Abstract | March 24, 2024

A Rare Case of Primary Endobronchial Schwannoma: A Case Report

Ferdusy Dia, MD, Internal Medicine, PGY2, Novant Health, Wilmington, NC

Katherine R. Ruiz, MD, Internal Medicine, PGY2, Novant Health, Wilmington, NC; Bhumi Patak, MD, Internal Medicine, PGY2, Novant Health, Wilmington, NC; Brian Legere, MD, Pulmonary Critical Care, Faculty, Novant Health, Wilmington, NC

Learning Objectives

  1. Understanding the importance of continued monitoring of pulmonary lesions found on initial bronchoscopy
  2. Recognizing the need for individualized management of rare lesions with progression of symptoms.

Introduction: Endobronchial schwannomas are very rare and benign tumors that arise from the nerve sheath of the peripheral nervous system. They are usually seen as solitary masses and in rare cases, the first presentation are in the lungs. The incidence of primary neurogenic tumors of the lung sheath, are estimated to be 0 to 2% of pulmonary neoplasms. Here, we present a case of a primary endobronchial schwannoma in the lungs.

Case presentation: A 66-year-old female presented with weakness, chest pain, shortness of breath and hemoptysis. Her past medical history included hypertension and COPD. She is a current smoker with a 40-pack year history. On physical exam, she was noted to have decreased breath sounds over the right lung field, with otherwise normal examination. Bloodwork was unremarkable. Initial CT scan showed moderate to severe emphysema with a right middle lobe nodule measuring 8mm in size. A bronchoscopy was performed and it had evidence of inflammatory cells with a 8mm sessile mass in the right bronchus intermedius. Due to high risk factors for malignancy, a follow up CT scan was recommended. Over time, she continued to experience debilitating weakness, progressive shortness of breath and increased frequency of coughing spells. A repeat CT scan was performed and there was evidence of increase in mass size, which now measured 11mm, with significant airway compromise.  A bronchoscopy with biopsies was performed again due to concerns for impending airway collapse.

Final diagnosis: Pathology from the biopsies revealed a diagnosis of benign endobronchial schwannoma. Immunohistochemical stains revealed spindle cells positive for S-100. 

Management/follow-up: She was referred to Interventional Pulmonology for further treatment with endobronchial cryotherapy.

References and Resources

  1. Imen, T., Sadok, B. M., Raoudha, A., Ksissa, S., Yosra, B., Yosr, B. A., Meriem, K., Soumaya, B., Nadia, K. B., Leila, B., & Jalel, K. (2021). Endobronchial schwannoma in adult: A case report. Respiratory medicine case reports, 33, 101396. https://doi.org/10.1016/j.rmcr.2021.101396.
  2. Nasiri H, Zeki AA,Timothy. A rare diagnosis: Endobronchial schwannoma. Journal Res Diseases 2010; Available at: www.physcianpractice.com.
  3. Dumoulin, Elaine MD, FRCPC*; Gui, Xianyong MD, PhD†; Stather, David R. MD, FRCPC, FCCP‡; MacEachern, Paul MD, FRCPC, FCCP‡; Tremblay, Alain MDCM, FRCPC, FCCP‡. Endobronchial Schwannoma. Journal of Bronchology & Interventional Pulmonology 19(1):p 75-77, January 2012. | DOI: 10.1097/LBR.0b013e318241e5aa.
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