Benign Bronchial Tumours: A Rare Case of Endobronchial Fibroma With Hilar-Mediastinal Lymphadenopathy.

Abstract

Background: Endobronchial fibroma is a rare benign tumour that can mimic lung cancer, especially when accompanied by airway obstruction and hilar-mediastinal lymphadenopathy.

Case presentation: A 73-year-old man under radiological surveillance for pulmonary nodules developed interval growth of a middle-lobe nodule with new hilar-mediastinal lymphadenopathy and an obstructing B4 endobronchial mass. Bronchoscopy revealed a smooth, firm, rubbery polypoid lesion. Tissue sampling included fine-needle aspiration of the endobronchial mass and EBUS-TBNA of nodal stations (7, 11Ri and 11 L). Histology showed fibromatous tissue without atypia; lymph nodes exhibited inflammatory changes. The lesion was fully removed via rigid bronchoscopy with forceps and laser, leading to symptom relief and planned radiological follow-up. We propose a stepwise evaluation pathway for endobronchial tumours when lymphadenopathy is present, highlight pathology features that distinguish fibroma from malignant and benign mimickers and outline practical considerations for bronchoscopic resection.

Conclusion: In patients with concurrent endobronchial mass and lymphadenopathy, a targeted approach using EBUS-TBNA can exclude nodal metastasis and support definitive, minimally invasive treatment, potentially avoiding unnecessary surgery.