Endobronchial lipoma is more frequent in males than females; the mean patient age is 60 years. The tumor shows a preference for an airway lobar or subsegmental location and is more frequent on the right side, as in our case [1]. Common clinical symptoms include cough, wheezing, intermittent shortness of breath, sputum production, and fever caused by bronchial obstruction. Such symptoms may result in misdiagnosis of asthma or chronic obstructive pulmonary disease. CT and MRI are useful for diagnostic confirmation. Typically, CT reveals a homogenous area of fat density that is not contrast-enhanced, while MRI may reveal a mass of high intensity on T1-weighted images but low intensity on fat suppression images [3].
We failed to diagnose the tumor bronchoscopically because insufficient material was obtained; the tumor bled readily. Elsayed et al. failed to diagnose endobronchial lipoma via flexible bronchoscopy for the same reason and reported that large excisional biopsy was optimal for diagnosing benign tumors such as endobronchial lipomas [4]. Nussbaumer et al. reported that endobronchial lipomas mimicked bronchial carcinoid tumors [5]; thus, there is a need for differential diagnosis because the latter tumors may exhibit low-grade malignancy. Surgical resection was considered desirable if diagnosis via bronchoscopic biopsy failed. We considered segmentectomy preferable to bronchoscopic resection in our case.
Muraoka et al. recommended surgical resection of endobronchial lipomas under the following conditions: (1) difficulty in obtaining a definitive diagnosis along with a possibly malignant tumor, (2) peripheral destructive lung disease caused by long-term atelectasis or pneumonia, (3) presence of an extrabronchial growth or subpleural lipomatous disease, and (4) expected technical difficulties during bronchoscopy due to the presence of multiple tumors [1]. Unfortunately, we failed to diagnose the tumor bronchoscopically due to bleeding of the tumor. Therefore, we could not deny the possibility of carcinoid tumor. Additionally, the patient suffered from repeated pneumonia although her lung was not destructive. We considered these findings almost met with the 1st and 2nd criteria Muraoka proposed. In their review, no patients with endobronchial lipoma underwent pulmonary segmentectomy; lobectomy was the preferred surgical approach. However, the review did not mention which the surgical approach is selected thoracotomy or thoracoscopy. To minimize invasiveness, preserve the lung, and reduce postoperative pain, segmentectomy or a uniportal approach is desirable when we choose surgical resection for this benign disease. To the best of our knowledge, only Galvez et al. has reported successful use of uniportal pulmonary segmentectomy to treat a patient with an endobronchial lipoma [6]. Here, we successfully performed right basal segmentectomy via a uniportal thoracoscopic approach despite encountering a severe pleural adhesion and dense hilum. This minimally invasive surgical procedure contributed to the rapid recovery of our patient.