Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy
A 49-year-old man was referred to our hospital for bronchoscopic evaluation for obstructive pneumonia on superior segment of right lower lung (RS6) on chest X-ray and chest computed tomography (CT) (). The bronchoscopic examination with autofluorescence bronchoscopy (system: Onco-Life for Improved Cancer Detector; Xillix, Richmond, Canada and bronchoscope: BF-1T40; Olympus, Tokyo, Japan) showed the superior segmental bronchus of right lower lung (RB6) was obstructed by pedunculated mass. The cryotherapy was performed for endobronchial biopsy and tumor cryodebridement. Flexible cryoprobe (length 80 cm, length of probe tip 7 mm, diameter 2.2 mm) with cryomachine (ERBE, Tubingen, Germany) was passed through the working channel of the flexible bronchoscopy (system: ELVIS LUCERA CV-260 and CLV-260; Olympus and bronchoscope: BF-1T260; Olympus) into the tumor. The tip of flexible bronchoscope was positioned 1.0 cm from the tumor. The cryoprobe was kept about 4 mm away from the tip of the bronchoscope. Then, the tip of the cryoprobe that was placed in direct contact with the tumor was cooled to approximately -89℃ with cryogen (nitrous oxide; N2O) for 10 seconds using the foot pedal. After that time, the probe was pulled, the probe with frozen tissue was withdrawn with bronchoscope (pull-out method). The mass was successfully removed with several repeated procedures with small amount of bleeding (). The bleeding was controlled by iced saline. The biopsy result of removed mass was chondroid hamartoma (). Imaging study at 3 months after removal of endobronchial hamartoma showed completely resolution of previous obstructive pneumonia on RS6 (). And bronchoscopic examination after 3 months after removal showed good patency without any obstruction of RB6 ().