Large Endobronchial Enchondroma with Bronchopulmonary Aspergillosis & Fibrocavitation of the Lung

Large Endobronchial Enchondroma with Bronchopulmonary Aspergillosis & Fibrocavitation of the Lung | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Large Endobronchial Enchondroma with Bronchopulmonary Aspergillosis & Fibrocavitation of the Lung Simran Agarwal, Girija Nair This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6247089/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract We report a case of a patient with an endobronchial mass in the left main bronchus of the lung, presenting with recurrent pneumonia and hemoptysis. Initial bronchoscopic investigations and endobronchial tissue biopsy had been non-specific, suggestive only of a fibroepithelial polyp. However, in consideration of the recurrent nature of the patient’s symptoms over the years, he was advised to undergo a left pneumonectomy. Tissue biopsy sent post-operatively revealed the presence of multiple upper lobe cavities with fungal colonies caused by Aspergillosis, with the endobronchial mass showing features of benign endobronchial enchondroma. Based on the clinical history, and histopathological findings, patient has been started on oral Itraconazole. Follow-up, 1 month postoperatively, and 2 weeks since starting medication shows stable results, with no sign of adverse events. This case highlights the importance of regular follow-ups and repeat tissue biopsies, where required, of endobronchial lesions, especially in high-TB burden countries like India. Tuberculosis Pneumonectomy DR-TB Drug-resistant Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Tumours of the tracheobronchial tree are rare, with benign tumors forming only about 6% of all lung tumours( 1 ). Of all benign endobronchial tumours, hamartomas and papillomas are the most common histologic diagnosis, and other differentials include neurogenic tumors, lipomas and chondromas. Due to the rare occurrence of these clinical entities, along with non-specific symptoms at presentation, they can be commonly misdiagnosed as respiratory infections, particularly in resource-limited settings. Here we present the case of a 52-year-old man presenting with complaints of recurrent hemoptysis, and diagnosed with TB radiologically and treated, twice in the past. CASE PRESENTATION A man in his early 50s, non-smoker, with well-controlled type 2 diabetes, and a left-sided fibrocavitatory lung, presented with complaints of cough with yellowish expectoration, associated with 3–4 episodes of blood-tinged sputum, over 3 days. Patient has a history of frequent chest infections, requiring hospital admission 1–2 times every year for the past 5 years. Notably, the patient had received anti-tubercular treatment twice, 20 years and 17 years before his current admission, with no microbiological evidence. In addition, patient has been taking an inhaled LABA + LAMA combination regularly since his previous admission 1 year back. On examination, patient was afebrile, and mildly dyspneic, with normal vital signs; blood pressure 130/80 mm Hg, pulse 90 beats per minute, respiratory rate 20 breaths per minute and oxygen saturation 97% on room air. Lung auscultation revealed breath sounds absent on the left, with no wheeze or rhonchi. There was also a tracheal shift to the left. His routine blood workup revealed hemoglobin of 10 g/dL, white blood counts of 10,000 cells/dl, and platelets 305×10⁹/L, with normal renal and liver function tests. Radiological Findings: Chest radiography revealed a left fibrocavitatory lung, along with an ipsilateral mediastinal shift, indicative of significant pulmonary collapse (Fig. 1 ), leading to his admission in consideration along with his presenting complaints of hemoptysis. Regular follow-up and serial annual CT chest have demonstrated a calcified mass within the left main bronchus with multiple thin-walled bullae in the left upper lobe and multiple cavitations with air-fluid levels in the left lower lobe in 2023 [Figure 2 C & 2 D], 2022 [Figure 2 E & 2 F], also reported same in 2020. Bronchoscopic Examination: In view of the CT findings, along with the recurrent nature of the patient’s complaints, bronchoscopic examination with biopsy of the endobronchial mass was done, and findings were consistent with previous bronchoscopic evaluations. FOBs performed in 2023 [Figure 3 A] and 2020 [Figure 3 B], revealed a glossy, multilobulated lesion implanted at the mouth of the left main bronchus, 1 cm from the carina, totally obstructing the left main bronchus and the rest of the left lung. Importantly, the mucosa overlying the mass appeared healthy, with no evidence of necrosis or bleeding. Owing to the history of recurrent hemoptysis, and in the interest of securing the normal right lung from spill-over infection, a cardiothoracic surgery opinion was sought for pneumonectomy. As per the surgeon’s request, a CT review and virtual bronchoscopy was also performed suggestive of a large endobronchial mass 1.2 cm away from the carina, and lung distal to the obstruction could not be delineated, most likely due to obstructive collapse. Spirometry was also performed pre-operatively, to check for pulmonary reserves, with FEV1 68% (1.64 L). The nature and purpose of the surgery was explained to the patient, along with all associated risk, benefits and possible post-operative complications. He was also briefed on potential alternatives, should he be unwilling for surgery. Once the patient consented to the procedure, a left pneumonectomy was performed. There was a 2.8 x 2.3 cm solid, yellowish-white, nodular endobronchial mass [Figure 4 A]. The excised left lung measured 13.5 x 6.5 x 4.8 cm, with an adherent pleura [Figure 4 C]. The left main bronchus was filled with brownish necrotic material. The post-pneumonectomy pathology revealed fungal colonies comprising long, slender septate hyphae with acute angle branching, suggesting aspergillosis [Figure 4 B, 4 D]. The left main bronchus showed ulcerated respiratory lining with squamous metaplasia. Focal epithelioid cell granulomas with multi-nucleated giant cells present in the subepithelium. Rest of the lung parenchyma showed fibrosis with bronchiectatic changes. Microscopic pathology of the endobronchial mass showed subepithelial lobules of benign hyaline cartilage with areas of endochondral ossification and admixed fatty marrow spaces, all features suggestive of bronchial enchondroma. Treatment: Initially, the patient had been managed conservatively and symptomatically over the years, with short courses of antibiotics, and as-required anti-fibrinolytics. However, considering the persistently recurring symptoms, a left lung pneumonectomy was performed, after all appropriate pre-operative evaluations. Following surgery, based on the histopathologic findings, patient was started on oral Itraconazole 200 mg twice a day. Along with that, the patient is also continuing with his inhaled LABA and LAMA combination. Patient is currently on the prescribed treatment and tolerating the medications well without any significant adverse events. DISCUSSION This case highlights the challenges in the diagnosis of endobronchial lung pathologies, in the setting of an underlying fibrocavitatory disease. In a resource-limited setting, in countries with high-burden of tuberculosis, oftentimes such lesions can be mislabelled as TB, and started on anti-tuberculosis therapy. Along with the necessary facilities, it is also essential to have a high index of suspicion for other more likely differentials, to manage the underlying disease in an appropriate manner. Endobronchial enchondromas are extremely rare benign tumours, of mesodermal origin, often misclassified as hamartomas( 1 , 2 ). It is a slow growing, rounded, smooth mass with fibrous encapsulation consisting of calcified, cartilaginous components ( 2 ). Although non-invasive, its increasing size may give rise to signs and symptoms due mechanical obstruction, and pressure effects, as was seen in this patient, with resultant destruction of the ipsilateral lung. Isolated presentation of such tumours is uncommon, and it usually presents as part of Carney triad, a rare non-familial syndrome of unknown etiology, seen in young women, associated with gastric stromal tumours, pulmonary chondromas and endocrine tumours (paragangliomas) ( 3 ). In consideration of the same, our patient gave no history of signs and symptoms pointing towards paragangliomas, during any of his visits. Isolated endobronchial chondromas are unusual, and mostly seen in men, in third to fifth decade ( 4 , 5 ). In retrospect, the history, clinical and radiological findings of our patient should have prompted further investigation into the exact underlying cause. However, considering the timeframe, constraints at the time of his tb diagnosis, while he was living in a small village in northern India, patient was treated with anti-TB medication, as per protocol. Owing to its versatile presentation, it is easy to over diagnose tuberculosis, particularly in endemic regions like India. Appropriate sampling and diagnosis of endobronchial growths requires facilities for high-resolution CT, with subsequent bronchoscopic visualisation and biopsy. These are only possible in specialised tertiary healthcare settings. As such, clinicians should be alert, and timely referrals of these cases should be sought. This not only prevents the patient from undergoing unnecessary and potentially toxic drug therapy but also may help in the early recognition of any possible malignant etiology. There is no specific consensus on the most suitable management of endobronchial chondromas, but bronchoscopic or surgical resection should be considered, immediately on diagnosis, to minimise secondary effects. Our patient, at the time of presentation in 2019, already had a left-sided destroyed lung secondary to mechanical obstruction and was frequently presenting recurrent respiratory infections and episodes of blood-tinged sputum. In lieu of the same, resection of the lung was the most appropriate approach, both for symptom relief as well as to protect the contralateral, normal lung from spill-over infection. Declarations ACKNOWLEDGEMENTS None FUNDING No funds were received to prepare the present manuscript. CORRESPONDING AUTHOR Correspondence to Agarwal Simran. ETHICS APPROVAL & CONSENT TO PARTICIPATE Not Applicable CONSENT FOR PUBLICATION Informed consent for publication was obtained from the patient. The patient gave written informed consent for his clinical details and images to be published in this study by signing the consent form. AVAILABILITY OF DATA AND MATERIALS The datasets used during the current case report are available from the corresponding author on reasonable request. Author Contribution Both authors wrote the main manuscript text, prepared all figures, and have reviewed the manuscript References Stevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis [Internet]. 2016 [cited 2024 Sep 23];8(11):3401. Available from: /pmc/articles/PMC5179373/ Brewster DC, Macmillan IKR, Edwards FR. CASE REPORTS Chondroma of the Trachea Report of a Case and Review of the Literature. 19:576–84. Carney JA. Carney Triad: A Syndrome Featuring Paraganglionic, Adrenocortical, and Possibly Other Endocrine Tumors. J Clin Endocrinol Metab [Internet]. 2009 Oct 1 [cited 2024 Sep 23];94(10):3656–62. Available from: https://dx.doi.org/10.1210/jc.2009-1156 Agarwal A, Agrawal A, Alagusundarmoorthy SS, Meena N. Benign Endobronchial Neoplasms: A Review. J Pulm Respir Med. 2015;5:275. Stevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis [Internet]. 2016 [cited 2024 Sep 23];8(11):3401–13. Available from: https://jtd.amegroups.org/article/view/10537/html Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6247089","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":452362530,"identity":"08830b18-10b5-4ef9-aa41-4ef39f5a2144","order_by":0,"name":"Simran Agarwal","email":"data:image/png;base64,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","orcid":"","institution":"D Y Patil University","correspondingAuthor":true,"prefix":"","firstName":"Simran","middleName":"","lastName":"Agarwal","suffix":""},{"id":452362531,"identity":"f612987e-1007-4300-9268-4e17444f3a17","order_by":1,"name":"Girija Nair","email":"","orcid":"","institution":"D Y Patil University","correspondingAuthor":false,"prefix":"","firstName":"Girija","middleName":"","lastName":"Nair","suffix":""}],"badges":[],"createdAt":"2025-03-17 18:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6247089/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6247089/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82279661,"identity":"5ca63e9f-1b06-4405-bb16-8ae825952720","added_by":"auto","created_at":"2025-05-08 15:06:09","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":919938,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6247089/v1/0c70036626b81cb474cc5c2b.jpeg"},{"id":82277195,"identity":"50851814-6243-4083-ab3b-f8c4d13e53ad","added_by":"auto","created_at":"2025-05-08 14:50:09","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1688693,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6247089/v1/8ae5816468d681ffc4c507a3.jpeg"},{"id":82277198,"identity":"719fa133-cd3e-4e08-ae9e-eb986bea403d","added_by":"auto","created_at":"2025-05-08 14:50:09","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":532616,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6247089/v1/8634da5879aee6cccc71ebc2.jpeg"},{"id":82277206,"identity":"cb748c0c-32de-4337-9243-318165459910","added_by":"auto","created_at":"2025-05-08 14:50:09","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2337704,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6247089/v1/ca4321d896d35ab5bb4c41e4.jpeg"},{"id":82279673,"identity":"2018b8ed-2836-4ef5-b061-8b597add20ab","added_by":"auto","created_at":"2025-05-08 15:06:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5758276,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6247089/v1/971b360a-31df-4acd-9e8b-9429ca3bd646.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Large Endobronchial Enchondroma with Bronchopulmonary Aspergillosis \u0026 Fibrocavitation of the Lung","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eTumours of the tracheobronchial tree are rare, with benign tumors forming only about 6% of all lung tumours(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Of all benign endobronchial tumours, hamartomas and papillomas are the most common histologic diagnosis, and other differentials include neurogenic tumors, lipomas and chondromas. Due to the rare occurrence of these clinical entities, along with non-specific symptoms at presentation, they can be commonly misdiagnosed as respiratory infections, particularly in resource-limited settings.\u003c/p\u003e \u003cp\u003eHere we present the case of a 52-year-old man presenting with complaints of recurrent hemoptysis, and diagnosed with TB radiologically and treated, twice in the past.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA man in his early 50s, non-smoker, with well-controlled type 2 diabetes, and a left-sided fibrocavitatory lung, presented with complaints of cough with yellowish expectoration, associated with 3\u0026ndash;4 episodes of blood-tinged sputum, over 3 days. Patient has a history of frequent chest infections, requiring hospital admission 1\u0026ndash;2 times every year for the past 5 years. Notably, the patient had received anti-tubercular treatment twice, 20 years and 17 years before his current admission, with no microbiological evidence. In addition, patient has been taking an inhaled LABA\u0026thinsp;+\u0026thinsp;LAMA combination regularly since his previous admission 1 year back.\u003c/p\u003e \u003cp\u003eOn examination, patient was afebrile, and mildly dyspneic, with normal vital signs; blood pressure 130/80 mm Hg, pulse 90 beats per minute, respiratory rate 20 breaths per minute and oxygen saturation 97% on room air. Lung auscultation revealed breath sounds absent on the left, with no wheeze or rhonchi. There was also a tracheal shift to the left. His routine blood workup revealed hemoglobin of 10 g/dL, white blood counts of 10,000 cells/dl, and platelets 305\u0026times;10⁹/L, with normal renal and liver function tests.\u003c/p\u003e \u003cp\u003eRadiological Findings:\u003c/p\u003e \u003cp\u003eChest radiography revealed a left fibrocavitatory lung, along with an ipsilateral mediastinal shift, indicative of significant pulmonary collapse (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), leading to his admission in consideration along with his presenting complaints of hemoptysis.\u003c/p\u003e \u003cp\u003eRegular follow-up and serial annual CT chest have demonstrated a calcified mass within the left main bronchus with multiple thin-walled bullae in the left upper lobe and multiple cavitations with air-fluid levels in the left lower lobe in 2023 [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC \u0026amp; \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD], 2022 [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE \u0026amp; \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF], also reported same in 2020.\u003c/p\u003e \u003cp\u003eBronchoscopic Examination:\u003c/p\u003e \u003cp\u003eIn view of the CT findings, along with the recurrent nature of the patient\u0026rsquo;s complaints, bronchoscopic examination with biopsy of the endobronchial mass was done, and findings were consistent with previous bronchoscopic evaluations.\u003c/p\u003e \u003cp\u003eFOBs performed in 2023 [Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA] and 2020 [Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB], revealed a glossy, multilobulated lesion implanted at the mouth of the left main bronchus, 1 cm from the carina, totally obstructing the left main bronchus and the rest of the left lung. Importantly, the mucosa overlying the mass appeared healthy, with no evidence of necrosis or bleeding.\u003c/p\u003e \u003cp\u003eOwing to the history of recurrent hemoptysis, and in the interest of securing the normal right lung from spill-over infection, a cardiothoracic surgery opinion was sought for pneumonectomy. As per the surgeon\u0026rsquo;s request, a CT review and virtual bronchoscopy was also performed suggestive of a large endobronchial mass 1.2 cm away from the carina, and lung distal to the obstruction could not be delineated, most likely due to obstructive collapse. Spirometry was also performed pre-operatively, to check for pulmonary reserves, with FEV1 68% (1.64 L).\u003c/p\u003e \u003cp\u003eThe nature and purpose of the surgery was explained to the patient, along with all associated risk, benefits and possible post-operative complications. He was also briefed on potential alternatives, should he be unwilling for surgery. Once the patient consented to the procedure, a left pneumonectomy was performed. There was a 2.8 x 2.3 cm solid, yellowish-white, nodular endobronchial mass [Figure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eA]. The excised left lung measured 13.5 x 6.5 x 4.8 cm, with an adherent pleura [Figure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eC]. The left main bronchus was filled with brownish necrotic material.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe post-pneumonectomy pathology revealed fungal colonies comprising long, slender septate hyphae with acute angle branching, suggesting aspergillosis [Figure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eB, \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eD]. The left main bronchus showed ulcerated respiratory lining with squamous metaplasia. Focal epithelioid cell granulomas with multi-nucleated giant cells present in the subepithelium. Rest of the lung parenchyma showed fibrosis with bronchiectatic changes.\u003c/p\u003e \u003cp\u003eMicroscopic pathology of the endobronchial mass showed subepithelial lobules of benign hyaline cartilage with areas of endochondral ossification and admixed fatty marrow spaces, all features suggestive of bronchial enchondroma.\u003c/p\u003e \u003cp\u003eTreatment:\u003c/p\u003e \u003cp\u003eInitially, the patient had been managed conservatively and symptomatically over the years, with short courses of antibiotics, and as-required anti-fibrinolytics. However, considering the persistently recurring symptoms, a left lung pneumonectomy was performed, after all appropriate pre-operative evaluations.\u003c/p\u003e \u003cp\u003eFollowing surgery, based on the histopathologic findings, patient was started on oral Itraconazole 200 mg twice a day. Along with that, the patient is also continuing with his inhaled LABA and LAMA combination. Patient is currently on the prescribed treatment and tolerating the medications well without any significant adverse events.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis case highlights the challenges in the diagnosis of endobronchial lung pathologies, in the setting of an underlying fibrocavitatory disease. In a resource-limited setting, in countries with high-burden of tuberculosis, oftentimes such lesions can be mislabelled as TB, and started on anti-tuberculosis therapy. Along with the necessary facilities, it is also essential to have a high index of suspicion for other more likely differentials, to manage the underlying disease in an appropriate manner.\u003c/p\u003e \u003cp\u003eEndobronchial enchondromas are extremely rare benign tumours, of mesodermal origin, often misclassified as hamartomas(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is a slow growing, rounded, smooth mass with fibrous encapsulation consisting of calcified, cartilaginous components (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although non-invasive, its increasing size may give rise to signs and symptoms due mechanical obstruction, and pressure effects, as was seen in this patient, with resultant destruction of the ipsilateral lung.\u003c/p\u003e \u003cp\u003eIsolated presentation of such tumours is uncommon, and it usually presents as part of Carney triad, a rare non-familial syndrome of unknown etiology, seen in young women, associated with gastric stromal tumours, pulmonary chondromas and endocrine tumours (paragangliomas) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In consideration of the same, our patient gave no history of signs and symptoms pointing towards paragangliomas, during any of his visits. Isolated endobronchial chondromas are unusual, and mostly seen in men, in third to fifth decade (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn retrospect, the history, clinical and radiological findings of our patient should have prompted further investigation into the exact underlying cause. However, considering the timeframe, constraints at the time of his tb diagnosis, while he was living in a small village in northern India, patient was treated with anti-TB medication, as per protocol. Owing to its versatile presentation, it is easy to over diagnose tuberculosis, particularly in endemic regions like India.\u003c/p\u003e \u003cp\u003eAppropriate sampling and diagnosis of endobronchial growths requires facilities for high-resolution CT, with subsequent bronchoscopic visualisation and biopsy. These are only possible in specialised tertiary healthcare settings. As such, clinicians should be alert, and timely referrals of these cases should be sought. This not only prevents the patient from undergoing unnecessary and potentially toxic drug therapy but also may help in the early recognition of any possible malignant etiology.\u003c/p\u003e \u003cp\u003eThere is no specific consensus on the most suitable management of endobronchial chondromas, but bronchoscopic or surgical resection should be considered, immediately on diagnosis, to minimise secondary effects. Our patient, at the time of presentation in 2019, already had a left-sided destroyed lung secondary to mechanical obstruction and was frequently presenting recurrent respiratory infections and episodes of blood-tinged sputum. In lieu of the same, resection of the lung was the most appropriate approach, both for symptom relief as well as to protect the contralateral, normal lung from spill-over infection.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds were received to prepare the present manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCORRESPONDING AUTHOR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Agarwal Simran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL \u0026amp; CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent for publication was obtained from the patient. The patient gave written informed consent for his clinical details and images to be published in this study by signing the consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current case report are available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBoth authors wrote the main manuscript text, prepared all figures, and have reviewed the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis [Internet]. 2016 [cited 2024 Sep 23];8(11):3401. Available from: /pmc/articles/PMC5179373/\u003c/li\u003e\n\u003cli\u003eBrewster DC, Macmillan IKR, Edwards FR. CASE REPORTS Chondroma of the Trachea Report of a Case and Review of the Literature. 19:576\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eCarney JA. Carney Triad: A Syndrome Featuring Paraganglionic, Adrenocortical, and Possibly Other Endocrine Tumors. J Clin Endocrinol Metab [Internet]. 2009 Oct 1 [cited 2024 Sep 23];94(10):3656\u0026ndash;62. Available from: https://dx.doi.org/10.1210/jc.2009-1156\u003c/li\u003e\n\u003cli\u003eAgarwal A, Agrawal A, Alagusundarmoorthy SS, Meena N. Benign Endobronchial Neoplasms: A Review. J Pulm Respir Med. 2015;5:275. \u003c/li\u003e\n\u003cli\u003eStevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis [Internet]. 2016 [cited 2024 Sep 23];8(11):3401\u0026ndash;13. Available from: https://jtd.amegroups.org/article/view/10537/html\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tuberculosis, Pneumonectomy, DR-TB, Drug-resistant","lastPublishedDoi":"10.21203/rs.3.rs-6247089/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6247089/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe report a case of a patient with an endobronchial mass in the left main bronchus of the lung, presenting with recurrent pneumonia and hemoptysis. Initial bronchoscopic investigations and endobronchial tissue biopsy had been non-specific, suggestive only of a fibroepithelial polyp. However, in consideration of the recurrent nature of the patient\u0026rsquo;s symptoms over the years, he was advised to undergo a left pneumonectomy. Tissue biopsy sent post-operatively revealed the presence of multiple upper lobe cavities with fungal colonies caused by Aspergillosis, with the endobronchial mass showing features of benign endobronchial enchondroma. Based on the clinical history, and histopathological findings, patient has been started on oral Itraconazole. Follow-up, 1 month postoperatively, and 2 weeks since starting medication shows stable results, with no sign of adverse events. This case highlights the importance of regular follow-ups and repeat tissue biopsies, where required, of endobronchial lesions, especially in high-TB burden countries like India.\u003c/p\u003e","manuscriptTitle":"Large Endobronchial Enchondroma with Bronchopulmonary Aspergillosis \u0026amp; Fibrocavitation of the Lung","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 14:50:04","doi":"10.21203/rs.3.rs-6247089/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-01T14:17:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229622739896260059702710026815029089650","date":"2025-05-25T10:32:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118821061186626579368715629161217418004","date":"2025-05-16T10:00:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82541511760425451051666542626134043809","date":"2025-05-05T13:33:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T13:21:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T13:47:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-07T05:18:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-04T10:43:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-04-04T10:42:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"34ca29e0-d870-4e0e-9a2e-aa63447e6548","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-08T14:50:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-08 14:50:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6247089","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6247089","identity":"rs-6247089","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}