Benign tumors of the tracheobronchial tree are rare and their incidence ranges from 1-5% of all tumors.These tumors are usually peripheral and endobronchial involvement is seldom seen. We describe a case of an endobronchial chondroma which was left untreated for 4 years due to non-compliance and grew to cause complete left lung collapse.
A 54 year old male was evaluated in the pulmonary clinic for a positive tuberculin test and persistent cough. Chest radiograph showed left upper lobe collapse. This prompted a bronchoscopy which revealed a tumor at the bifurcation of the left mainstem bronchus with complete occlusion of left upper lobe orifice. Biopsy showed benign cartilaginous tissue consistent with a chondroma. The patient was lost to follow up for 4 years when he returned with increasing cough, dyspnea and fevers. Chest xray and CT showed near total collapse of left lung with post obstructive pneumonia. A bronchoscopy showed a large tumor protuding from the left mainstem bronchus with 100% occlusion of the lumen. Specimens at bronchoscopy were identical to the tissue obtained four years back. V/Q scan did not show any ventilation or perfusion of the left lung. FEV1 was 1.92L which was reduced from 2.4L at the time of the initial presentation.The patient underwent a left pneumonectomy.
Chondromas are rare benign pulmonary tumors. They are almost always found in the lung parenchyma and can be seen in association with Carney’s complex(gastric stromal sarcoma, extra-adrenal paraganglioma with pulmonary chondroma). Failure to follow up on part of our patient led to more extensive surgery with greater loss of pulmonary function. He was not a candidate for laser resection of the tumor as the lung distal to the obstruction was destroyed.
Benign endobronchial tumors although rare should be treated early aggressively with either laser resection or surgery. If left alone they have the potential to destroy an entire lung.
P. Grover, None.