Abstract Pulmonary leiomyomas are benign proliferations of smooth muscle that can involve the airways, lung parenchyma or pleura. They are most often described in the context of benign metastasizing leiomyoma, which is associated with uterine leiomyomas (or fibroids). However, leiomyomas can arise as a primary site in the respiratory system, without evidence of distant disease. This phenomenon is seen in male patients with pulmonary leiomyoma, which is extremely rare with few cases described in the literature. This case describes a 72-year-old male with a history of atrial fibrillation on oral anticoagulation who presented to the Emergency Department with chest pain and was found to have a non-ST-segment elevation myocardial infarction (NSTEMI). Left heart catheterization demonstrated multivessel coronary artery disease, so the patient was evaluated for coronary artery bypass grafting (CABG). During his pre-operative workup, computed tomography of the chest revealed a 1.8 cm endobronchial lesion in the right upper lobe (RUL) bronchus. After multidisciplinary discussion, bronchoscopy was performed, which noted a pale, bulbous mass protruding from the RUL into the bronchus intermedius, with near complete obstruction of the RUL bronchus. Forceps biopsies of the lesion were obtained, with pathology showing benign smooth muscle proliferation, a non-specific finding. Following this biopsy, the patient remained on a heparin infusion and subsequently developed small-volume hemoptysis. Due to concerns regarding the patient’s ability to tolerate antiplatelet or anticoagulant medications following his CABG if the hemoptysis continued, the patient was referred to Interventional Pulmonology for airway debulking and hemostasis. Approximately one week from the patient’s initial bronchoscopy, repeat bronchoscopy noted a dark red polypoid lesion protruding into the right mainstem bronchus from the RUL bronchus. Multiple biopsies were obtained using cryotherapy, which returned positive for leiomyoma. The lesion was debulked piecemeal using cryotherapy and argon plasma coagulation, with patency of the RUL bronchus restored. Since this time, the patient underwent his CABG successfully, and has had additional bronchoscopies, with tumor growth now into the distal trachea. He has been deemed not a surgical candidate for resection given the extent of tumor involvement. Going forward, his management plan consists of serial bronchoscopy with further debulking as needed. Pulmonary leiomyomas are exceedingly rare, especially in male patients where the lung is the primary site of involvement. Given that these tumors can arise endobronchially, within the lung parenchyma, or along the pleura, the management approach is individualized and involves collaboration with a multidisciplinary team. This abstract is funded by: None
Hannon et al. (Fri,) studied this question.