대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Endobronchial Neurilemmoma

Radiologic Findings

Chest radiograph shows well-defined nodule in retrocardiac area of left lower lobe. Non-contrast CT scan shows well-defined low-attenuation (35 HU) mass in left lower lobe. Contrast-enhanced CT scans show smooth endobronchial mass in posterior basal segment of left lower lobe, which shows strong (63 HU) heterogeneous enhancement. Lung specimen shows mass in segmental bronchus.

Brief Review

Intrathoracic neurogenic tumors, neurilemmoma and neurofibroma, occur most often in the posterior mediastinum and only rarely in the lungs. In a large series of pulmonary neoplasms, neurogenic tumor constituted 0.2% of the tumors. Most neurogenic tumors are intraparenchymal and manifest as asymptomatic masses; however, 25% of tumors are endobronchial and often cause obstructive symptoms. Neurilemmomas can occur in all regions of the bronchial tree and they often progress into intraluminal and extraluminal spaces. Most tumors are solitary and not associated with Reckling-hausen's disease. The clinical course depends on tumor size and the degree of bronchial obstruction.

Chest radiography shows well-defined mass and other findings related to endobronchial obstruction. A few reports of endobronchial neurogenic tumors describe the tumors as round, ovoid, or lobulated and as sharply demarcated, homogeneous masses on CT. Like those of other benign endobronchial masses, the CT characteristics of neurogenic tumor are not specific. However, neurogenic tumor could be included in the differential diagnosis whenever a endobronchial mass without fatty component and calcification is identified on CT scans. Treatment is usually resection, either endoscopic or by thoracotomy. The prognosis is excellent in the absence of neurofibromatosis.

References

1. Ko JM, Jung JI, Park SH, et al. Benign tumors of the tracheobronchial tree: CT-pathologic correlation. AJR 2006; 186: 1304-1313

2. Kasahara K, Fukuoka K, Konishi M, et al. Two cases of endobronchial neurilemmoma and review of the literature in japan. Intern Med. 2003; 42(12): 1215-1218

3. Feldhaus RJ, Anene C, Bogard P. A rare endobronchial neurilemmoma (Schwannoma). Chest 1989; 95: 461-462

Keywords

Airway, Benign tumor,