Obstructive Lung Diseases |

Central Airway Obstruction: We Struck a Nerve! FREE TO VIEW

Peter Liebling, MD; William Bishop, MD; Franklin Ho, MD; Farhad Mazdisnian, MD
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UC Irvine Medical Center, Orange, CA

Chest. 2015;148(4_MeetingAbstracts):753A. doi:10.1378/chest.2251041
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SESSION TITLE: Obstructive Lung Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Endobronchial lesions are a common problem in pulmonary medicine. We present a very rare and unexpected cause of central airway obstruction.

CASE PRESENTATION: A 62 year old female with past medical history of breast cancer treated with bilateral mastectomy and chemotherapy two years prior to presentation developed a right mainstem endobronchial lesion on surveillance CT scans. Her symptoms included dyspnea with exertion and orthopnea. There was no cough, wheeze, fevers, chills, or weight loss. Her physical examination was only notable for bilateral mastectomies. Her lungs were clear to auscultation. The patient underwent flexible bronchoscopy, which demonstrated a large flesh colored mass with some hypervascularity in the right mainstem bronchus with obstruction of approximately 75% of the lumen. A forceps biopsy was done and sent to pathology. Histology showed a combination of hypercellular and hypocellular (Antoni A and B) areas. There were elongated, spindled cells with indistinct cytoplasmic borders arranged in short fascicles, and Verocay bodies were also present. The overlying bronchial mucosa was normal. Immunohistochemical stain for S-100 was strongly positive confirming the diagnosis of schwannoma. She underwent rigid bronchoscopy with laser ablation of the mass with excellent post-operative results. Repeat flexible bronchoscopy several weeks after demonstrated no evidence of recurrence with a well healed scar. She was asymptomatic at follow-up.

DISCUSSION: Endobronchial schwannomas are rare, benign tumors that fall into the category of peripheral nerve sheath tumors. This catagory includes schwannomas, neurofibromas, perineuriomas, ganglioneuromas and malignant peripheral nerve sheath tumors. They arise in the submucosa from Schwann cells surrounding peripheral nerves. There are less than 20 other cases of endobronchial schwannoma documented in the adult English literature. They can be asymptomatic, but sometimes present with cough, dyspnea, hemoptysis, or obstructive pneumonia. They have been shown to be FDG-PET avid in several cases. The prognosis is excellent, as resection is often curative and metastasis has not been described.

CONCLUSIONS: Schwannomas are a rare type of peripheral nerve sheath tumor that can present endobronchially. They are very amenable to resection with rigid bronchoscopy and carry an excellent prognosis.

Reference #1: Jung YY, Hong ME, Han J, et al. Bronchial schwannomas: Clinicopathologic analysis of 7 cases. Korean J Pathol 2013;47:326-331.

DISCLOSURE: The following authors have nothing to disclose: Peter Liebling, William Bishop, Franklin Ho, Farhad Mazdisnian

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