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Case : Tumor in the right upper lobe

Fumihiro Asano, MD, PhD

Department of Pulmonary Medicine,

Gifu Prefectural General Medical Center

 

 

 

Procedure information

Scope: BF-1TH1200
Case:Tumor in the right upper lobe
Location: Right upper lobe bronchus
Patient information: Male, 70 years old
Medical history:Chest CT during his health checkup revealed a mass shadow in the right pulmonary hilum, and he was referred to our institution.

1-1 Tumor in the right intermediate trunk (WLI)
An elevated polypoid lesion can be observed in the right upper lobe when viewed from the right main bronchus using WLI.

1-2 Tumor in the right intermediate trunk (TXI)
By using TXI, the structures around the tumor, such as longitudinal folds and the fine vascular network of the mucous membrane are enhanced more clearly than using WLI. The longitudinal folds gradually converge towards the distal side, narrowing in a pointed manner.

1-3 Close-up of the tumor in the right upper lobe (WLI)
The tumor's surface is visibly uneven and irregular, and there are indications of bleeding. A part of the lesion (The upper right part of the image) suggests that the tumor may have infiltrated the epithelium. Furthermore, the tumor is obstructing the upper lobe bronchus.

1-4 Close-up of the tumor in the right upper lobe (TXI)
The TXI mode enhances the vessels on the tumor surface than with white light, and some red dots are visible.

1-5 Close-up of the tumor in the right upper lobe (RDI)
In RDI, no active bleeding from the tumor is recognized.

Case Video

Pathological Findings

  • Lung squamous cell carcinoma (diagnosed with TBB of the right upper lobe tumor and EBUS-TBNA of metastasized mediastinal lymph node)
  • Proliferation of lung squamous cell carcinoma with a tendency to keratinization is observed.

Overall Comment

This was a case of squamous cell carcinoma of the lung (cT1N2M0 stage, IIIA). Bronchoscopy showed that the advanced peripheral squamous cell carcinoma partially progressed towards the central bronchi in a polypoid fashion. The convergence of longitudinal folds suggested that the upper right lobe bronchus was narrowed in a pointed fashion and the lesion extended around the bronchus. In TXI, structures such as longitudinal folds and fine vascular networks on the mucosa were more enhanced and could be observed more clearly than with white light.

Case 14 : Right lung tumor Case 16 : Right lung tumor
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