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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Solitary endobronchial papillomas &#40;SEPs&#41; are rare non-invasive tumours mainly described as case reports&#46; They exhibit a broad spectrum of clinical presentations and therefore&#44; misdiagnosis is not uncommon&#46;<a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Still&#44; prompt diagnosis and early treatment are mandatory due to the risk of malignancy&#44; which has been associated to squamous cell subtype&#44; human papilloma virus &#40;HPV&#41; infection&#44; smoking and age greater than 40 years&#46;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a></p><p class="elsevierStylePara">We report a case of a 52-year-old man&#44; heavy-smoker and drinker&#44; referred to a follow-up appointment two months after being admitted for <span class="elsevierStyleItalic">Streptococci</span> pneumonia at our pulmonology ward&#46; His past medical history revealed oligophrenia&#44; chronic bronchitis and an episode of lower limbs erysipela&#46;</p><p class="elsevierStylePara">He had recent complaints of productive cough and minor bleeding sputum&#46; Physical examination was unremarkable and routine blood sample analysis was normal&#46; Chest X-ray showed significant improvements when compared to the initial abnormal findings&#44; but showed a linear opacity at the horizontal fissure of the right lung and a heterogeneous and poorly defined opacity located above the left hilum&#46; Chest computed tomography described fibrotic lesions at the upper right lobe&#44; diffuse thickened bronchial walls and small bronchiectasis in the anterior segment of the upper left lobe&#46; Positron-emission tomography reported a mild increase of metabolic activity in the right hilum region&#46; Videobronchoscopy revealed a bleeding cauliflower lesion on the posterior segment of the right upper bronchus and minor hematic secretions&#46; Bronchial biopsies disclosed bronchial squamous papilloma with moderate metaplasia&#44; cellular atypia and moderate dysplasia of the respiratory epithelium &#40;<a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#41;&#46;</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385619fig1.jpg" alt="Chest X-ray before &#40;A&#41; and after &#40;B&#41; antibiotic treatment for pneumococci pneumonia&#46; &#40;C&#41; Computed tomography scan showing diffuse thickened bronchial walls and small bronchiectasis in the upper left lobe&#46; &#40;D&#41; Positron-emission tomography&#47;Computed tomography with 18-fludeoxyglucose &#40;FDG&#41; displaying increased metabolic activity in the right hilum region&#46; On bronchoscopic examination &#40;E&#41;&#44; a cauliflower lesion was observed on the posterior segment of the right upper bronchus&#46; &#40;F&#41; High-power microscopic appearance of fibrovascular cores surrounded by squamous epithelium &#40;original magnification 100&#215;&#44; haematoxylin and eosin stain&#41;&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; Chest X-ray before &#40;A&#41; and after &#40;B&#41; antibiotic treatment for pneumococci pneumonia&#46; &#40;C&#41; Computed tomography scan showing diffuse thickened bronchial walls and small bronchiectasis in the upper left lobe&#46; &#40;D&#41; Positron-emission tomography&#47;Computed tomography with 18-fludeoxyglucose &#40;FDG&#41; displaying increased metabolic activity in the right hilum region&#46; On bronchoscopic examination &#40;E&#41;&#44; a cauliflower lesion was observed on the posterior segment of the right upper bronchus&#46; &#40;F&#41; High-power microscopic appearance of fibrovascular cores surrounded by squamous epithelium &#40;original magnification 100&#215;&#44; haematoxylin and eosin stain&#41;&#46;</p><p class="elsevierStylePara">HPV DNA has been detected in almost half of the squamous cell papillomas reported so far&#44; why some consider SEPs as HPV-related neoplasms&#46;<a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Nevertheless&#44; as we could verify in our case&#44; detection by <span class="elsevierStyleItalic">in situ</span> hybridization is frequently negative&#46;</p><p class="elsevierStylePara">Treatment options should consider the possibility of malignant transformation&#46; Lung resection surgery or endoscopic removal of the lesion followed by close monitoring of the patient&#44; are equally acceptable alternatives&#46;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> However&#44; some authors favour lung-sparing procedures due to previous descriptions of malignant involvement at distant sites of the lung&#46;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Our patient underwent endoscopic treatment with rigid bronchoscopy and neodymium-YAG laser&#46; A fibreoptic bronchoscopy performed two weeks after the procedure confirmed complete destruction of the endobronchial lesion&#46; Ultimately&#44; the best treatment should be considered on an individual basis but&#44; in our experience&#44; bronchoscopy is a good and reasonable alternative treatment&#46;</p><p class="elsevierStylePara">Corresponding author&#46; anafilomena&#64;hotmail&#46;com</p>"
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Solitary endobronchial papilloma: A case report
A.T.. Castroa,
Corresponding author
anafilomena@hotmail.com

Corresponding author. anafilomena@hotmail.com
, L.. Carvalhoa, S.. Freitasa
a Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Solitary endobronchial papillomas &#40;SEPs&#41; are rare non-invasive tumours mainly described as case reports&#46; They exhibit a broad spectrum of clinical presentations and therefore&#44; misdiagnosis is not uncommon&#46;<a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Still&#44; prompt diagnosis and early treatment are mandatory due to the risk of malignancy&#44; which has been associated to squamous cell subtype&#44; human papilloma virus &#40;HPV&#41; infection&#44; smoking and age greater than 40 years&#46;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a></p><p class="elsevierStylePara">We report a case of a 52-year-old man&#44; heavy-smoker and drinker&#44; referred to a follow-up appointment two months after being admitted for <span class="elsevierStyleItalic">Streptococci</span> pneumonia at our pulmonology ward&#46; His past medical history revealed oligophrenia&#44; chronic bronchitis and an episode of lower limbs erysipela&#46;</p><p class="elsevierStylePara">He had recent complaints of productive cough and minor bleeding sputum&#46; Physical examination was unremarkable and routine blood sample analysis was normal&#46; Chest X-ray showed significant improvements when compared to the initial abnormal findings&#44; but showed a linear opacity at the horizontal fissure of the right lung and a heterogeneous and poorly defined opacity located above the left hilum&#46; Chest computed tomography described fibrotic lesions at the upper right lobe&#44; diffuse thickened bronchial walls and small bronchiectasis in the anterior segment of the upper left lobe&#46; Positron-emission tomography reported a mild increase of metabolic activity in the right hilum region&#46; Videobronchoscopy revealed a bleeding cauliflower lesion on the posterior segment of the right upper bronchus and minor hematic secretions&#46; Bronchial biopsies disclosed bronchial squamous papilloma with moderate metaplasia&#44; cellular atypia and moderate dysplasia of the respiratory epithelium &#40;<a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#41;&#46;</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385619fig1.jpg" alt="Chest X-ray before &#40;A&#41; and after &#40;B&#41; antibiotic treatment for pneumococci pneumonia&#46; &#40;C&#41; Computed tomography scan showing diffuse thickened bronchial walls and small bronchiectasis in the upper left lobe&#46; &#40;D&#41; Positron-emission tomography&#47;Computed tomography with 18-fludeoxyglucose &#40;FDG&#41; displaying increased metabolic activity in the right hilum region&#46; On bronchoscopic examination &#40;E&#41;&#44; a cauliflower lesion was observed on the posterior segment of the right upper bronchus&#46; &#40;F&#41; High-power microscopic appearance of fibrovascular cores surrounded by squamous epithelium &#40;original magnification 100&#215;&#44; haematoxylin and eosin stain&#41;&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; Chest X-ray before &#40;A&#41; and after &#40;B&#41; antibiotic treatment for pneumococci pneumonia&#46; &#40;C&#41; Computed tomography scan showing diffuse thickened bronchial walls and small bronchiectasis in the upper left lobe&#46; &#40;D&#41; Positron-emission tomography&#47;Computed tomography with 18-fludeoxyglucose &#40;FDG&#41; displaying increased metabolic activity in the right hilum region&#46; On bronchoscopic examination &#40;E&#41;&#44; a cauliflower lesion was observed on the posterior segment of the right upper bronchus&#46; &#40;F&#41; High-power microscopic appearance of fibrovascular cores surrounded by squamous epithelium &#40;original magnification 100&#215;&#44; haematoxylin and eosin stain&#41;&#46;</p><p class="elsevierStylePara">HPV DNA has been detected in almost half of the squamous cell papillomas reported so far&#44; why some consider SEPs as HPV-related neoplasms&#46;<a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Nevertheless&#44; as we could verify in our case&#44; detection by <span class="elsevierStyleItalic">in situ</span> hybridization is frequently negative&#46;</p><p class="elsevierStylePara">Treatment options should consider the possibility of malignant transformation&#46; Lung resection surgery or endoscopic removal of the lesion followed by close monitoring of the patient&#44; are equally acceptable alternatives&#46;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> However&#44; some authors favour lung-sparing procedures due to previous descriptions of malignant involvement at distant sites of the lung&#46;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Our patient underwent endoscopic treatment with rigid bronchoscopy and neodymium-YAG laser&#46; A fibreoptic bronchoscopy performed two weeks after the procedure confirmed complete destruction of the endobronchial lesion&#46; Ultimately&#44; the best treatment should be considered on an individual basis but&#44; in our experience&#44; bronchoscopy is a good and reasonable alternative treatment&#46;</p><p class="elsevierStylePara">Corresponding author&#46; anafilomena&#64;hotmail&#46;com</p>"
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Article information
ISSN: 08732159
Original language: English
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