Fig. 1(A) Pneumonia observed on chest X-ray. (B) Corresponding computed tomography scan showing a polyploid bronchial mass and postobstructive pneumonia. (C) A tumor located in the carina with lobulated contour and extraluminal extension. (D) An endobronchial nodule. (E) A lobulated mass completely obstructing the bronchial lumina. (F) A well-circumscribed, raised lesion. (G) A whitish, round mass almost completely obstructing the bronchial lumen. (H) Bronchoscopy showing a whitish, smooth surfaced tumor at the carina. (I) A bronchoscopically resected tumor showing a smooth, lobulated contour. (J) Patient no. 6 shows segmental bronchial involvement and undergo a left lower lobectomy. (K) Surgical resection of a recurred tumor is performed in case no. 2. (L) Bronchial cartilage and a well-circumscribed tumor at low magnification. (M) Tumor showing a palisading arrangement of nuclei (Verocay bodies). (N) Eosinophilic infiltration and collagen deposition is noted in some cases. (O) Tumor with ancient change showing degenerative cells with pleomorphic, hyperchromatic nuclei. (P) Positive immunohistochemical staining for S100 protein can help make a correct diagnosis.
Table 1.Demographics and characteristics of seven patients with bronchial schwannoma
Case No. |
Sex/Age(yr) |
Size (cm) |
Location |
Clinical presentation |
Duration of symptom (mo) |
Clinical/Radiologic impression (differential diagnosis list) |
Bronchoscopic findings |
Treatment |
Histology |
1 |
F/81 |
4.0 |
Left main bronchus |
Dyspnea |
19 |
Tumor, not otherwise specified |
Complete narrowing of left main bronchus by lobulated mass |
Rigid bronchoscopy for mass removal |
|
2 |
F/52 |
3.0 |
Carina |
Dyspnea, hemoptysis |
9 |
Malignant tumor such as squamous cell carcinoma or carcinoid tumor |
Carinal mass with total obstruction of distal trachea and right and left main bronchus |
Rigid bronchoscopic tumor removal (initial), surgical resection for recurred tumor |
|
3 |
F/21 |
2.1 |
Left main bronchus |
Cough, fever |
1 |
Adenoid cystic carcinoma, leiomyoma, mucoepidermoid carcinoma, cylindroma, schwannoma |
Complete obstruction of proximal left main bronchus by round beefy mass |
Bronchoscopic tumor excision |
Eosinophilic infiltration |
4 |
F/50 |
2.8 |
Carina and right main bronchus |
Recurrent cough, dyspnea |
4 |
Metastatic breast cancer (history of breast cancer) |
50% obstruction of distal trachea by white tumor |
Rigid bronchoscopic mass excision |
Ancient change |
5 |
F/58 |
1.5 |
Bronchus intermedius |
Pleuritic chest pain |
2 |
Peripheral organizing pneumonia |
Well-circumscribed raised lesion on the lateral wall side of bronchus intermedius |
Bronchoscopic tumor excision |
Ancient change |
6 |
M/16 |
2.3 |
Anterior segmental brochus of left lower lobe |
Asymptomatic |
- |
Atypical carcinoid |
Smooth surfaced mass with visible vessels on the surface |
Lobectomy, left lower lobe |
|
7 |
M/36 |
3.0 |
Right main bronchus |
Dyspnea |
7 |
Inflammatory pseudotumor (diagnosis of previous biopsy at outside hospital) |
Almost complete obstruction of right main bronchus by beefy mass |
Bronchoscopic tumor excision |
|