Diagnosis of calcified endobronchial sarcoma using transbronchial cryobiopsy: Primary pulmonary spindle cell sarcoma case.

EY. Kim^a (Dr), HS. Kim^b (Prof), CY. Lee^c (Prof), SH. Yong*^a (Prof)

^a Division of Pulmonology and Critical Care, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF ; ^b Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF ; ^c Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF

* roneirire@yuhs.ac

Background:

Traditionally, a bronchoscopic forcep biopsy could not remove endobronchial mass with severe inner calcification (such as pulmonary sarcoma). However, cryo-biopsy can be helpful in the removal of such lesions, both safely and effectively.

Case report:

A 74-year-old Asian woman was referred to a pulmonologist for further evaluation of chronic cough with persistent wheezing. Due to her symptom, she was initially diagnosed with uncontrolled asthma and received treatment but had minimal improvement. Sequentially, chest computed tomography (CT) was performed. CT scan revealed an approximately 2.6 cm sized lobulated lesion with punctate calcifications at the distal part of the left main bronchus, which was suspected as hamartoma or aspergilloma with calcification. Fiberoptic bronchoscopy (FOB) with cryo-biopsy was planned to simultaneously remove and confirm the pathologic diagnosis. At the first FOB, a calcified endobronchial lesion causing near-total obstruction of the left main bronchus was identified. Over hours were spent removing the calcified layer using cryoprobe to maintain airway patency. However, due to severe calcification, cannulation could not be achieved in the first attempt, so a stepwise attempt was planned. Two days later, a subsequent FOB was performed. In the second procedure, more of the mass was removed, and a severely calcified inner core was observed. We planned surgical removal for cannulation. After the second approach, the final pathologic diagnosis was approved by the pathologist. Calcified endobronchial mass was primary lung synovial spindle cell sarcoma. The plan was revised, and the patient was referred to both oncologist and a thoracic surgeon for treatment of sarcoma.

Conclusion:

Pathologic confirmation and partial removal of calcified endobronchial mass were successfully performed via stepwise cryo-biopsy. Cryo-biopsy might be an alternative method to surgery in patients with a high risk of perioperative complications with optimal safety and diagnostic power.

Disclosure of funding source(s): none