule which accounts for
6% of the pulmonary
nodules
 This patient without popcorn calcification
and without presence of fat density in CT scan

it was easy uptake of 18-FDG to

to distinguish this tumorous the adjacent blood
lesion from malignant tumours pool

although malignant transformation is

exceedingly
rare, there are some presented case reports
of mesenchymoma with
malignant alteration
So, surgery is recommended
for those
patients presented with rapid
growth of the tumour
The patient in this case had progressive respiratory
symptoms and occlusion of the right main bronchus
for which right upper lobectomy was performed

As this case describes, endobronchial lesions

including pulmonary mesenchymomas may present
with the symptoms of asthma and may be treated
mistakenly for a long time with bronchodilators

Patients with chronic symptoms suggestive of asthma,

poor response to asthma medications, and frequent
exacerbations should be evaluated for endobronchial
lesions.
Thankyou...