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2</a>A and B&#41;&#46; Immunostaining for S-100 was positive &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#44; and a diagnosis of schwannoma was confirmed&#46; Rapid on-site cytologic evaluation was not performed&#46; The patient underwent tumorectomy due to the possibility of obstructive pneumonia&#46; Pathological examination of the surgical specimen further supported the diagnosis of schwannoma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Pathological diagnosis is generally important in choosing the treatment plan for lung tumors&#46; Conventional bronchoscopy is extensively used to obtain samples for pathological examination&#44; but it is impossible to biopsy intrapulmonary tumors situated beyond the reach of the bronchoscope&#46; In these cases EBUS-TBNA&#44; a relatively safe technique with a complication rate of 1&#46;23&#37; is often useful for establishing the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Moreover&#44; its sensitivity and specificity for the diagnosis of intrapulmonary lesions are 94&#46;1&#37; and 94&#46;3&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> respectively&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Positron emission tomography &#40;PET&#41; with 2-deoxy-2-&#91;18F&#93;fluoro-<span class="elsevierStyleSmallCaps">d</span>-glucose &#40;FDG&#41; is widely used to identify malignant lesions&#44; with a sensitivity and specificity of 96&#46;8&#37; and 77&#46;8&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; schwannoma shows a high level of FDG uptake in some cases&#44; although it is a benign tumor&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> making it difficult to differentiate it from malignant tumors using PET&#46; Intrapulmonary schwannoma is usually diagnosed by postoperative pathological examination&#59; no cases of intrapulmonary schwannoma diagnosed by EBUS-TBNA have been described&#46; In our patient however&#44; this procedure facilitated diagnosis&#44; while preoperative pathological diagnosis was useful for performing the tumorectomy&#46; EBUS-TBNA might therefore be helpful for the diagnosis of intrapulmonary schwannoma and for establishing the treatment plan&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On ultrasound&#44; schwannoma is a well-defined hypoechogenic tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In some cases an echogenic capsule&#44; posterior acoustic enhancement and nerve continuity are also detected&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; these characteristics are typical of schwannoma located in the limbs or near the surface of the body&#46; As far as we know&#44; identification of an intrapulmonary schwannoma with endobronchial ultrasound has not hitherto been described&#46; In our case&#44; it showed a well-defined hypoechogenic encapsulated mass&#44; with posterior acoustic enhancement&#44; although nerve continuity was not detected&#46; These characteristics could be useful for diagnosing a tumor of nerve origin in the lung&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; we present the first case of intrapulmonary schwannoma diagnosed by EBUS-TBNA&#46; This procedure together with endobronchial ultrasound findings might be helpful for the diagnosis of intrapulmonary schwannoma&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 47-year-old woman was referred to our hospital for further examination of a lung tumor&#46; CT of the chest revealed a round&#44; well-defined 2&#46;4-cm nodule in S2&#44; adjacent to right superior lobe bronchus&#46; Endobronchial ultrasonography showed a well-defined&#44; hypoechoic tumor with echogenic capsule and posterior acoustic enhancement&#46; Diagnosis of schwannoma was confirmed from the specimen obtained by endobronchial ultrasound-guided transbronchial needle aspiration&#46; She underwent tumorectomy due to the possibility of obstructive pneumonia&#46; Pathology diagnosis from the surgical specimen was also schwannoma&#46; Endobronchial ultrasound-guided transbronchial needle aspiration and findings with endobronchial ultrasonography might be helpful in the diagnosis of intrapulmonary schwannoma&#46;</p>"
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Case Report
Intrapulmonary Schwannoma Diagnosed With Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Case Report
Un caso de schwannoma intrapulmonar diagnosticado mediante aspiración por punción transbronquial guiada con ecografía endobronquial
Keisuke Watanabea, Masaharu Shinkaia,
Corresponding author
shinkai@yokohama-cu.ac.jp

Corresponding author.
, Masahiro Shinodaa, Yoshiaki Ishigatsubob, Takeshi Kanekoc
a Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
b Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
c Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Biochemistry and hematology tests were unremarkable&#46; Chest X-ray showed a 2-cm nodule in the upper right lung field&#46; Chest computed tomography &#40;CT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41; revealed a round&#44; well-defined 2&#46;4-cm nodule in S2&#44; adjacent to the right upper lobe bronchus&#46; A sub-mucosal lesion and almost complete occlusion of the right upper lobe bronchus were identified on bronchscopy&#46; EBUS showed a well-defined hypoechoic tumor&#44; with an echogenic capsule and posterior acoustic enhancement &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and D&#41;&#46; Nerve continuity was not detected&#46; EBUS-TBNA was performed&#44; as a histological diagnosis may have been difficult to obtain with transbronchial biopsy&#46; The EBUS-TBNA sample showed hypercellular areas with proliferation of fusiform cells and hypocellular areas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46; Immunostaining for S-100 was positive &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#44; and a diagnosis of schwannoma was confirmed&#46; Rapid on-site cytologic evaluation was not performed&#46; The patient underwent tumorectomy due to the possibility of obstructive pneumonia&#46; Pathological examination of the surgical specimen further supported the diagnosis of schwannoma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Pathological diagnosis is generally important in choosing the treatment plan for lung tumors&#46; Conventional bronchoscopy is extensively used to obtain samples for pathological examination&#44; but it is impossible to biopsy intrapulmonary tumors situated beyond the reach of the bronchoscope&#46; In these cases EBUS-TBNA&#44; a relatively safe technique with a complication rate of 1&#46;23&#37; is often useful for establishing the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Moreover&#44; its sensitivity and specificity for the diagnosis of intrapulmonary lesions are 94&#46;1&#37; and 94&#46;3&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> respectively&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Positron emission tomography &#40;PET&#41; with 2-deoxy-2-&#91;18F&#93;fluoro-<span class="elsevierStyleSmallCaps">d</span>-glucose &#40;FDG&#41; is widely used to identify malignant lesions&#44; with a sensitivity and specificity of 96&#46;8&#37; and 77&#46;8&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; schwannoma shows a high level of FDG uptake in some cases&#44; although it is a benign tumor&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> making it difficult to differentiate it from malignant tumors using PET&#46; Intrapulmonary schwannoma is usually diagnosed by postoperative pathological examination&#59; no cases of intrapulmonary schwannoma diagnosed by EBUS-TBNA have been described&#46; In our patient however&#44; this procedure facilitated diagnosis&#44; while preoperative pathological diagnosis was useful for performing the tumorectomy&#46; EBUS-TBNA might therefore be helpful for the diagnosis of intrapulmonary schwannoma and for establishing the treatment plan&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On ultrasound&#44; schwannoma is a well-defined hypoechogenic tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In some cases an echogenic capsule&#44; posterior acoustic enhancement and nerve continuity are also detected&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; these characteristics are typical of schwannoma located in the limbs or near the surface of the body&#46; As far as we know&#44; identification of an intrapulmonary schwannoma with endobronchial ultrasound has not hitherto been described&#46; In our case&#44; it showed a well-defined hypoechogenic encapsulated mass&#44; with posterior acoustic enhancement&#44; although nerve continuity was not detected&#46; These characteristics could be useful for diagnosing a tumor of nerve origin in the lung&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; we present the first case of intrapulmonary schwannoma diagnosed by EBUS-TBNA&#46; This procedure together with endobronchial ultrasound findings might be helpful for the diagnosis of intrapulmonary schwannoma&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Una mujer de 47 a&#241;os fue remitida a nuestro hospital para un estudio diagn&#243;stico de un tumor pulmonar&#46; La TC de t&#243;rax revel&#243; la presencia de un n&#243;dulo redondeado&#44; bien definido&#44; de 2&#44;4<span class="elsevierStyleHsp" style=""></span>cm en S2&#44; adyacente al bronquio del l&#243;bulo superior derecho&#46; La ecograf&#237;a endobronquial mostr&#243; un tumor hipoecog&#233;nico&#44; bien definido&#44; con una c&#225;psula ecog&#233;nica y un refuerzo ac&#250;stico posterior&#46; El diagn&#243;stico de schwannoma se confirm&#243; con el material obtenido mediante aspiraci&#243;n por punci&#243;n transbronquial guiada con ecograf&#237;a endobronquial&#46; Se practic&#243; a la paciente una tumorectom&#237;a porque exist&#237;a la posibilidad de una neumon&#237;a obstructiva&#46; El diagn&#243;stico anatomopatol&#243;gico de la pieza quir&#250;rgica fue tambi&#233;n de schwannoma&#46; La aspiraci&#243;n por punci&#243;n transbronquial guiada con ecograf&#237;a endobronquial y los resultados de la ecograf&#237;a endobronquial podr&#237;an ser &#250;tiles para el diagn&#243;stico de un schwannoma intrapulmonar&#46;</p>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Watanabe K&#44; Shinkai M&#44; Shinoda M&#44; Ishigatsubo Y&#44; Kaneko T&#46; Un caso de schwannoma intrapulmonar diagnosticado mediante aspiraci&#243;n por punci&#243;n transbronquial guiada con ecograf&#237;a endobronquial&#46; Arch Bronconeumol&#46; 2014&#59;50&#58;490&#8211;492&#46;</p>"
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        "titulo" => "Acknowledgement"
        "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">Authors thank to Ms&#46; Yoriko Inoue for her editorial support&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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