Noninvasive papillary endobronchial lesions are among the least common of pulmonary neoplasms. We de­scribe the occurrence of a papillary squamous tumor sur­rounding an aspirated sunflower seed foreign body.

Case Report

A 48-year-old man presented to our hospital with right-sided pleural pain and cough. The initial chest x-ray film revealed a middle lobe infiltrate. The outpatient physician treated this patient with erythromycin for his diagnosis of community-acquired pneu­monia. Twenty-four hours later, the patient returned. The right lower lobe was now involved, and a small pleural effusion was seen. The WBC count was 18,700/m3. Pleural fluid examination revealed an LDH of 1,028; protein, 3.7 g/dl; and glucose, 48 mg/dl. Cultures of sputum and pleural fluid were negative but the intermediate PPD was positive. A CT of the chest revealed right middle and lower lobe atelectasis and a loculated right pleural effusion. There were no other abnormalities. Because of the atelectasis and a 50- pack year history of cigarette smoking, fiberoptic bronchoscopy was performed. cialis 10 mg

FIGURE 1. Biopsy specimen reveals

FIGURE 1. Biopsy specimen reveals well-differentiated stratified squamous epithelium of a papillomatous configuration (H and E, original magnification x 50).

Immediately distal to the takeoff of the right middle lobe bronchus, which was narrowed, a white cauliflower-like lesion protruded from the anterior wall. Multiple biopsies revealed well- differentiated stratified squamous epithelium of a papillomatous configuration (Fig 1). Fragments of an unusual foreign body were appreciated in the deeper biopsies (Fig 2). Several days later, rigid bronchoscopy was carried out. A brown-black foreign body was extracted from the depths of the papillomatous growth. On gross examination, it was a discolored but well-preserved sunflower seed husk. Microscopic examination of the husk revealed this to be the foreign material previously noted.

FIGURE 2. Fragments of an unusual foreign

FIGURE 2. Fragments of an unusual foreign body were noted in deeper biopsy specimens (H and E, original magnification x 20).

After the foreign body removal, the patients pulmonary findings resolved and he is free of symptoms or signs of abnormality two years later.
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