C78-35 Beyond the Malignant Mimic: Endoscopic Resection of a Tracheal Lipoma

Abstract Introduction Endobronchial lipomas are rare benign lung tumors that may cause bronchial obstruction and clinically mimic obstructive pulmonary disease. Early recognition with prompt biopsy and possible endoscopic resection is often required. Herein, we present a rare case of endobronchial lipoma successfully managed with endobronchial snare resection and cryobiopsy. Case Presentation A 68-year-old man with a history of alcoholic cirrhosis, degenerative joint disease, and a 30-pack-year smoking history was referred to pulmonary clinic for evaluation of an incidental tracheal lesion. A chest radiograph obtained for back pain revealed a hyperdense lesion of the left first rib, prompting further evaluation with chest CT. Imaging demonstrated a 4 × 2 mm sessile lesion along the lateral tracheal wall (Image 1a). Review of prior imaging showed the lesion had been present for at least one year without interval change. The patient reported a 10-pound weight loss over the preceding month and baseline dyspnea but denied fever, chills, night sweats, cough, or hemoptysis. Given his clinical history and concern for malignancy, flexible bronchoscopy was performed. This revealed a polypoid protuberance arising from the left anterior trachea, which was resected using an endoscopic snare (Image 1b). Histopathologic examination demonstrated fibromyxoid stroma with admixed adipocytes. Both spindle cells and adipocytes stained positive for S-100, confirming the diagnosis of endobronchial lipoma. Discussion Endobronchial lipomas (EL) are rare, benign tumors encompassing 0.1 to 0.4% of all bronchial tumors, and most commonly arise in middle-aged men. In a 2022 review, only 50 cases of endobronchial lipomas were documented in the preceding decade. Anatomically, EL often occur in the first three subdivision of the tracheobronchial tree, and appear as circumscribed, soft tumors of white-yellow tissue. The manifestations of EL varies, and ranges from asymptomatic to nonspecific dyspnea, cough, or wheezing. Radiographically, lesions are often indistinguishable from malignancy, and ultimately require biopsy for diagnosis. This patient’s smoking history and tracheal lesion raised concern for malignancy when he developed weight loss and prompted further evaluation with biopsy. Such atypical presentations highlight the importance of heightened clinical awareness to ensure appropriate management of these uncommon cases. This abstract is funded by: None