Endobronchial chondroma presenting as recurrent pneumonia - diagnostic role of bronchoscopy and surgical management: A case report

Abstract

BACKGROUND

Endobronchial chondroma is an exceptionally rare benign tumor of the tracheobronchial tree. Although histologically benign, its intraluminal growth may cause airway obstruction and lead to recurrent or non-resolving pulmonary infections. Due to its nonspecific clinical presentation and radiologic features, delayed diagnosis is common.

CASE SUMMARY

A 42-year-old male smoker presented with fever, productive cough, and generalized weakness. He had experienced two similar episodes of left upper lobe pneumonia within the previous 6 months, each resolving with antibiotic therapy. Chest computed tomography revealed an endobronchial mass located between the left main bronchus and the left upper lobar bronchus, associated with consolidation and a small pleural effusion. Flexible bronchoscopy identified a 7-mm polypoid lesion, and histopathological examination of biopsy specimens confirmed the diagnosis of endobronchial chondroma. Following resolution of pneumonia, the patient underwent left upper segmentectomy with bronchoplasty as definitive treatment. The postoperative course was uneventful.

CONCLUSION

Endobronchial chondroma, although rare, should be considered in patients presenting with recurrent pneumonia involving the same pulmonary lobe. Prompt bronchoscopic evaluation and histopathological confirmation are essential for accurate diagnosis. Early and complete excision is essential to prevent persistent airway obstruction and irreversible pulmonary damage. In the present case, definitive management was achieved with left upper segmentectomy combined with bronchoplasty.

Key Words: Endobronchial chondroma; Recurrent pneumonia; Benign airway tumor; Airway obstruction; Carney triad; Case report

Core Tip: Endobronchial chondroma is an exceptionally rare benign airway tumor that may present with recurrent pneumonia due to bronchial obstruction. Because clinical and radiologic findings can mimic common respiratory conditions, delayed diagnosis is frequent. This case highlights the importance of considering endobronchial tumors in patients with recurrent pneumonia affecting the same lobe and emphasizes the role of bronchoscopy and histopathological examination in establishing a definitive diagnosis. Early recognition and complete excision are crucial to prevent irreversible pulmonary damage.

INTRODUCTION

Endobronchial chondroma is an exceptionally rare benign tumor of the tracheobronchial tree. Despite its benign nature, its intraluminal growth may result in airway obstruction and lead to recurrent or non-resolving pulmonary infections. Because clinical presentation is often nonspecific and may mimic common respiratory conditions such as pneumonia or asthma, diagnosis is frequently delayed[1,2].

Patients typically present with symptoms related to bronchial obstruction, including cough, dyspnea, wheezing, or recurrent infections affecting the same pulmonary lobe. In such cases, repeated involvement of the same anatomical region should raise suspicion for an underlying obstructive lesion and prompt further evaluation with imaging and bronchoscopy[2,3].

Due to its rarity and nonspecific presentation, endobronchial chondroma remains a diagnostic challenge in clinical practice. Early recognition is important to prevent complications such as persistent infection, bronchiectasis, or irreversible parenchymal damage.

In this report, we present a case of recurrent pneumonia caused by an endobronchial chondroma, highlighting the clinical presentation, diagnostic approach, and therapeutic decision-making associated with this uncommon entity.

CASE PRESENTATION

Chief complaints

A 42-year-old male smoker (10 pack-years) presented to the emergency department with a 48-hour history of fever (up to 38.6 °C), productive cough with white sputum, and generalized weakness.

History of present illness

His medical history was notable for two similar episodes during the preceding 6 months.

History of past illness

On both occasions, chest radiographs demonstrated consolidation of the left upper lobe, and the patient was treated with amoxicillin-clavulanic acid, resulting in complete clinical and radiological resolution within one week.

Personal and family history

The patient had no significant past medical history and no known family history of respiratory or neoplastic diseases.

Physical examination

On current presentation, physical examination revealed decreased breath sounds over the upper zone of the left hemithorax.

Laboratory examinations

Laboratory investigations revealed leukocytosis (white blood cell count: 13.8 × 10⁹/L) and elevated inflammatory markers (C-reactive protein: 78 mg/L), consistent with acute infection.

Imaging examinations

A chest radiograph confirmed consolidation involving the left upper lobe. Computed tomography (CT) of the chest demonstrated an endobronchial mass, which was identifiable as a focal intraluminal soft-tissue lesion at the level of the left main bronchus and left upper lobar bronchus, causing partial obstruction. No calcifications were observed. Associated findings included consolidation with air bronchograms, ground-glass opacities in the posterior segment of the left upper lobe, and a small ipsilateral pleural effusion (Figure 1A).

Figure 1 Chest computed tomography result. A: Left upper lobe consolidation secondary to endobronchial obstruction. Axial chest computed tomography (CT; lung window) showing consolidation with air bronchograms in the left upper lobe, associated with surrounding ground-glass opacities. The imaging findings are consistent with post-obstructive pneumonia related to an underlying endobronchial lesion located between the left main bronchus and the left upper lobar bronchus (not shown in this slice); B: Endobronchial chondroma. Axial chest CT image showing an endobronchial lesion located between the left main bronchus and the left upper lobar bronchus (arrow), corresponding to the obstructing mass identified on bronchoscopy.

MULTIDISCIPLINARY EXPERT CONSULTATION

Flexible bronchoscopy revealed a polypoid endobronchial lesion at the aforementioned location (Figure 2). The mass measured approximately 7 mm in diameter and had a smooth, sub-reddish, vascularized surface. No necrosis, ulceration, or discoloration was observed. The lesion appeared broad-based with smooth margins. Endobronchial biopsy specimens were obtained using biopsy forceps.

Figure 2 Bronchoscopic appearance of endobronchial chondroma. Flexible bronchoscopy demonstrating a polypoid, smooth, vascularized endobronchial lesion partially obstructing the lumen of the left upper lobar bronchus. The mass appears broad-based, with intact overlying mucosa and no visible necrosis or ulceration, findings consistent with a benign endobronchial tumor subsequently confirmed as chondroma on histopathological examination.

Histopathological examination demonstrated nodular aggregates of mature hyaline cartilage embedded in myxoid stroma, without cytologic atypia or malignant features, confirming the diagnosis of endobronchial chondroma (Figure 3).

Figure 3 Histopathological features of endobronchial chondroma (hematoxylin and eosin stain). Microscopic examination demonstrates well-circumscribed nodular aggregates of mature hyaline cartilage embedded within a myxoid stroma. The chondrocytes are uniform, residing in lacunae, and show no cytologic atypia, pleomorphism, increased cellularity, or mitotic activity. No infiltrative growth pattern is observed. These histopathological findings are consistent with a diagnosis of endobronchial chondroma.

The patient received a 10-day course of moxifloxacin, leading to rapid clinical improvement. Follow-up chest CT showed complete resolution of the left upper lobe consolidation and disappearance of the pleural effusion (Figure 1B).

FINAL DIAGNOSIS

Given the diagnosis of pulmonary chondroma, clinical evaluation for features of Carney triad was considered; however, no clinical or imaging findings suggestive of associated gastrointestinal stromal tumor or paraganglioma were identified.

TREATMENT

In view of the recurrent nature of the infection and the obstructive lesion, definitive surgical management was undertaken. The patient underwent left upper segmentectomy with bronchoplasty. The lesion size (approximately 7 mm) was estimated based on bronchoscopic visualization. Pulmonary function tests were not performed prior to surgery due to the acute infectious presentation and the need for prompt management of the obstructive lesion.

OUTCOME AND FOLLOW-UP

The postoperative course was uneventful, and the patient recovered without complications. At follow-up, the patient remained asymptomatic, with no recurrence of respiratory infections, cough, or other respiratory symptoms.

DISCUSSION

Epidemiology of bronchial chondroma

Endobronchial chondromas are exceedingly rare, accounting for approximately 0.04% of all tumors of the tracheobronchial tree[3]. Among benign endobronchial neoplasms, papillomas and hamartomas are far more frequently encountered[3]. Chondromas are non-epithelial mesenchymal tumors composed exclusively of mature hyaline cartilage, distinguishing them from hamartomas, which typically contain a mixture of mesenchymal elements[4,5].

Although chondromas most commonly arise in the axial skeleton, their occurrence in the respiratory tract is uncommon. When present in the airway, they may involve the larynx, trachea, or major bronchi, with tracheal localization reported more frequently than bronchial involvement[6]. Their rarity contributes to limited epidemiological data and frequent diagnostic delays.

Endobronchial chondromas may occur sporadically or, more rarely, as part of the Carney triad, a non-hereditary syndrome characterized by the coexistence of pulmonary chondroma, extra-adrenal paraganglioma, and gastrointestinal stromal tumor[7]. Recognition of this association is important, as identification of a pulmonary chondroma—particularly in younger patients—should prompt consideration of a broader syndromic evaluation.

Clinical presentation, imaging, and differential diagnosis

Clinical manifestations are primarily related to the degree of bronchial obstruction rather than tumor size. Patients may be asymptomatic or present with nonspecific respiratory symptoms, including chronic cough, dyspnea, wheezing mimicking asthma, hemoptysis, or recurrent pneumonia[2]. In particular, repeated infections involving the same pulmonary lobe should raise suspicion for an underlying obstructive lesion.

Radiologically, findings are often nonspecific and may include segmental or lobar consolidation, atelectasis, or features of post-obstructive pneumonitis. CT typically demonstrates an endobronchial lesion, although characterization may be limited. Bronchoscopy plays a central role in diagnosis, allowing direct visualization of a polypoid, well-circumscribed lesion and enabling tissue sampling for histopathological confirmation.

The differential diagnosis includes hamartoma, chondrosarcoma, primary lung carcinoma, and tracheobronchial amyloidosis. Hamartomas typically exhibit mixed mesenchymal components, such as cartilage and fat, sometimes with characteristic “popcorn” calcifications on imaging[5]. In contrast, chondrosarcomas demonstrate cytologic atypia, increased cellularity, and infiltrative growth patterns. Definitive diagnosis relies on histopathological evaluation demonstrating mature cartilage without atypia and the absence of entrapped respiratory epithelium[4,5].

Treatment and clinical implications

Due to the rarity of this entity, no standardized management guidelines exist. Treatment decisions are individualized and depend on tumor size, location, degree of airway obstruction, and patient-related factors. Endoscopic resection, including mechanical debulking or laser-assisted techniques, has been successfully used in selected cases[2,3]. However, surgical resection remains the preferred approach when complete endoscopic excision is not feasible, when there is concern for malignancy, or when irreversible parenchymal damage has occurred due to chronic obstruction[2,6].

In the present case, surgical resection was favored despite the small tumor size, due to its location at a critical bronchial junction, its broad-based morphology, and the presence of recurrent post-obstructive pneumonia, all of which increased the likelihood of incomplete endoscopic removal and persistent airway compromise.

Importantly, although endobronchial chondromas are considered benign, recurrence and even malignant transformation have been reported. The study by Salminen et al[8] described a case in which incomplete excision led to recurrence after 5 years. Subsequent recurrences demonstrated malignant transformation to chondrosarcoma, ultimately resulting in metastatic disease and death. This case underscores the importance of complete tumor removal and careful long-term follow-up.

Overall, timely recognition and definitive management are essential to prevent persistent airway obstruction, recurrent infections, and potential long-term complications.

In the present case, although the lesion was small (7 mm) and histologically benign, surgical resection was preferred over endoscopic management. The tumor was located at the junction between the left main bronchus and the left upper lobar bronchus, a critical anatomical site where complete endoscopic excision may be technically challenging. Additionally, the lesion exhibited a broad-based attachment, increasing the likelihood of incomplete removal with bronchoscopic techniques. The patient had also experienced recurrent post-obstructive pneumonia, indicating clinically significant airway compromise. Taken together, these factors supported a more definitive surgical approach. Endoscopic resection was considered; however, it was not pursued due to concerns regarding incomplete excision and potential recurrence.

Overall, although histologically benign, endobronchial chondromas may lead to significant morbidity due to delayed diagnosis and chronic bronchial obstruction. Awareness of this rare entity is therefore crucial, particularly in cases of recurrent pneumonia affecting the same anatomical region.

To better contextualize the present case within the existing literature, a summary of selected reported cases of endobronchial and tracheobronchial chondroma is provided in Table 1.

Table 1 Summary of selected reported cases of endobronchial and tracheobronchial chondroma.

Ref.	Age/sex	Location	Key clinical features	Treatment	Outcome
Mahmud et al[4]	Adult male	Endobronchial	Chronic cough	Bronchoscopic resection	Symptom resolution
Salminen et al[8]	Adult	Trachea	Recurrent tumor	Surgical resection	Malignant transformation, death
Fernandez-Bussy et al[2]	Adult	Bronchus	Airway obstruction symptoms	Endoscopic resection	Favorable
Present case	42/male	Left upper lobar bronchus	Recurrent pneumonia	Segmentectomy with bronchoplasty	Complete recovery

As shown in Table 1, most reported cases of endobronchial chondroma present with nonspecific respiratory symptoms such as cough or airway obstruction. In contrast, our case is distinguished by recurrent pneumonia affecting the same pulmonary lobe, emphasizing the importance of considering an underlying obstructive lesion in such presentations. Furthermore, while many cases are managed endoscopically, surgical resection was required in our patient due to tumor location and morphology.

The present case highlights several distinctive features compared with previously reported cases, including the small size of the lesion (7 mm), its location at a critical bronchial bifurcation, and its presentation with recurrent pneumonia affecting the same pulmonary lobe. Furthermore, despite its benign histology, surgical resection was required due to anatomical constraints and recurrent infection, underscoring the importance of individualized management strategies in such cases.

CONCLUSION

Endobronchial chondroma is an exceptionally rare benign tumor of the tracheobronchial tree that may present with recurrent or non-resolving pneumonia due to localized airway obstruction. Because its clinical and radiologic manifestations are often nonspecific and may mimic more common respiratory conditions, delayed diagnosis is frequent. Recurrent infections affecting the same pulmonary lobe should prompt thorough evaluation for an underlying obstructive lesion, including advanced imaging and bronchoscopic assessment. Definitive diagnosis relies on histopathological confirmation, distinguishing chondroma from other benign cartilaginous tumors and malignant entities. Although benign in nature, timely and complete excision—either endoscopic or surgical—is essential to prevent persistent airway compromise and irreversible parenchymal damage. Increased awareness of this rare condition may facilitate earlier recognition and appropriate management, thereby improving patient outcomes.