Surgical Resection of a Mixed Bronchial Papilloma with Elevated Tumor Markers and 18F-fluorodeoxyglucose Positron Emission Tomography Uptake: A Case Report

We present the case of a 78-year-old man who was referred to our institution in June, due to abnormal findings on a chest radiograph. Chest computed tomography (CT) revealed a polygonal lesion measuring 30 mm in diameter, with irregular margins in the lingular segment of the left upper lobe. The lesion was initially considered to be an inflammatory nodule and was managed through observation without intervention. On follow-up CT in August, the lesion persisted, and bronchoscopy was performed, which revealed a white nodular lesion in the left B4b bronchus. Although transbronchial biopsy findings were consistent with bronchial papilloma, subsequent 18F-fluorodeoxyglucose positron emission tomography (18FFDG-PET) showed intense FDG uptake in the lesion, with a maximum standardized uptake value of 13.41, raising suspicion of concomitant malignancy. A thoracoscopic left lingular segmentectomy was performed. Histopathological analysis of the surgical specimen confirmed a mixed bronchial papilloma without malignancy or infection. Solitary bronchial papilloma is a rare benign tumor with the potential for malignant transformation. Treatment decisions should be guided by a multidisciplinary approach, including collaboration with thoracic surgeons, and should be based on tumor characteristics and patient-specific factors.