PMC6010637_01
Posteroanterior radiograph of the chest showing a mass like opacity in the medial aspect of the right lower lung (arrow), silhouetting the right heart border, likely located in the medial segment of the right middle lobe.
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Chest radiograph showed right middle lobe opacity (Fig. 1).
Noncontract computed tomography of the chest at the level of bronchus intermedius, showing a mass (circle) with large dystrophic calcification (black arrow) and an area of cystic appearing lesion more anteriorly (blue arrow), which is likely a bronchocele associated with the mass.
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Unenhanced computed tomography (CT) of the chest showed endobronchial mass of the bronchus intermedius containing dystrophic calcifications (Fig. 2).
Right mainstem bronchus-endobronchial large, smooth, friable mass occluding bronchus intermedius.
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Patient underwent inspection bronchoscopy which revealed bright red blood originating from large endobronchial tumor obstructing the bronchus intermedius (Fig. 3).
Reconstructed contrast enhanced CT of the chest in oblique coronal Maximal Intensity Projection (MIP) at the area of the tumor, showing the mass in the right bronchus intermedius with dystrophic calcification (circle). The bronchial artery supplying the mass is visible (blue arrow). Black arrow points to bronchial blocker placed for massive hemorrhage and displaced into the left bronchial tree.
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The mass appeared to be supplied by a bronchial artery at the level of T4 (Fig. 4).
Digital subtraction catheter angiographic image at the site of the tumor demonstrates the bronchial artery supplying the mass (arrow). Faint blushing of contrast is seen at the site of the tumor, in keeping with hypervascular nature of the tumor.
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Right bronchial arteriogram showed a right bronchial artery perfusion to a hypervascular right hilar mass corresponding with the hemorrhagic mass shown on CT chest and bronchoscopy (Fig. 5).
Gross photo of right middle lobe and right lower lobe with poorly demarcated, firm yellow-white mass (black circle) expanding the right mainstem bronchus (black arrow).
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On cross section, the mainstem bronchus was expanded by a poorly demarcated, irregular, yellow-white, firm mass that measured 3.5 cm in greatest dimension (Fig. 6).
Hematoxylin and Eosin; Typical Carcinoid Tumor (200x). Small, polygonal neoplastic cells with granular, pale eosinophilic cytoplasm. Nuclei are round with open, "salt and pepper" chromatin. Mitotic figures are absent. Inset (400x); Finely stippled, "salt and pepper" chromatin (black arrow) without nuclear atypia or mitotic activity.
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Mitoses were infrequent (Fig. 7) and there were regions of squamous and osseous metaplasia observed within the mass.