Successful Endobronchial Electrosurgical Snare Resection of a Pedunculated Leiomyoma: A Minimally Invasive Alternative to Surgery.

BACKGROUND Bronchial leiomyoma is a rare benign tumor of the respiratory tract. This clinical presentation is usually nonspecific and is often discovered incidentally during bronchoscopy or chest computed tomography (CT) scans. In this report, we present a case of endobronchial leiomyoma that was successfully resected using an electrosurgical snare under flexible bronchoscopy, highlighting a minimally invasive approach to managing this rare condition. CASE REPORT A 60-year-old non-smoking woman with a 5-year history of asthma presented with a 4-day febrile illness (peak temperature 38.8°C). She denied any respiratory symptoms. Pulmonary function tests were normal. Chest CT revealed a round mass, approximately 8×10 mm in size, at the orifice of the lingular segment bronchus of the left upper lobe, with no contrast enhancement. Bronchoscopy identified a pedunculated, pale, smooth-surfaced polypoid tumor completely occluding the orifice. The tumor was resected using an electrosurgical snare during a 20-minute procedure. The resection site bled minimally, and bleeding was completely controlled by spraying with epinephrine solution (final concentration 0.0167 mg/mL). Histopathological analysis revealed spindle-shaped cells that were immunoreactive for both smooth muscle actin and desmin, confirming a diagnosis of bronchial leiomyoma. The patient has been followed for 36 months with no evidence of recurrence. CONCLUSIONS Endobronchial leiomyoma is a rare benign airway tumor. Electrosurgical snare resection is an effective, lung-sparing option for pedunculated or narrow-based lesions without evidence of extraluminal invasion. Surgical resection remains the standard of care when complete endoscopic removal is not feasible, extramural extension is suspected, or the diagnosis is uncertain.