Multiple endobronchial polyposis; differentiation from squamous cell papillomas

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We report a case of multiple tracheobronchial inflammatory polyps, and discuss the differences between inflammatory polyps and squamous cell papillomas. Inflammatory polyps have been misdiagnosed as squamous cell papillomas, but only the latter have been found to undergo malignant transformation.

Case report

A 36-year-old woman was referred to the Cleveland Clinic with pleuritic pain in the left anterior chest, temperature of 100 to 101 F, and a nonproductive cough. She had been hospitalized for three episodes of left lower lobe pneumonia within a 3-month period. Sputum cultures from her last hospitalization grew normal flora and a few colonies of Candida albicans. Acid-fast bacillus smears and cultures were negative and the sputum revealed no malignant cells. Delayed hypersensitivity was found to be intact and quantitative immunoglobulins were normal.

Physical examination disclosed rales in the left base and the chest roentgenogram revealed residual alveolar infiltration in the left lower lobe (Fig. 1).

The patient underwent fiberoptic bronchoscopy. Multiple polypoid grayish-white masses were found in the carina extending to the base of the right main stem bronchus, at the superior segment of the right lower lobe, the lingula, and the superior segment of the left lower lobe, and two in the basal segments of the lower lobe. The masses varied from 0.5 to 2.0 cm in diameter. On the following day a repeat bronchoscopy and excisional biopsy of the carinal lesion with the rigid bronchoscope revealed an inflammatory lesion with considerable granulation tissue (Figs. 2 and 3). The base of the lesion was . . .



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