Intramural neurofibroma of the trachea treated by multiple stents

A rare case report of endobronchial neurofibroma treated with transbronchial endoscopic resection and literature review

RATIONALE

Endobronchial neurofibroma is an extremely rare neoplastic disease. The majority of endobronchial neurofibroma are symptomatic, but nonspecific. The treatment of endobronchial neurofibroma is controversial that surgery is previously considered to be the main option. With the development of bronchoscopic intervention, most endobronchial neurofibroma can be treated with transbronchial endoscopic resection with few complications. Here we reported a case of diagnosed endobronchial neurofibroma that was successfully resected with transbronchial electrical snaring and laser coagulation. Moreover, the relevant literature was reviewed to raise awareness of this disease.

PATIENT CONCERNS

A 57-year-old man presented to our hospital with cough, sputum, and shortness of breath for 2 days. Physical examination was normal. Laboratory tests revealed moderately increased C-reactive protein. Chest computed tomography showed a 10 × 8 mm round, polypoid-shaped nodule located in the left main bronchus, which was heterogeneous after contrast enhancement. It demonstrated a smooth, round, hypervascularized neoplasma obstructing most of the lumen of the upper left main bronchus under bronchoscopy.

INTERVENTIONS AND OUTCOMES

The tumor was removed with electrical snaring and laser coagulation completely instead of surgical resection, without any complications. Pathologically, it was confirmed of endobronchial neurofibroma. Repeated bronchoscopy showed no recurrence of the tumor, and the procedure site healed with a little of fibrotic scar formation.

LESSONS

Endobronchial neurofibroma is rare. Although the standard treatment for endobronchial neurofibroma is surgery, transbronchial endoscopic resection (electrical snaring and laser coagulation) is an applicable option, especially for those lesions strictly in the lumen.

Diffuse Tracheobronchial Neurofibromatosis and Papillomatosis. Key Diagnostic Aspects and Treatment

Diffuse tracheobronchial neurofibromatosis is a rare condition and its clinical manifestations include obstruction, cough, wheezing and dyspnea. Furthermore, the limited amount of data makes treatment decisions challenging. In addition, airway papillomatosis tends to affect the upper airway and the larynx, in the form of well-delimited lesions leading to obstruction, predominantly in children. Diffuse involvement of the trachea and the bronchial tree, as well as its association with neurofibromatosis, have been rarely reported in adults.