Abstract Introduction Tumors in the tracheobronchial tree are rare, accounting for less than 0.4% of all body tumors, and most are malignant. Schwannomas are tumors of the peripheral nervous system that arise in the myelin nerve sheath. Most schwannomas occur in posterior mediastinum and do not involve the airways. Pulmonary schwannomas are quite rare and their diagnosis is generally delayed and dependent on tissue sampling because symptoms are vague and may develop over a period of years. In large sessile tumors, surgical resection may reduce local relapse compared with bronchoscopic resection but carries higher postoperative morbidity and mortality. Case Report A 68-year-old female, non-smoker, with past medical history significant for hypertension and osteoporosis presented with fever, cough and shortness of breath due to community acquired pneumonia. A CT chest revealed the presence of an endotracheal lesion, 1 cm in size. Fiberoptic bronchoscopy revealed a round, shiny lesion with smooth contours occupying close to 50% of the tracheal lumen. A decision to proceed with rigid bronchoscopy under general anesthesia. The endotracheal tumor was detected 2 cm from the carina, originating from the posterior wall of the trachea. The tumor was tan in color, wide-based “sessile”, polypoid in appearance and covered with small superficial non-pulsating blood vessels. In anticipation of bleeding, Holmium laser, 600-micron fiber was introduced via the RB. Coagulation was performed using 15Hz frequency and 15 watts of power. The tumor did not appear to coagulate very well as it did not change in color. Then the rigid forceps was used, and resection was repeated until 80% of the tumor was resected successfully. Then ablation via Holmium Laser of the wide base was carried out until the tumor was completely dissipated. The pathology report was consistent with benign schwannoma. Magnetic Resonance Imaging (MRI) of the thorax was performed to exclude extraluminal component of the schawnnoma. Bronchoscopy was performed at 4 months, 12 months, and 18 months intervals with no recurrence observed. Conclusion Despite its rarity, endotracheal schwannoma should be considered in the differential diagnosis of central airway tumors, especially when the above, unique bronchoscopic characteristics are present. Resection via rigid bronchoscopy technique is safe and effective with low recurrence rate for endoluminal tumors. This abstract is funded by: none
Feghali et al. (Fri,) studied this question.