PMC3295585_01
(a) On p.a. chest X-ray a prominent right hilum and a subtle increase in parenchymal density in the right infrahilar region was noted, a mass could not be clearly identified, however. (b) A noncontrast-enhanced CT scan of the chest revealed a mass within the bronchus intermedius (arrow) consisting mostly of fat with minimal inclusions of soft tissue density (Ao: Aorta ascendens; PT: pulmonary trunk; LA: left atrium). (c) Coronal slide in inverted thin-volume-rendering-technique of a contrast-enhanced CT scan performed for further workup demonstrated position and extent of the mass within the bronchus intermedius. (d) Virtual-bronchoscopy reconstruction from the nonenhanced CT scan displayed the mass within the proximal bronchus intermedius. The adjacent upper lobe bronchus was not affected. (e) Endobronchial round tumorous obstruction of the intermediate bronchus with a smooth surface with subtotal obstruction of the intermediate bronchus. (f) Recurent subtotal exclusion of the intermediate bronchus in the course of the disease and repetition of Argon laser therapy. (g) Incipient focal metaplasia of respiratory mucosa into squamous epithelium.
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fig1
Presence of relevant coronary calcium was excluded, but MDCT revealed a round mass of 1.9 cm diameter with fat equivalent CT density values in the right intermediate bronchus as an incidental finding (Figures 1(a)-1(d)). The intermediate bronchus could be passed by the bioptic gripper and brush only, but not with the bronchoscope itself (Figures 1(e)-1(g)).
(a) Part of the hamartoma extending polyploidly into the endobronchial lumen with transition in the more spindle-celllike (arrow) and osseous component (star) (HE, 25-fold magnification). (b) Further components of the hamartoma with chondroid parts (B, HE, 100-fold magnification) within a cell-reduced, partly fascilular stroma with a hemangio pericytoma-like vessel pattern.
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fig2
Histological examination of the resected tissue showed a mature benign tissue consisting of different components in accordance with the diagnosis of an endobronchial hamartoma (Figure 2).