Optimal treatment for primary benign intratracheal schwannoma: A case report and review of the literature

Abstract

A 53-year-old male was admitted to Xinhua Hospital (Shanghai, China) due to coughing and dyspnea that had persisted for half a year, with aggravation of chest tightness and dyspnea for 1 week. Chest computed tomography (CT) revealed a mass within the distal third of the trachea. Flexible bronchoscopy confirmed an ~2.0 cm, smooth, tan-colored mass in the trachea, 2 cm above the carina. Endoscopic resection by argon plasma coagulation combined with electronic snaring was applied, however, recurrence was found 2 weeks later. Finally, the tumor was completely removed by surgery and the post-operative course was uneventful. Since schwannoma is rare in the intrapulmonary region and extremely rare in the trachea, a review of 51 cases of primary tracheal schwannoma previously reported in the English literature was performed. The majority of cases occurred in adults and were usually located in the distal third of the trachea. The predominant tumor size was 1-3 cm and airway obstruction symptoms were common. Half of the patients were misdiagnosed with asthma, and CT scan and bronchoscopy were contributory to the correct diagnosis. The treatment of choice depended on the patient's condition, however, surgery should be chosen in the event of local recurrence following endoscopic treatment.

Keywords: clinical characteristics; intratracheal tumor; management of schwannoma; schwannoma.

Figure 1.

Intratracheal schwannoma on computed tomography scan and bronchoscopy examination. (A) Coronal reconstruction and (B) sagittal reconstruction showing the tumor in the lumen of the trachea (arrow), arising from the posterior tracheal wall. (C) Bronchoscopy revealed that ~90% of the trachea was obstructed by the round, tan-colored mass, which was covered with several small vessels on the surface (arrow).

Figure 2.

Pathological findings. The tumor was composed of spindled cells and elongated nuclei arranged in a palisading pattern, as shown by (A) hematoxylin and eosin staining (magnification, ×100). (B) The tumor showed positivity for S-100 protein on immunohistochemical staining (magnification, ×100).