Flexible bronchoscopic complete removal of the longest ever documented -7cm tumor- A nerve sheath tumor along with EUS-B-FNA for staging in the same sitting under conscious sedation

V. Chachra*^a (Dr), A. Mendiratta^a (Dr), M. Ketkar^a (Dr), G. Agarwal^a (Dr)

^a Max Superspeciality Hospital, Dehradun, INDIA

* vaibhavchachra@gmail.com

Background:

In the lung,neurogenic tumors are a rare clinical entity.Malignant tumors causing central airway obstruction usually are provided with a palliative form of intervention,with minimal invasive techniques including electrocautery,argon-plasma or cryotherapy.

Case Report:

A 64 year old female patient with history of asthma,diabetes and hypertension having non resolving shortness of breath despite treatment optimization.A HRCT chest was suggestive of soft tissue opacity in the right main bronchus and protruding out at carina.Patient came to us with 2 failed rigid bronchoscopy attempts for the lung mass causing central airway obstruction and even a diagnosis was yet to be proven.The mass completely occluded the right main bronchus.PET scan was suggestive of active multiple mediastinal lymph nodes with non tracer avid bronchial mass in right intermediate bronchus.She was also subjected to serum 5-alpha DHT,5-HIAA, Chromogranin A, which all were normal.

Eventually through flexible bronchoscopy the tumor extraction with the help of electrocautery snaring and argon-plasma coagulation was done and the entire 7 centimeter tumor was removed successfully in a single piece.In the same sitting PET positive lymph node sampling was also done through esophageal route(EUS-B-FNA).The tumor was sent for immunohistochemistry evaluation which turned out to be primary pulmonary schwannoma.Lymph nodes were only reactionary.

Conclusion:

Flexible bronchoscopy at times can be superior than rigid in a few therapeutic interventions where distal airways are involved.Not only the longest tumor was retrieved itself with a flexible bronchoscope it was not a palliative form of treatment but also complete recanalization and restoration of the airway along with a tumor free patient.Also in the same sitting staging of the tumor through the esophageal route from an Endobronchial Ultrasound(EUS-B-FNA) was done and achieved the desired outcome in only councious sedation.The patient was discharged 36 hours post procedure tumor free.

Disclosure of funding source(s): none