Letter to the Editor
Bronchial Schwannoma: An Uncommon Tumor
Schwannoma bronquial, un tumor poco frecuente
Pedro Landete, Eusebi Chiner
, José Norberto Sancho-Chust, Patricia Pérez-Ferrer
Corresponding author
Servicio de Neumología, Hospital Universitario San Juan de Alicante, San Juan, Alicante, Spain
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Patricia Pérez-Ferrer" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Landete" ] 1 => array:4 [ "nombre" => "Eusebi" "apellidos" => "Chiner" "email" => array:1 [ 0 => "echinervives@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "José Norberto" "apellidos" => "Sancho-Chust" ] 3 => array:2 [ "nombre" => "Patricia" "apellidos" => "Pérez-Ferrer" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital Universitario San Juan de Alicante, San Juan, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Schwannoma bronquial, un tumor poco frecuente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 1342 "Tamanyo" => 278756 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) An area of bronchial epithelium can be seen on lower magnification (top right, darker area). The rest of the sample consists of tumor tissue. (B) Fusiform cells and granular cytoplasma can been seen on greater magnification. Bronchial schwannoma or granular cell tumor. (C) Immunohistochemistry positive for S100 (darker staining).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchial schwannomas, also known as granular cell tumors and myoblastomas, are uncommon benign tumors<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> that rarely occur in the bronchi. Disease course is benign and treatment of choice is surgery.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 40-year-old woman, smoker of 20 pack-years, with clinical criteria for chronic bronchitis, presented in the emergency department with a 2-day history of fever 39<span class="elsevierStyleHsp" style=""></span>°C, general malaise, dry cough, myalgia, headache, and pharyngeal pain. Chest X-ray revealed alveolar infiltrate in the left upper lobe (LUL). A diagnosis of community-acquired pneumonia was given, and she was prescribed levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg for 7 days in an outpatient setting. Four weeks later, a radiological control was performed and the patient was referred to the respiratory medicine department. During anamnesis, she reported a long history of episodes of lower respiratory tract infections. Physical examination and blood test results were normal. Chest X-ray showed LUL atelectasis with left hilar elevation. Chest computed tomography revealed a 2<span class="elsevierStyleHsp" style=""></span>cm nodular lesion in the LUL, causing partial atelectasis, with no mediastinal or hilar lymphadenopathies. Spirometric results were normal. Fiberoptic bronchoscopy showed a pedunculated lesion in the left bronchial tree, obstructing the upper lobe. The lesion surface was smooth, shiny and vascularized. It was contingent on the carina dividing the lobes, and there was no adhesion to the lateral walls. Biopsy showed fusiform, polygonal cells and granular cytoplasm with immunohistochemical (IHC) expression of neuron-specific enolase, S100 protein and vimentin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), indicative of LUL schwannoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The LUL was lobectomized, and the patient did not require any further treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Schwannomas are extremely rare<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> benign tumors, originating in the Schwann cells that produce the myelin sheath of the peripheral nerves. The first case was described by Feckner in 1938, and at least 80 cases have been published since then. These are slow-growing tumors, that do not infiltrate the neuronal axon, but which can affect nerve conduction by extrinsic compression. They appear in wide range of sites, the most common of which are the skin and the tongue.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Endobronchial presentation occurs in only 6% of cases.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Schwannomas generally occur in middle age, and no differences are observed between sexes.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Clinical presentation can very, and is determined by the size and location. Early symptoms include asthma, unproductive cough, recurrent infections (as in our case), fever, dyspnea and hemoptysis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> Lesions tend to develop in the large bronchi or in bifurcatons.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> Up to 25% may be multiple, and they can even mimic metastasis, if they occur concomitantly with other neoplasms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Radiographs can be useful in differential diagnosis, but definitive diagnosis is usually obtained on fiberoptic bronchoscopy for atelectasis and secondary pneumonia, as in our case.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On histological examination, tumor cells are polygonal and fusiform, with granular cytoplasma. On IHC, antigen expression is positive for S100 protein, vimentin, neuron-specific enolase, and negative for keratins.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">While endoscopic resection has been recommended for treating small lesions, surgical resection is still the treatment of choice due to the risk of recurrence, irrespective of tumor size.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,5</span></a> Prognosis is favorable, and mean survival after surgery is longer than 5 years.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Landete P, Chiner E, Sancho-Chust JN, Pérez-Ferrer P. Schwannoma bronquial, un tumor poco frecuente. Arch Bronconeumol. 2015;51:471–472.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 1342 "Tamanyo" => 278756 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) An area of bronchial epithelium can be seen on lower magnification (top right, darker area). The rest of the sample consists of tumor tissue. (B) Fusiform cells and granular cytoplasma can been seen on greater magnification. Bronchial schwannoma or granular cell tumor. (C) Immunohistochemistry positive for S100 (darker staining).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign lung tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.B. Shrager" 1 => "L.R. Kaiser" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Pearson's thoracic-esophageal surgery" "paginaInicial" => "691" "paginaFinal" => "693" "edicion" => "3rd ed." "serieFecha" => "2008" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granular cell tumor of the lung. Clinicopathologic study of 20 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Deavers" 1 => "D. Guinee" 2 => "M.N. Koss" 3 => "M.D. Travis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1995" "volumen" => "19" "paginaInicial" => "627" "paginaFinal" => "635" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7755149" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granular cell tumours: an uncommon endobronchial neoplasm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.C. Durán Toconás" 1 => "G.A. Obeso Carillo" 2 => "M.Á. 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Quinones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3941/jrcr.v4i8.474" "Revista" => array:6 [ "tituloSerie" => "J Radiol Case Rep" "fecha" => "2010" "volumen" => "4" "paginaInicial" => "29" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22470750" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary malignant granular cell tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Jiang" 1 => "T. Anderson" 2 => "C. Nwogu" 3 => "D. Tan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Surg Oncol" "fecha" => "2003" "volumen" => "1" "paginaInicial" => "1" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12773198" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000009/v2_201509070947/S1579212915002207/v2_201509070947/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000009/v2_201509070947/S1579212915002207/v2_201509070947/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002207?idApp=UINPBA00003Z" ]
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| 2020 February | 38 | 15 | 53 |
| 2020 January | 45 | 16 | 61 |
| 2019 December | 42 | 25 | 67 |
| 2019 November | 42 | 24 | 66 |
| 2019 October | 26 | 12 | 38 |
| 2019 September | 41 | 13 | 54 |
| 2019 August | 51 | 14 | 65 |
| 2019 July | 43 | 20 | 63 |
| 2019 June | 26 | 8 | 34 |
| 2019 May | 46 | 21 | 67 |
| 2019 April | 75 | 24 | 99 |
| 2019 March | 42 | 17 | 59 |
| 2019 February | 44 | 19 | 63 |
| 2019 January | 40 | 22 | 62 |
| 2018 December | 45 | 16 | 61 |
| 2018 November | 80 | 31 | 111 |
| 2018 October | 68 | 24 | 92 |
| 2018 September | 27 | 10 | 37 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 47 | 7 | 54 |
| 2018 March | 30 | 8 | 38 |
| 2018 February | 44 | 5 | 49 |
| 2018 January | 65 | 10 | 75 |
| 2017 December | 75 | 5 | 80 |
| 2017 November | 28 | 7 | 35 |
| 2017 October | 24 | 8 | 32 |
| 2017 September | 25 | 7 | 32 |
| 2017 August | 24 | 20 | 44 |
| 2017 July | 25 | 12 | 37 |
| 2017 June | 30 | 26 | 56 |
| 2017 May | 28 | 9 | 37 |
| 2017 April | 32 | 9 | 41 |
| 2017 March | 28 | 10 | 38 |
| 2017 February | 15 | 7 | 22 |
| 2017 January | 25 | 7 | 32 |
| 2016 December | 18 | 13 | 31 |
| 2016 November | 29 | 13 | 42 |
| 2016 October | 22 | 12 | 34 |
| 2016 September | 37 | 21 | 58 |
| 2016 August | 30 | 11 | 41 |
| 2016 July | 21 | 15 | 36 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
Show all
