tracheal schwannomas are extremely rare . since there have been only a few case reports of these , there is no consensus on the correct approach to treatment . there are not many reports of the use of bronchoscopic techniques to resect such tumors , and generally surgical options seem to have been adopted more often , with curative intent . we report a case of tracheal schwannoma , which was completely resected using bronchoscopic techniques . a 24-year - old man presented with dry cough and shortness of breath for 1 year and noisy breathing for 2 months . he had been on several medications for asthma for the past 1 year with no response . on examination his spirometry revealed reduction in maximum mid expiratory flow rate ( mmef ) with flattening of both inspiratory and expiratory limbs of the flow volume loop , suggestive of a fixed upper airway obstruction [ figure 1a ] . hence , he underwent a computed tomography ( ct ) of the neck [ figure 2a ] , which revealed a well - defined , lobulated , mildly enhancing soft tissue density lesion arising from the right lateral and posterior wall of the trachea , projecting into the tracheal lumen and causing luminal narrowing at c7-t1 level . flow volume loop . ( a ) pre - operative ; ( b ) post - operative ( a ) pre - operative computed tomography ( b ) post - operative magnetic resonance imaging he was then subjected to a flexible bronchoscopy through a laryngeal mask airway ( lma ) under general anesthesia , with an intent of de - bulking the tumor . there was a smooth vascular tumor seen , almost completely occluding the tracheal lumen , arising from its right lateral and posterior walls , with its proximal extent 2 cm from the vocal cords [ figure 3a ] . adrenaline ( 1 ml of 1 in 10,000 ) was injected at its base , through a conventional tbna ( trans - bronchial needle aspiration ) needle to prevent severe endo - bronchial bleeding . since the pieces were large , with the help of a head down tilt of the operating table , they were delivered into a foreign body basket and successfully removed along with the lma [ figure 3c ] . the location of its pedicle was 9.5 cm from the carina and 3.5 cm from the vocal cords , at the right postero - lateral wall of the trachea . ( c ) picture of the tumor removed within a foreign body basket along with the laryngeal mask airway ( lma ) post procedure , he became asymptomatic and the spirometry and flow volume loop reverted to normal [ figure 1b ] . the fibrovascular tissue was replaced by a tumor , composed of fascicles of spindle cells arranged in a palisading fashion forming verocay bodies [ figure 4 ] . spindle cells were diffusely and strongly positive for s-100 [ inset of figure 4 ] . ( a ) tumor with palisading arrangement of spindle cells is seen , h and e ( hematoxylin and eosin ) , 20 magnification . ( b ) tumor cells staining for s-100 , immunohistochemistry , 10 magnification since there was a doubt on the pre - procedure ct of a posterior extra - luminal extension , an mri ( magnetic resonance imaging ) was done post bronchoscopy , which showed minimal mucosal thickening along the right lateral and posterior wall of the trachea and minimal hyperintensity in the paratracheal soft tissue at the same level , which were consistent with post - operative changes [ figure 2b ] . since there was no residual tumor , it was decided to keep the patient on bronchoscopic surveillance . at the sixth month review , bronchoscopy revealed no recurrence . primary tracheal tumors are rare and comprise only 1% of all neoplasms . among these only a quarter schwannoma is an uncommon benign tracheal tumor , and thus tracheal schwannomas are extremely rare . till date , there are around 35 reported cases of tracheal schwannomas . since schwannomas are slow growing tumors of the trachea , they produce symptoms only when they are large enough to cause obstructive symptoms . since they present with cough and breathlessness , they are often mistreated for years as asthma or copd , until one suspects an endotracheal lesion due to unresponsiveness to inhaled medications or by the appearance of the flow volume loop or when the symptoms progress to stridor , like it did in our subject . bronchoscopic biopsy will yield the diagnosis , but when the tumor is large , as in this case , it is better done under general anesthesia , to reduce complications and mortality . this also gives the opportunity to do therapeutic debulking , which by itself is curative as noted in the literature , provided there is no significant extraluminal component . the literature seems to suggest that when these patients have been managed surgically , the primary approach has been surgical removal with limited resection of the trachea with preservation of the lung , except in a case of carinal schwannoma , when the patient had to undergo a carinal pneumonectomy , since one lung had been significantly damaged due to post obstructive collapse . among the cases which have been dealt with bronchoscopically , there have been no recurrence reported during the follow up period , ranging from one to five years . it may be desirable to keep these patients on bronchoscopic surveillance , at least yearly to tackle recurrence if at all they occur .
tracheal schwannomas are rare benign tumors of the trachea . 
 there are only a few reported cases in the literature . 
 surgeons have generally resected these tumors , whereas bronchoscopists have attempted to remove them bronchoscopically . 
 we report a case of tracheal schwannoma which was completely resected using bronchoscopic techniques .