Bronchial artery embolization followed by bronchoscopic electrosurgical snare resection for diagnosis and treatment of primary pulmonary osteosarcoma: case report and literature review.

Primary pulmonary osteosarcoma (PPOS) is an extremely rare extraskeletal osteosarcoma. Because its clinical and radiological features are nonspecific, establishing a diagnosis is challenging. We report the case of a 58-year-old man who presented with a 1-month history of cough and 5 days of dyspnea. Initial chest computed tomography showed destructive changes in the left lung and an endobronchial lesion in the left main bronchus. To relieve airway obstruction and obtain diagnostic tissue, a sequential strategy of bronchial artery embolization followed by bronchoscopic electrosurgical snare resection was used. Pathological examination showed a high-grade sarcoma with characteristic malignant osteoid matrix, chondroid differentiation, and numerous multinucleated tumor giant cells. Immunohistochemistry showed positivity for SATB2 and vimentin, with a Ki-67 proliferation index of approximately 30%. Whole-body bone scintigraphy, brain magnetic resonance imaging, and contrast-enhanced abdominal and pelvic computed tomography excluded a primary bone tumor and extrapulmonary metastasis, supporting the diagnosis of PPOS. After the procedure, dyspnea improved, follow-up chest computed tomography showed partial re-expansion of the left lung and disappearance of the left main bronchial lesion, and the patient was referred to a higher-level hospital for radiotherapy. He remained alive at 9-month follow-up after diagnosis. This case suggests that bronchial artery embolization-assisted bronchoscopic electrosurgical snare resection may provide a minimally invasive option for obtaining diagnostic tissue and relieving airway obstruction in selected hypervascular endobronchial tumors.