Erdoğan ÇETİNKAYA, Sedat ALTIN, Nur SOLMAZER, Sinem TİMUR, Levent DALAR, Levent KARASULU

Resection of giant endobronchial hamartoma by electrocautery and cryotherapy via flexible bronchoscopy

Endobronşiyal hamartomlar tüm hamartom olgularının %3-10’unu kapsayan nadir tümörlerdir. Bu yazıda fiberoptik fleksibl bronkoskop aracılığıyla elektrokoter ve kriyoterapi kullanılarak tamamen rezeke edilen bir endobronşiyal hamartom olgusu tartışıldı. Egzersiz dispnesi, göğüs ağrısı ve hemoptizi yakınmalarıyla başvuran 71 yaşındaki erkek olgunun bilgisayarlı toraks tomografisinde trakea lümeni alt ucunu ve sol ana bronşu oblitere eden kitle izlendi. Tanısal bronkoskopik incelemesinde sol ana bronşu tama yakın tıkayan geniş polipoid kitle görüldü. Lezyon solunum hareketleriyle sağ bronş sistemine protrude oluyordu. Elektrokoterin snare probu kullanılarak kitle dört parça halinde eksize edildi ve tümörün kaynaklandığı bazal bölüme kriyoterapi uygulandı. On gün ve üç ay sonra yapılan bronkoskopik kontrolde tüm bronş sisteminin tamamen açık olduğu görüldü.Tümörün patolojik tanısı fibrovasküler komponent içeren hamartom olarak kondu. Sonuç olarak; malignite şüphesi taşımayan endobronşiyal hamartom olgularında endoskopik tedavi yaklaşımları güvenli ve minimal invazivdir. Bu nedenle öncelikli tedavi yaklaşımı olarak değerlendirilmelidir.

Dev bir endobronşiyal hamartomun fiberoptik bronkoskop kullanılarak elektrokoter ve kriyoterapi ile tedavisi

Endobronchial hamartoma is a rare tumor which is 3-10% of all hamartomas. We presented a case of endobronchial hamartoma that was resected and ablated with electrocautery and cryotherapy by fiberoptic bronchoscopy. A 71-year-old male, presented with progressive dispnea on exertion, chest pain and hemoptysis. Chest computed tomography (CT) scan of the patient revealed a mass lesion mostly obliterating tracheal lumen and left main bronchus. An initial bronchoscopy showed a large polypoid lesion within the left mainstem bronchus. Polipoid lesion protrudes to the right with respiration. Interventional bronchoscopy with snare probe of the electrocautery resected the polyp in 4 pieces followed by cryotherapy of the base. Pathology of the resected lesion diagnosed as bronchial hamartoma with fibrovasculer component. Control bronchoscopy applied 10 days later revealed patency of all airways. The majority of hamartomas is parenchymal and is often located in the periphery of the lung, unlike our patient who had a more central lesion. Where a firm diagnosis is made preoperatively, surgical removal may not be necessary unless symptoms are present, or tumor expansion is noted. Our case demonstrates resection of an endobronchial hamartoma by snare probe of the electrocautery and with cryotherapy. Electrocautery and crytherapy may present an alternative therapy for resection of selected benign endobronchial benign tumors.

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