Women Presenting With Asthma and Persistent Wheezing

A Case Series
      A 54-year-old African-American woman with a longstanding history of smoking, asthma, gastroesophageal reflux disease, and chronic sinusitis presented with persistent dry cough, wheezing, and intermittent shortness of breath. Physical examination revealed diffuse expiratory wheezing with decreased air movement throughout all lung fields. Inspiratory squeaks were noted in the left lower posterior chest. A CT scan of the chest showed narrowing of the posterior segment of the left lower lobe bronchus with soft tissue density (Fig 1A).
      Figure thumbnail gr1
      Figure 1A, CT Chest image showing narrowing of the posterior segment of the left lower lobe bronchus with soft tissue density. B, Bronchoscopy showing pedunculated polypoid endobronchial lesion at the bifurcation of the left lower lobe posterobasal segment bronchus. C, Endobronchial biopsy showing a submucosal tumor consisting of sheets of eosinophilic cells underlying the bronchial epithelium (arrow) that has a thickened basement membrane consistent with the patient’s clinical history of asthma. A higher power view of the tumor cells shows characteristic granular cell tumor histopathologic features, including large cells with granular cytoplasm and small nuclei (inset). D, The granular cells infiltrate submucosal glands (arrowheads) and are S-100 protein positive by immunohistochemical stain (E, red). F, Endobronchial biopsy performed 6 months later showing a granular cell tumor underlying the bronchial epithelium (arrow) with identical histopathologic features as the original tumor. Original magnification, 200×; inset, 1,000×.
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