DISCUSSION
Benign tracheobronchial tumors are sporadic tumors representing only
0.2% of all pulmonary tumors in the United States.4The two most common types of benign pulmonary tumors are hamartomas and
papillomas, and leiomyomas, lipomas, chondromas, and neurogenic tumors
can present as less frequent benign neoplasms.1 Most
benign pulmonary tumors are slow-growing and asymptomatic and often
remain undiagnosed before they cause bronchial obstruction or mass
effects on surrounding organs. The diagnosis of these tumors is often
challenging because the symptoms and signs are non-specific, and a
simple chest X-ray fails to present remarkable findings. Thus, they are
frequently misdiagnosed as more common causes of chronic cough or
dyspnea, such as chronic obstructive bronchitis, asthma, and
bronchogenic carcinomas.2, 3, 5 Because most of the
symptoms of bronchial tumors are primarily caused by their growth and
complications to adjacent structures, early detection and treatment are
clinically significant.
Bronchial chondromas are very rare benign tumors arising from
bronchial cartilage.1 Because they are often
misclassified as hamartomas, the most common type of endobronchial
neoplasm, the accurate incidence of bronchial chondroma is still unclear
yet.1 In contrast to hamartomas, endobronchial
chondromas have a distinct pathology consisting of calcified/ossified
cartilaginous components without adipose tissue, smooth muscle,
epithelial, and stromal elements characteristics of
hamartomas.6, 7 Well-differentiated chondrosarcomas
can resemble chondromas,4, 8.they can be
differentiated by the presence of tissue invasion or
mitosis,9 and clinicians should also evaluate the
possibility of lung metastasis from other skeletal systems considering
higher incidence.
Bronchial chondromas are occasionally present as a component of the
Carney triad characterized by the simultaneous presence of gastric
epithelioid leiomyoblastoma, extra-adrenal paragangliomas, and pulmonary
chondroma.10 In this case, after his tumor was defined
as an endobronchial enchondroma, in consideration of the presence of the
Carney triad, we performed a gastroscopic examination to evaluate the
presence of the gastric leiomyoblastoma. We did complete history-taking
and physical examination again to assess symptoms and signs representing
paragangliomas. However, there was no evidence of the Carney triad, and
the tumor was eventually diagnosed as an isolated endobronchial
enchondroma, which is extremely rare among pulmonary chondromas.
Although there is no consensus of the best treatment approach to
bronchial chondroma, most treatments were performed by complete excision
with bronchoscopy or surgery including VATS or open thoracotomy. The
choice of therapy should be considered in each case based on the tumor’s
operability, size, type, and location.10 Even if just
a small number of cases were reported, none of the patients died or had
severe complications regardless of the treatment options, and recurrence
after treatment was very low. There was a report that only one presented
recurrence among 23 cases of treated cases between 1945 and
1980.9 In addition, there was a report presenting the
recurrent tracheal chondroma with the sarcomatous
transformation.12, 13 Considering the low risk of
treatment morbidity, mortality, and recurrence, and potential risk of
malignant transformation and structural destruction of adjacent organs,
prompt and proper treatment options for complete excision should be
considered individually based on the tumor situation.
In the current case, when the patient visited the pulmonary clinic for
the first time, he had a chronic cough for more than six months, and it
was initially considered the effect of cigarette smoking by him. Even if
most benign bronchial tumors are asymptomatic, some patients may have
symptoms, such as intractable cough or hemoptysis, suggesting chronic
airway diseases.2, 3, 14 After excising the tumor
entirely by the lobectomy procedure, his cough disappeared one month
after discharge from the hospital. This case is a good example
emphasizing the benefit of early recognition and adequate treatment of
bronchial tumors to clinicians.