Abstract Benign endobronchial hamartomas can mimic malignancy, especially in patients with prior cancers. Accurate diagnosis through bronchoscopy and multidisciplinary review prevents misclassification and unnecessary treatment. We present the case of a 76 year old woman with a history of basal cell and squamous cell skin cancers, right-sided breast carcinoma treated with lumpectomy and radiation in 2001, and vitamin D deficiency, who was referred for evaluation of an incidental endobronchial lesion. Cross-sectional imaging demonstrated a 6 mm soft tissue density within the bronchus intermedius, consistently visualized across two studies. Despite her oncologic history, she remained entirely asymptomatic, reporting no hemoptysis, weight loss, or respiratory decline. She had never smoked, denied vaping or other inhalational exposures, and had a 20-year occupational history in perfume sales.Flexible bronchoscopy revealed a polypoid, pedunculated mass arising from the lateral and posterior wall of the mid bronchus intermedius. The distal bronchi remained patent. Using an electrocautery snare, the lesion was completely excised, with adjunctive cryotherapy applied for hemostasis. Endobronchial ultrasound (EBUS) demonstrated enlarged station 11R lymph nodes, which were sampled; other mediastinal nodes were sub-centimeter and not sampled. Bronchoscopic inspection after excision confirmed no residual lesion.Initial pathology suggested a low-grade fibromyxoid neoplasm, raising concern for malignancy. Cytology from bronchial washings and EBUS sampling revealed atypical but reactive epithelial cells, without definitive malignancy. Given this discordance, the specimen underwent expert review, which reclassified the lesion as a stromal-rich pulmonary hamartoma. Histologic features included bland spindle cells intermixed with adipose tissue beneath pseudostratified ciliated epithelium, with characteristic epithelial invagination. Immunohistochemistry supported a benign process, with positivity for vimentin and weak Bcl-2, and negativity for markers of epithelial, hematopoietic, neural, and myogenic differentiation. No atypia, mitoses, or necrosis were identified. This case underscores key lessons in the evaluation of central airway lesions. Endobronchial hamartomas, although uncommon and reported in only 1-10% of pulmonary hamartomas, should remain in the differential even in patients with extensive cancer histories. Limited biopsy specimens may overcall atypia, highlighting the importance of expert pathology review to avoid misclassification. Bronchoscopic resection not only provides diagnostic tissue but can achieve definitive therapy, sparing patients from unnecessary surgical resection. Advances in interventional pulmonology have shifted management away from lobectomy or pneumonectomy toward minimally invasive approaches, reinforcing the value of bronchoscopy as both diagnostic and therapeutic. Ultimately, careful multidisciplinary evaluation allowed this benign lesion, initially worrisome for malignancy, to be accurately identified and curatively treated. This abstract is funded by: none
Nethala et al. (Fri,) studied this question.