Background. Primary tracheal schwannoma is a rare disease. We report a case of tracheal schwannoma originating in the thoracic trachea. Case. A 26-year-old woman, who had been treated for bronchial asthma, complained of progressive dyspnea. Computed tomography scans revealed the presence of a tumor 15mm in diameter in the thoracic trachea. She was referred to our hospital, and endoscopic resection was performed with a high frequency electrosurgical snare under general anesthesia. There has been no sign of recurrence during the 1-year period after the operation. Conclusion. We report a case of tracheal schwannoma. Endoscopic resection with high frequency electrosurgical snare was useful in this case, successfully eliminating the schwannoma.

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Background. Endobronchial metastases secondaries to extrapulmonary malignant tumors are rare. However, the increasingly widespread use of bronchial endoscopy has increased the number of reported cases. Case. An 82-year-old man with a history of surgical resection for rectal cancer 3 years earlier consulted our hospital with a chief complaint of coughing. A nodule measuring about 2cm in pulmonary right apex and a polypoid tumor extending from the trachea to the right main bronchus were detected. The histological examination demonstrated metastasis of rectal cancer. A 69-year-old man had undergone surgical resection for left ureteral cancer 8 months earlier. The patient was asymptomatic but multiple pulmonary nodules were apparent on the follow-up CT scan. Bronchial endoscopy demonstrated occlusion of the right B^8 by tumor, which was cytologically diagnosed as metastasis from ureteral cancer. These two cases were both diagnosed with endobronchial metastases, which is a rare form of metastatic lung tumor. The rectum is a common site of primary lesions, but to the best of our knowledge, this is the first report of endobronchial metastasis from ureteral cancer. Conclusion. We encountered 2 cases of endobronchial metastases. Bronchial endoscopy contributed to the differential diagnosis from primary lung cancer.

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Background. We report a case of pulmonary sarcoidosis with endobronchial involvement and bilateral pleural effusion. Case. A 27-year-old man was admitted because of dry cough and shortness of breath. Chest radiography and computed tomography (CT) revealed bilateral mediastinal and hilar lymphadenopathy and bilateral pleural effusion. The pleural effusion revealed lymphocyte-predominant exudate. Bronchoscopy showed bronchial mucosal irregularity and small nodules. The bronchoalveolar lavage fluid revealed an increase in the number of lymphocytes and the CD4/CD8 ratio. Transbronchial lung biopsy and bronchial biopsy showed non-caseating epithelioid cell granuloma. These findings are compatible with sarcoidosis. Corticosteroid therapy immediately improved the symptoms, pleural effusion and bronchoscopic findings. Conclusion. This is a rare case of pulmonary sarcoidosis with endobronchial involvement and bilateral pleural effusion.

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Background. The efficacy of interventional pulmonology and limited surgery is reported in a case of endobronchial low-grade malignancies including typical carcinoid. Case. A woman in her seventh decade with bloody sputum had a checkup at a nearby hospital. Chest CT revealed an abnormal shadow in the right truncus intermedius. Bronchoscopy revealed a tumor protruding from the right bifurcation of the truncus intermedius. Transbronchial biopsy revealed typical carcinoid. Although transbronchial resection by rigid bronchoscopy was attempted, complete excision was not possible. Therefore we decided to perform wedge resection of the lobar bronchus between the right middle lobe bronchus and lower lobe bronchus without removing lung parenchyma. Result. The postoperative clinical course was stable and the patient was discharged 7 days after the surgery. The loss of pulmonary function was minimal and the patient has remained stable for 4 months. Conclusion. The treatment starategies of typical carcinoid depends on the location of each case. A complete resection could be done in this case with wedge resection of bronchus without removing lung parenchyma. This procedure has the merit of preserving respiratory function. This procedure is recommended in carefully selected cases.

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Background. Endobronchial schwannomas are relatively rare benign tumors. We report a case of an endobronchial benign schwannoma treated with argon plasma coagulation (APC) followed by segmentectomy. Case. A 59-year-old man was admitted to our hospital because of fever. He was initially given a diagnosis of communityacquired pneumonia in the left lower lung field. Because antibiotics failed to improve his condition and chest computed tomography revealed obstruction of the left lower lobe bronchus, bronchoscopy was performed and revealed a smooth-surfaced vascularized polypoid tumor covered with yellow-white mucosa originating from the orifice of the left lower lobe bronchus. Histopathologic examination of the biopsy specimen showed schwannoma. After repeated treatment by APC, the left basal bronchus was opened but the tumor still obstructed the left B^6. Segmentectomy of the left S^6 was performed for complete resection and the final pathological diagnosis was schwannoma. The patient has been free of recurrence for 18 months since surgery. Conclusion. We successfully performed complete resection of a bronchial schwannoma after reducing its tumor volume by repeated APC.

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Background. We report a case of adenoid cystic carcinoma originating in the trachea, treated with transcutaneous arterial embolization (TAE) before the bronchoscopic tumor removal procedure. Case. An 84-year-old man with a tracheal tumor was referred to our hospital. The tumor had already been diagnosed as adenoid cystic carcinoma at another hospital. Although we planned to remove the tumor, we were concerned that the removal procedure might cause massive bleeding because the tumor was markedly stained in his enhanced chest computed tomography. Moreover, the doctor, who diagnosed the patient's tracheal tumor, informed us it was difficult to stop bleeding during bronchoscopic biopsy at the original hospital. Thus TAE was performed before tumor removal. The feeding artery was one of the branches of his right internal mammary artery. After the arterial embolization, the tumor was removed safely with only minor bleeding using a rigid bronchoscope under general anesthesia. Conclusion. In this report, we propose that TAE before interventional bronchoscopy could be a treatment option to avoid massive bleeding.

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Background. We report an extremely rare case of left main bronchomegaly with cystic enlargement. Case. A 62-year-old woman presented complaining of long-term cough and sputum. Her mother said she had aspirated a peanut in the left main bronchus which had been removed bronchoscopically when one year old. Her chest X-ray film revealed infiltrative shadows in the left middle lung field and computed tomography revealed the left main bronchus with cystic enlargement and an ill-defined mass (5cm) in the lingular bronchus (S^4). Bronchoscopy revealed the membranous portion of the left main bronchus with cystic enlargement, maintenance of the cartilage ring and bronchial mucosa with red and disappearance of longitudinal fold. Conclusion. Mounier-Kuhn syndrome is a distinct clinical and radiologic condition of marked enlargement of the trachea and major bronchi that is often associated with chronic respiration tract infection. In this case, in which there was the possibility of an infant anamnesis, although the details were unclear, there was marked cystic enlargement in the left main bronchus alone.

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Background. Double primary lung cancer associated with Lambert-Eaton myasthenic syndrome is very rare. Case. A 67-year-old man had experienced difficulty with walking for 2 months. He presented with hyposthenia of the lower limbs, and an electromyography showed waning/waxing. Therefore, Lambert-Eaton myasthenic syndrome was diagnosed. CT scanning of the chest detected stenosis of the left upper lobe bronchus and squamous cell carcinoma was detected in a specimen obtained from this area by bronchoscopy. The carcinoma was classified as cT1N1M0-stage IIA, and lobectomy of the left superior lobe and mediastinal lymphadenectomy were performed. The resected tumor contained squamous cell cancer cells, and the resected segmental lymph node contained small cell cancer cells. This was a case of double primary lung cancer associated with Lambert-Eaton myasthenic syndrome. After the surgery there was marked improvement in a neurological function. Conclusion. We suggest that bronchoscopy as well as CT scan should be performed immediately when symptoms of Lambert-Eaton myasthenic syndrome are present.

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