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Benign Tumors of the Tracheobronchial Tree: CT-Pathologic Correlation

Jeong Min Ko1, Jung Im Jung1, Seog Hee Park1, Kyo Young Lee2, Myung Hee Chung1, Myeong Im Ahn1, Ki Jun Kim1, Yo Won Choi3 and Seong Tai Hahn1

1 Department of Radiology, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdungpo-gu, Seoul 150-713, Korea.
2 Department of Pathology, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
3 Department of Radiology, Hanyang University Hospital, Seoul, Korea.


Figure 1
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  		Fig. 1A —75-year-old man with endobronchial hamartoma with fat attenuation in bronchus intermedius. Patient had had recurrent pneumonia for several years. CT scan at level of right bronchus intermedius obtained after administration of contrast material shows horseshoe-shaped, fat-attenuated endobronchial lesion in right bronchus intermedius.

 

Figure 2
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  		Fig. 1B —75-year-old man with endobronchial hamartoma with fat attenuation in bronchus intermedius. Patient had had recurrent pneumonia for several years. Photomicrograph of specimen shows bland cartilage, columnar epithelium, and interposed fat (arrows) consistent with hamartoma. (H and E, x100)

 

Figure 3
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  		Fig. 2 —Endobronchial hamartoma as mass containing calcifications in bronchus intermedius of patient with situs inversus totalis. Contrast-enhanced CT scan shows calcified endobronchial mass (arrow) with fibrous cap in bronchus intermedius.

 

Figure 4
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  		Fig. 3A —62-year-old man with endobronchial hamartoma that manifested as soft-tissue-attenuating mass. The patient had complained of cough for 6 months. Contrast-enhanced CT scan shows low-attenuation (47 H) endobronchial mass (white arrow) obstructing right upper lobe bronchus.

 

Figure 5
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  		Fig. 3B —62-year-old man with endobronchial hamartoma that manifested as soft-tissue-attenuating mass. The patient had complained of cough for 6 months. Three-dimensional shaded-surface display reconstruction image shows bronchial obstruction.

 

Figure 6
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  		Fig. 3C —62-year-old man with endobronchial hamartoma that manifested as soft-tissue-attenuating mass. The patient had complained of cough for 6 months. Excised mass is round and lobulated with firm consistency. Pathologic diagnosis was hamartoma.

 

Figure 7
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  		Fig. 4 —39-year-old woman with tracheal leiomyoma. Contrast-enhanced CT scan shows smooth, round, 43-64 H intraluminal mass with wide attachment to right posterolateral wall of trachea.

 

Figure 8
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  		Fig. 5A —57-year-old woman with endobronchial leiomyoma. Contrast-enhanced CT scan shows low-attenuation (42 H) endobronchial mass (arrow) obstructing apical segmental bronchus of right upper lobe.

 

Figure 9
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  		Fig. 5B —57-year-old woman with endobronchial leiomyoma. Lung specimen shows mass (arrows) in segmental bronchus.

 

Figure 10
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  		Fig. 5C —57-year-old woman with endobronchial leiomyoma. Photomicrograph shows spindle-shaped cells with oval nuclei arranged in parallel bundles and whorls typical of leiomyoma. (H and E, x400)

 

Figure 11
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  		Fig. 5D —57-year-old woman with endobronchial leiomyoma. Desmin immunoreactivity (red) is evident in tumor cells.

 

Figure 12
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  		Fig. 6A —47-year-old man with lipoma who had fever and chills for several days. Contrast-enhanced chest CT scan shows -88 H rounded fatty mass (arrow) obstructing right middle lobe bronchus.

 

Figure 13
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  		Fig. 6B —47-year-old man with lipoma who had fever and chills for several days. Bronchoscopic photograph shows polypoid, whitish endobronchial mass.

 

Figure 14
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  		Fig. 6C —47-year-old man with lipoma who had fever and chills for several days. Histologic photograph shows mature adipocytes consistent with lipoma. (H and E, x400)

 

Figure 15
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  		Fig. 7A —37-year-old man with tracheal lipoma. CT scan shows 1.5-cm, -100 H, well-defined, pedunculated, intraluminal fatty mass in trachea.

 

Figure 16
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  		Fig. 7B —37-year-old man with tracheal lipoma. Pathologic specimen contains polypoid mass with glistening capsule and homogeneously yellow cut surfaces.

 

Figure 17
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  		Fig. 8A —34-year-old-woman with endobronchial schwannoma in bronchus intermedius. The patient had chronic cough, and sputum was present. Contrast-enhanced CT scan shows low-attenuation (45 H) endobronchial mass (arrow) obstructing bronchus intermedius. Atelectasis of right middle and lower lobes is evident.

 

Figure 18
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  		Fig. 8B —34-year-old-woman with endobronchial schwannoma in bronchus intermedius. The patient had chronic cough, and sputum was present. Cut surface of resected lung specimen shows yellowish white endobronchial mass (black arrow) obstructing bronchus intermedius. Distal bronchi are dilated and filled with mucous plugs (white arrows).

 

Figure 19
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  		Fig. 8C —34-year-old-woman with endobronchial schwannoma in bronchus intermedius. The patient had chronic cough, and sputum was present. Scanning microscopic view shows mass (M) with intact overlying respiratory epithelium.

 

Figure 20
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  		Fig. 8D —34-year-old-woman with endobronchial schwannoma in bronchus intermedius. The patient had chronic cough, and sputum was present. High-power view shows fascicles of wavy nuclei with tapered ends and palisading consistent with schwannoma. (H and E x400)

 

Figure 21
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  		Fig. 9A —65-year-old woman with endobronchial inflammatory polyp. The patient had had chronic cough. Contrast-enhanced CT scan shows low-attenuating endobronchial mass (arrow) obstructing right upper lobe bronchus.

 

Figure 22
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  		Fig. 9B —65-year-old woman with endobronchial inflammatory polyp. The patient had had chronic cough. Scanning microscopic view of excised polyp shows fibrovascular core lined by respiratory-type epithelium consistent with inflammatory polyp. (H and E, x1)

 

Figure 23
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  		Fig. 10A —50-year-old man with tracheobronchial amyloidosis and endobronchial amyloidoma. Contrast-enhanced CT scan shows nodular thickening of trachea and ovoid soft-tissue-density mass obstructing bronchus of right upper lobe.

 

Figure 24
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  		Fig. 10B —50-year-old man with tracheobronchial amyloidosis and endobronchial amyloidoma. Shaded-surface display 3D image shows multiple nodular indentations in tracheobronchial tree and occlusion of right upper lobe bronchus.

 

Figure 25
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  		Fig. 11A —48-year-old man with tracheal papillomatosis. CT scan at level of branch of brachiocephalic vessels shows small, well-defined nodule (arrow) in posterior wall of trachea.

 

Figure 26
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  		Fig. 11B —48-year-old man with tracheal papillomatosis. CT scan at level of aortic arch shows lobulating polypoid mass in posterior wall of trachea.

 

Figure 27
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  		Fig. 11C —48-year-old man with tracheal papillomatosis. Shaded-surface display 3D image of trachea shows irregular narrowing, secondary to nodular lesions with irregular surfaces.

 

Figure 28
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  		Fig. 11D —48-year-old man with tracheal papillomatosis. Histologic findings are proliferation of well-differentiated squamous epithelium with fibrovascular core. (H and E, x100)

 

Figure 29
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  		Fig. 12A —68-year-old woman with endobronchial pleomorphic adenoma. Patient had had recurrent pneumonia and chronic cough for 4 years. CT scan shows low-attenuating endobronchial mass (arrow) and distal pneumonia.

 

Figure 30
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  		Fig. 12B —68-year-old woman with endobronchial pleomorphic adenoma. Patient had had recurrent pneumonia and chronic cough for 4 years. Endobronchial adenoma with juxtaposed, solid, cellular zones and myxoid stroma. Ductlike and solid myoepithelial component is adjacent to myxoid stromal component. (H and E, x200)

 

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