PMC5575446_01
Axial CT images at lung window demonstrate only minimal increase in size from 8mm to 10mm of a solitary endobronchial nodule at the origin of the right lower lobe superior segmental bronchus.
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This lesion was present since at least 2012 and slightly increased in size since that time (Fig. 1).
Oblique coronal multiplanar reconstruction image (A) demonstrates the position of the circumscribed, endobronchial nodule at the origin of the right lower lobe superior segmental bronchus. Virtual bronchoscopic image from multiple detector CT reconstruction demonstrates the endoluminal lesion from the view of the right lower lobe bronchus.
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The lesion was further assessed using virtual bronchoscopy (Fig. 2).
Large endobronchial lesion at the take off of the superior segment take off. Using a snare the endobronchial abnormality was removed in its entirety. The superior segment was widely patent.
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Bronchoscopy revealed an obstructing lesion, which was completely excised with the snare (Fig. 3).
Representative photomicrographs of the resected endobronchial ganglioneuroma. At low power (20x magnification, upper left, H&E), a well-circumscribed polypoid submucosal lesion is apparent. At high magnification (200x), the lesion is composed of bundles of Schwannian spindle cells admixed with nests of mature ganglion cells (upper right, H&E) that both display immunoreactivity for chromogranin (lower left, brown pigment indicates positive reaction) as well as S-100 protein (lower mid, red pigment). SOX-10 immunohistochemistry highlights nuclei in the Schwannian component only (lower right, red pigment). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Pathology revealed a well-circumscribed submucosal proliferation of Schwannian spindle cells admixed with mature ganglion cells, displaying immunoreactivity for chromogranin, synaptophysin, and S-100 protein in both components, along with SOX-10 expression in the Schwannian component and focal expression of TTF-1 in the ganglion cells, supporting a diagnosis of ganglioneuroma (Fig. 4).