Cytological Diagnosis of Pulmonary Hydatid disease by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Cyst Fluid.

occasions diagnostic difficulties can arise with perivascular epithelioid cell tumors and alveolar sarcoma. Although this tumor type was initially described as benign and slow growing, with no tendency to recur, it has occasionally been shown to be malignant. The diagnosis of malignancy requires meeting at least 3 of the Fanburg-Smith criteria.10,11 None of the cases in our series could be considered malignant according to these criteria. However, respiratory GCTs can cause respiratory symptoms of type hemoptysis, cough, or dyspnea, which coupled with the fact that this tumor type lacks well-defined limits, can suggest a clinical diagnosis of malignancy (Table 1). In principle, the treatment for GCTs is not surgical, although the tumor size and certain pulmonary involvement could make surgery advisable. In this case, the surgery should be conservative. If the tumor is smaller than 8 mm, endoscopic resection is feasible. In the case of multiple lesions, clinical follow-up using imaging techniques and bronchoscopy are advisable. In our series, we opted for clinical follow-up for 2 patients, endoscopic polypectomy in 1 of them. In the 2 remaining patients, it was interpreted clinically that the tumor could be malignant and, therefore, proceeded to pulmonary bilobectomy. No complications resulting from the disease or surgery were detected in the follow-up period of at least 10 years. In summary, respiratory GCTs are benign neoplasms with a clear association with tobacco use and can arise as the consequence of chronic irritation of the bronchial nerves and whose treatment should be a clinical follow-up or endoscopic or surgical resection depending on tumor size, symptoms, and obstructive complications.