A Rare Case of Endobronchial Fibrous Tumor Resected Safely With Flexible Bronchoscopy and Electrocautery Snare

October 2015, Vol 148, No. 4_MeetingAbstracts

Lung Pathology | October 2015

A Rare Case of Endobronchial Fibrous Tumor Resected Safely With Flexible Bronchoscopy and Electrocautery Snare Virgil Secasanu, MD; Rehmat Awan, MBBS; Akrum Al-Zubaidi, DO; Steve Groshong, MD; James Ellis, MD; Ali Musani, MD University of Colorado, Aurora, CO Chest. 2015;148(4_MeetingAbstracts):630A. doi:10.1378/chest.2259156

Abstract SESSION TITLE: Lung Pathology Student/Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Except hamartomas and carcinoid tumors, all benign lung tumors are very rare [1]. Patients commonly present with cough, dyspnea, or hemoptysis. Surgical resection is usually the treatment of choice [2]. We report here a rare case of a patient with an endobronchial fibrous tumor that was completely resected with bronchoscopy and electrocautery snare polypectomy. CASE PRESENTATION: A 66 year old man with no significant past medical history was referred for evaluation of dyspnea on exertion and obstructive sleep apnea. He denied chest pain, hemoptysis, fever, chills, or weight loss. There was no past history of pneumonia, lung collapse, or pleural effusion. He had a 4 pack-year smoking history. Physical examination revealed normal oxygen saturation on room air, decreased breath sounds in the left posterior fields, and no clubbing. Pulmonary function tests showed FEV1 of 58% without bronchodilator response and a normal flow volume loop. A CT chest demonstrated near complete obstruction of the Left Main Bronchus (LMB) by a 1.2cm pedunculated mass (Fig 1A). Flexible bronchoscopy was performed with rigid bronchoscopy as backup, confirming the pedunculated mass with visible vascular supply in the stalk. An electrocautery snare was passed around the stalk (Fig 1B). With simultaneous cutting and coagulation, the lesion was entirely resected without blood loss (Fig 1C). Pathologic examination of the mass demonstrated a lobulated bland fibrous tumor lined by squamous metaplasia (Fig 1D). Immuno-stains were negative for S100 and positive for bcl2 and CD34, confirming the diagnosis of a benign fibrous tumor. The patient’s dyspnea and sleep apnea instantaneously improved. DISCUSSION: Endobronchial fibrous tumors are very rare benign lesions. Immunostaining can be positive for bcl2 and CD34. Surgical resection is usually the preferred treatment. In our patient the tumor was completely resected without complications using an electrocautery snare and flexible bronchoscopy. Electrocautery generates heat with an electric current to cut and coagulate tissue. It is a useful technique when resecting large vascular tumors [3]. Compared to other ablative tools such as laser and cryotherapy, electrocautery’s ancillary tools (such as a snare) make it especially versatile. Other benefits of electrocautery include its lower cost, ease of use, and wide availability. CONCLUSIONS: Endobronchial benign tumors are very rare and usually require surgical resection. Here we present a case of a pedunculated endobronchial fibrous tumor safely resected with electrocautery and flexible bronchoscopy.

Reference #1: Miller DR. Benign tumors of the lung and tracheobronchial tree. Ann of Thorac Surg. 1969;8(6):542-560. Reference #2: Li Z, et al. Surgical approaches of endobronchial neoplasms. J Thorac Dis. 2013;5(S4):S378-S382. Reference #3: Wahidi MM, et al. The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction. J Thorac Oncol. 2011;6:1516-1520. DISCLOSURE: The following authors have nothing to disclose: Virgil Secasanu, Rehmat Awan, Akrum Al-Zubaidi, Steve Groshong, James Ellis, Ali Musani No Product/Research Disclosure Information