Endobronchial Spindle Cell Tumor of Neurogenic Origin with Coexisting Bronchial Anthracofibrosis: A Rare Case Report

Endobronchial spindle cell tumors are rare pulmonary neoplasms that may arise from peripheral nerve sheath elements such as schwannoma or neurofibroma. We report a 69-year-old nonsmoking female from a hilly region presenting with progressive breathlessness for 3 months. She had a significant environmental exposure history of 45 years to biomass fuel combustion from bonfires and fireplace use for cooking and heating. Contrast-enhanced computed tomography (CT) revealed atelectasis with microcalcification in the lateral segment of the right middle lobe and extensive mediastinal lymphadenopathy. F18-fluorodeoxyglucose (FDG) positron emission tomography-CT showed FDG-avid soft tissue in the right middle lobe bronchus (maximum standardized uptake value: 9.17) with multiple FDG-avid lymph nodes. Bronchoscopy demonstrated narrowing of the right middle lobe bronchus with endobronchial obstruction. Histopathology and immunohistochemistry confirmed a low-grade spindle cell tumor of neurogenic origin (neurofibroma/schwannoma) with coexisting anthracofibrosis. The patient was managed using a multidisciplinary approach after comprehensive staging. This case highlights a rare presentation of an endobronchial spindle cell tumor in a nonsmoking female with associated bronchial anthracofibrosis. The unusual endobronchial location and neurogenic origin distinguish it from typical spindle cell tumors. It underscores the importance of considering rare tumors in patients with airway obstruction, the value of detailed exposure history, and the crucial role of bronchoscopic and histopathological evaluation in diagnosis. Early and accurate diagnosis enables appropriate management and is associated with a favorable prognosis.