Wrong place at the right time, a case of primary bronchial myoepithelial carcinoma

Primary bronchial myoepithelial carcinoma is a rare neoplasm, accounting for less than 1% of all primary lung malignancies. These tumours typically arise from submucosal tracheobronchial glands and are resistant to chemotherapy and radiotherapy, making surgical resection the preferred treatment. We present the case of a 78-year-old male who was incidentally found to have a right upper lobe endobronchial lesion following investigation for a chest infection. Imaging revealed a 3.8 cm obstructive mass in the right main bronchus. Bronchoscopic biopsy confirmed a high-grade myoepithelial carcinoma. He underwent a serratus-sparing thoracotomy with a bronchial sleeve upper lobectomy and mediastinal lymphadenectomy. The anastomosis was reinforced with a pedicled thymo-pericardial diaphragmatic fat flap. Postoperative recovery was complicated by pneumonia, delirium, and electrolyte imbalance, all of which resolved with appropriate management. Histopathology confirmed complete resection. Follow-up imaging showed no recurrence. This case underscores the importance of early recognition and meticulous surgical management in treating this rare pulmonary malignancy.