Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2008.65.4.313 Case Report A Case of Endobronchial Lipoma Causing Right Middle and Lower Lobes Collapse and Bronchiolitis Obliterans-organizing Pneumonia Son Ji Young M.D. 1 Jung Ji Ye M.D. 1 Ha You Jung M.D. 1 Hong Soo Jung M.D. 1 Jung Min Kyu M.D. 1 Chung Moon Jae M.D. 1 Seo Yong Sung M.D. 1 Moon Ji Ae M.D. 1 Byun Min Kwang M.D. 1 Park Byung Hoon M.D. 1 Moon Jin Wook M.D. 1 2 Park Moo Suk M.D. 1 2 Kim Young Sam M.D. 1 2 Chang Joon M.D. 1 2 Kim Sang Kyum M.D. 3 Chung Kyung Young M.D. 4 Kim Se Kyu M.D. 1 2 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea. Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Korea. Address for correspondence: Se Kyu Kim, M.D. Department of Internal Medicine, Yonsei University College of Medicine, 250, Seongsanno, Seodaemun-gu, Seoul 120-740, Korea. Phone: 82-2-2228-1954, Fax: 82-2-393-6884, sekyukim@yuhs.ac 10 2008 31 10 2008 65 4 313 317 23 07 2008 12 08 2008 Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases 2008

Lipoma is a common neoplasm in soft tissues. However, an intrapulmonary lipoma is a rare benign tumor. Patients with a bronchial lipoma might have a malignant potential related to their smoking history due to the case reports of lung cancer accompanied with lipoma. Endobronchial lipoma can cause irreversible parenchymal lung damage if not diagnosed and treated early. Therefore, it should initially be treated by fiberoptic bronchoscopy or surgery depending on the status of distal parenchymal lung damage. Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome that is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal air spaces. BOOP is caused by drug intoxication, connective tissue disease, infection, obstructive pneumonia, tumors, or an unknown etiology. We encountered a 58 year-old male patient with endobronchial lipoma, causing the collapse of the right middle and lower lobes, and BOOP due to obstructive pneumonia.

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Chest PA shows a hazy density in right lower lung field with obliteration of the costophrenic angle, suggesting lung collapse and pleural effusion.

(A) Chest CT scan shows an endobronchial mass (arrow) in the intermediate bronchus, and the portion of the mass contains fat attenuation, suggesting endobronchial hamartoma. (B) Obstructive pneumonia in right middle and lower lobes and small amount of right pleural effusion were observed.

Bronchoscopic finding of endobronchial lipoma. Intermedius bronchus was completely obstructed with a round mass, which has smooth, yellow colored surface. (A) Right second carina level. (B) Endobronchial mass.

Microscopic finding of endobronchial lipoma. Microscopic findings reveal mature fat tissue with overlying bland looking ciliated columnar bronchial epithelium (H&E stain, ×100).

Microscopic finding of Bronchiolitis obliteransorganizing pneumonia. Microscopic findings reveal plugging of small airways and alveoli with loose fibrotic material and surrounding interstitial inflammation (H&E stain, ×100).