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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary lung leiomyomas are rare benign tumors of smooth muscle origin&#46; Of all surgically excised tumors from the lung&#44; about 1&#46;9&#37; are benign<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and of these&#44; only less than 2&#37; are leiomyomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The majority of lung leiomyomas&#44; approximately 51&#37;&#44; are located in the parenchyma&#44; endobronchial accounts for 33&#37; and tracheal for the remaining 16&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In women&#44; parenchymal leiomyomas can occur as primary lung lesions or as a result of a benign extrauterine growth of smooth muscle cells&#44; an entity called benign metastasizing leiomyoma &#40;BML&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Endoluminal leiomyomas are usually described as primary solitary lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Literature on primary endobronchial leiomyomas is scarce&#44; with a 2009 review reporting only 108 cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although rarity and nonspecific clinical presentation may impose diagnostic challenge&#44; an excellent prognosis is usually obtained when removal by bronchoscopic techniques is feasible&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We present a case of successful laser resection of a right main bronchus &#40;RMB&#41; primary leiomyoma causing asthma-like symptoms and an obstructive pneumonia in a middle age female&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Presentation</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 44-year-old Portuguese white female presented with sporadic dry cough and wheezing for over three months&#46; She had been treated with inhalation therapy for bronchial asthma without improvement&#46; Exercise dyspnea appeared on the previous two weeks&#46; The patient denied other symptoms&#44; namely constitutional ones&#46; Her medical past history was negative&#44; including gynaecologic problems&#44; and she was a lifetime non-smoker&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Physical examination was unremarkable&#44; except for chest auscultation&#44; which revealed diminished breath sounds on the right hemithorax&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Blood test showed an increased C-reactive protein &#40;4&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; without any others abnormalities&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Chest computed tomography &#40;CT&#41; demonstrated a RMB well defined occlusive opacity and a right middle lobe consolidation with air bronchogram along with a small homolateral loculated pleural effusion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Flexible bronchoscopy revealed a round smooth and vascularised lesion in the RMB near the main carina&#44; arising from medial wall of the bronchus and causing occlusion of more than 90&#37; of its lumen &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Rigid bronchoscopy was performed with diagnostic and therapeutic purposes&#44; given the limited base of tumor insertion and patency of the remaining bronchial tree&#46; Mechanical debulking along with neodymium&#58; yttrium-alluminum-garnet &#40;Nd&#58;YAG&#41; laser allowed successful resection of the lesion with restoration of normal bronchial caliber in one session &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Histopathology was consistent with a lung leiomyoma &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; showing fusocellular proliferation of spindle cells with cigar-shaped nuclei&#44; eosinophilic cytoplasms&#44; no atypia or areas of necrosis&#44; no mitotic activity and diffuse positivity for actin and desmin and weak for vimentin on immunohistochemistry stain&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">There was also no clinical evidence of other organs involvement&#44; namely in the uterus&#44; which was confirmed by gynecological and ultrassonografic examination&#44; and estrogen receptors were negative in histology&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The patient was also given empiric antibiotics with clinical and radiological resolution&#44; and spirometry was normal&#46; After 2 years of follow-up&#44; the patient is well and no endoscopic signs of relapse were detected&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Endobronchial leiomyomas are rare benign tumors of the lung&#44; usually presenting as primary solitary lesions arising from bronchial tree smooth muscle layers&#46; The review of 108 primary endobronchial leiomyomas showed that they occur with no anatomic bronchial predilection&#44; are common in middle aged &#40;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 years&#41; patients and affect equally both sexes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In contrast&#44; lung leiomyomas&#44; in general&#44; occur predominantly in women&#44; and this may reflect the previous overreporting of pulmonary leiomyomas secondary to the variant of BML&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The majority of patients with endobronchial leiomyomas have respiratory symptoms due to partial or total obstruction of airways&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cough is the most common symptom&#44; wheezing and dyspnea may also be present&#44; sometimes being erroneously described as bronchial asthma&#44; like in this case&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Obstructive atelectasis and pneumonia can occur later in natural history of occlusive endoluminal lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Bronchiectasis&#44; hemoptisys and even a pneumothorax resulting from air trapped behind the endoluminal lesion were also described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Radiology is unspecific and may reveal features of bronchial obstruction&#46; Chest CT can be useful in characterizing lesions and demonstrating endoluminal tumors&#46; Final diagnosis may be achieved with bronchoscopic direct visualization and biopsy of lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Even so&#44; differentiation of an endobronchial leiomyoma from a BML or a low-grade leiomyosarcoma is especially important&#46; Little or absence of mitotic activity is the most important predictor of benignity of these tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> BML is histologically similar to primary leiomyomas&#44; except that it has estrogen and progesterone positive receptors and usually presents as multiple parenchymal nodules in women with a previous or current history of uterine leiomyomata&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Since no signs of leiomyomatous disease were found in other organs&#44; and hormonal receptors were negative in histology&#44; our case was considered unrelated and therefore a primary endobronchial leiomyoma&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Treatment of endobronchial leiomyomas&#44; whether symptomatic or not&#44; implies resection&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which depends on location&#44; size&#44; base of implantation of lesions&#44; as well as secondary lung destruction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Given the benign nature of these lesions and long-term outcomes after limited excision&#44; treatment is essentially based on conservative techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;9</span></a> Although lobectomy and pneumonectomy have been commonly used in endobronchial leiomyomas treatment&#44; parenchymal resection should be reserved only for situations in which advanced irreversible destruction secondary to chronic infections occurs&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;9</span></a> Bronchoplasty and bronchotomy were also described as an alternative for lesions arising from the main stem or proximal part of the lobar bronchus&#46; <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If complete resection is possible&#44; current knowledge favours&#44; however&#44; bronchoscopic intervention with a variety of techniques&#44; including electrocautery&#44; argon plasma coagulation&#44; cryotherapy and laser being documented with good results&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a>&#46; Best indications include strictly endoluminal tumors&#44; with limited extent within the endobronchial tree and central location&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;10</span></a> Except for cryotherapy&#44; the remaining techniques provide a rapidly target ablation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Nd&#58;YAG laser assisted mechanical debulking through rigid bronchoscopy has been reported in the literature as safe and effective in curative intent treatment of such benign tumors&#44; with a minor rate of complications when used by training physician&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;10</span></a> Our patient presented with a right main bronchus primary leiomyoma located immediately below the main carina&#44; with a limited insertion base&#44; which allowed successful Nd&#58;YAG laser resection and an excellent prognosis&#44; avoiding the need for a higher surgical risk procedure&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Primary endobronchial leiomyomas are rare tumors that must be considered when symptoms of bronchial obstruction develop and persist&#46; In women&#44; a secondary leiomyomatous origin must be excluded&#46; Successful laser resection and excellent prognosis can be achieved in limited extent central endobronchial leiomyomas&#46;</p></span></span>"
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Case report
Primary endobronchial leiomyoma – endoscopic laser resection
A.P. Vaza,
Corresponding author
vaz.anapaula@gmail.com

Corresponding author.
, A. Magalhãesa, C. Bartoschb, G. Fernandesc, A. Marquesc
a Pulmonology department, Hospital São João, Oporto, Portugal
b Pathology department, Hospital São João, Oporto, Portugal
c Pulmonology department, Hospital São João, Oporto, Portugal, Oporto Medical Faculty, Oporto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary lung leiomyomas are rare benign tumors of smooth muscle origin&#46; Of all surgically excised tumors from the lung&#44; about 1&#46;9&#37; are benign<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and of these&#44; only less than 2&#37; are leiomyomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The majority of lung leiomyomas&#44; approximately 51&#37;&#44; are located in the parenchyma&#44; endobronchial accounts for 33&#37; and tracheal for the remaining 16&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In women&#44; parenchymal leiomyomas can occur as primary lung lesions or as a result of a benign extrauterine growth of smooth muscle cells&#44; an entity called benign metastasizing leiomyoma &#40;BML&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Endoluminal leiomyomas are usually described as primary solitary lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Literature on primary endobronchial leiomyomas is scarce&#44; with a 2009 review reporting only 108 cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although rarity and nonspecific clinical presentation may impose diagnostic challenge&#44; an excellent prognosis is usually obtained when removal by bronchoscopic techniques is feasible&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We present a case of successful laser resection of a right main bronchus &#40;RMB&#41; primary leiomyoma causing asthma-like symptoms and an obstructive pneumonia in a middle age female&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Presentation</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 44-year-old Portuguese white female presented with sporadic dry cough and wheezing for over three months&#46; She had been treated with inhalation therapy for bronchial asthma without improvement&#46; Exercise dyspnea appeared on the previous two weeks&#46; The patient denied other symptoms&#44; namely constitutional ones&#46; Her medical past history was negative&#44; including gynaecologic problems&#44; and she was a lifetime non-smoker&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Physical examination was unremarkable&#44; except for chest auscultation&#44; which revealed diminished breath sounds on the right hemithorax&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Blood test showed an increased C-reactive protein &#40;4&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; without any others abnormalities&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Chest computed tomography &#40;CT&#41; demonstrated a RMB well defined occlusive opacity and a right middle lobe consolidation with air bronchogram along with a small homolateral loculated pleural effusion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Flexible bronchoscopy revealed a round smooth and vascularised lesion in the RMB near the main carina&#44; arising from medial wall of the bronchus and causing occlusion of more than 90&#37; of its lumen &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Rigid bronchoscopy was performed with diagnostic and therapeutic purposes&#44; given the limited base of tumor insertion and patency of the remaining bronchial tree&#46; Mechanical debulking along with neodymium&#58; yttrium-alluminum-garnet &#40;Nd&#58;YAG&#41; laser allowed successful resection of the lesion with restoration of normal bronchial caliber in one session &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Histopathology was consistent with a lung leiomyoma &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; showing fusocellular proliferation of spindle cells with cigar-shaped nuclei&#44; eosinophilic cytoplasms&#44; no atypia or areas of necrosis&#44; no mitotic activity and diffuse positivity for actin and desmin and weak for vimentin on immunohistochemistry stain&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">There was also no clinical evidence of other organs involvement&#44; namely in the uterus&#44; which was confirmed by gynecological and ultrassonografic examination&#44; and estrogen receptors were negative in histology&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The patient was also given empiric antibiotics with clinical and radiological resolution&#44; and spirometry was normal&#46; After 2 years of follow-up&#44; the patient is well and no endoscopic signs of relapse were detected&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Endobronchial leiomyomas are rare benign tumors of the lung&#44; usually presenting as primary solitary lesions arising from bronchial tree smooth muscle layers&#46; The review of 108 primary endobronchial leiomyomas showed that they occur with no anatomic bronchial predilection&#44; are common in middle aged &#40;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 years&#41; patients and affect equally both sexes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In contrast&#44; lung leiomyomas&#44; in general&#44; occur predominantly in women&#44; and this may reflect the previous overreporting of pulmonary leiomyomas secondary to the variant of BML&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The majority of patients with endobronchial leiomyomas have respiratory symptoms due to partial or total obstruction of airways&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cough is the most common symptom&#44; wheezing and dyspnea may also be present&#44; sometimes being erroneously described as bronchial asthma&#44; like in this case&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Obstructive atelectasis and pneumonia can occur later in natural history of occlusive endoluminal lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Bronchiectasis&#44; hemoptisys and even a pneumothorax resulting from air trapped behind the endoluminal lesion were also described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Radiology is unspecific and may reveal features of bronchial obstruction&#46; Chest CT can be useful in characterizing lesions and demonstrating endoluminal tumors&#46; Final diagnosis may be achieved with bronchoscopic direct visualization and biopsy of lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Even so&#44; differentiation of an endobronchial leiomyoma from a BML or a low-grade leiomyosarcoma is especially important&#46; Little or absence of mitotic activity is the most important predictor of benignity of these tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> BML is histologically similar to primary leiomyomas&#44; except that it has estrogen and progesterone positive receptors and usually presents as multiple parenchymal nodules in women with a previous or current history of uterine leiomyomata&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Since no signs of leiomyomatous disease were found in other organs&#44; and hormonal receptors were negative in histology&#44; our case was considered unrelated and therefore a primary endobronchial leiomyoma&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Treatment of endobronchial leiomyomas&#44; whether symptomatic or not&#44; implies resection&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which depends on location&#44; size&#44; base of implantation of lesions&#44; as well as secondary lung destruction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Given the benign nature of these lesions and long-term outcomes after limited excision&#44; treatment is essentially based on conservative techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;9</span></a> Although lobectomy and pneumonectomy have been commonly used in endobronchial leiomyomas treatment&#44; parenchymal resection should be reserved only for situations in which advanced irreversible destruction secondary to chronic infections occurs&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;9</span></a> Bronchoplasty and bronchotomy were also described as an alternative for lesions arising from the main stem or proximal part of the lobar bronchus&#46; <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If complete resection is possible&#44; current knowledge favours&#44; however&#44; bronchoscopic intervention with a variety of techniques&#44; including electrocautery&#44; argon plasma coagulation&#44; cryotherapy and laser being documented with good results&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a>&#46; Best indications include strictly endoluminal tumors&#44; with limited extent within the endobronchial tree and central location&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;10</span></a> Except for cryotherapy&#44; the remaining techniques provide a rapidly target ablation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Nd&#58;YAG laser assisted mechanical debulking through rigid bronchoscopy has been reported in the literature as safe and effective in curative intent treatment of such benign tumors&#44; with a minor rate of complications when used by training physician&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;10</span></a> Our patient presented with a right main bronchus primary leiomyoma located immediately below the main carina&#44; with a limited insertion base&#44; which allowed successful Nd&#58;YAG laser resection and an excellent prognosis&#44; avoiding the need for a higher surgical risk procedure&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Primary endobronchial leiomyomas are rare tumors that must be considered when symptoms of bronchial obstruction develop and persist&#46; In women&#44; a secondary leiomyomatous origin must be excluded&#46; Successful laser resection and excellent prognosis can be achieved in limited extent central endobronchial leiomyomas&#46;</p></span></span>"
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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Os leiomiomas representam menos de 2&#37; de todos os tumores benignos do pulm&#227;o&#46; Apenas um ter&#231;o tem origem endobr&#244;nquica&#44; geralmente apresentando-se como les&#245;es prim&#225;rias solit&#225;rias condicionando obstru&#231;&#227;o da via a&#233;rea&#46; A literatura sobre os leiomiomas endobr&#244;nquicos prim&#225;rios &#233; portanto escassa&#44; incluindo o relato de pouco mais de 100 casos&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Descreve-se o caso de uma doente de 44 anos com sintomas sugestivos de asma br&#244;nquica e uma pneumonia obstrutiva no contexto de um leiomioma prim&#225;rio do br&#244;nquio principal direito&#44; que foi removido com sucesso utilizando o Nd&#58;YAG laser atrav&#233;s da broncoscopia r&#237;gida&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pretende-se real&#231;ar a singularidade do diagn&#243;stico de um leiomioma endobr&#244;nquico prim&#225;rio e a relev&#226;ncia da ressec&#231;&#227;o laser no seu tratamento definitivo&#46; Uma breve revis&#227;o sobre os leiomiomas pulmonares &#233; apresentada ao longo do texto&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Vaz AP&#44; et al&#46; Leiomioma endobr&#244;nquico prim&#225;rio&#8212;ressec&#231;&#227;o laser endosc&#243;pica&#46; Rev Port Pneumol&#46; 2011&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.rppneu.2011.01.002">doi&#58;10&#46;1016&#47;j&#46;rppneu&#46;2011&#46;01&#46;002</span>&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography scan&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Well defined occlusive opacity in the right main bronchus &#40;A&#41; Middle lobe consolidation with air bronchogram and a homolateral loculated pleural effusion &#40;B&#41;&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flexible bronchoscopy&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Right main bronchus before &#40;A&#41; and after endobronchial leiomyoma laser resection &#40;B&#41;&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Histopathologic slide &#40;Hematoxylin and eosin stain&#44; 20x&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Fusocellular proliferation of spindle cells with cigar-shaped nuclei and eosinophilic cytoplasms&#44; with no atypias or areas of necrosis and no mitotic activity&#46;</p>"
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Pulmonology

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