Combined Posterior and Interlobar Approaches Enable S10 Segmentectomy for a Centrally Located Intrapulmonary Schwannoma Diagnosed by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Surgical Strategy and Technical Consideration.

introductionIntrapulmonary schwannoma is a rare benign tumor that often presents diagnostic and therapeutic challenges due to its nonspecific radiological findings and central location. Establishing a histological diagnosis before surgery is crucial to avoid unnecessary extensive lung resection. CASE PRESENTATION: A 46-year-old non-smoking woman presented with an incidental 2.4 cm pulmonary nodule centrally located in segment 10 (S10) of the left lower lobe. CT showed the tumor compressing the bronchus and pulmonary artery without direct airway communication, making transbronchial biopsy unfeasible. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) successfully obtained tissue samples, and histopathological examination revealed spindle cells with diffuse S100 protein positivity, confirming the diagnosis of an intrapulmonary schwannoma. Given the benign nature of the tumor, an S10 segmentectomy was planned. Preoperative 3D CT suggested that while the pulmonary vein (V10) could be approached posteriorly, the artery (A10) and bronchus (B10) would require an interlobar approach due to the tumor's central location. Intraoperative findings confirmed this, and the tumor was successfully resected. The patient had an uneventful recovery and was discharged on POD 4. Final pathology confirmed the diagnosis of an intrapulmonary schwannoma and negative margin.

conclusionsPreoperative histological diagnosis of an intrapulmonary schwannoma by EBUS-TBNA is both feasible and clinically advantageous, enabling a limited anatomical resection. A preoperative strategy that incorporates both the tumor's benign nature and its central location is essential for achieving optimal surgical outcomes.