CT-Occult Primary Benign Tracheobronchial Neoplasms: A Single-Center 40-Case Clinicopathologic Series.

Background: Primary benign tracheobronchial neoplasms are rare and often misdiagnosed due to non-specific presentation.

Objective: To describe the clinical, bronchoscopic, histopathologic and immunohistochemical features of these tumors in a TB-enriched population.

Methods: We retrospectively identified 40 patients with primary benign tracheobronchial tumors diagnosed by bronchoscopic biopsy in a single TB center over a period of 7 years (2017-2024) and summarized clinical data, bronchoscopic characteristics, pathology, and immunophenotype.

Results: Patients were predominantly middle-aged and older men. None of the tumors were detected by CT of the chest. The most common clinical symptoms were cough, sputum production, fever, hemoptysis, chest tightness and wheezing, The median symptom duration was 30 days (IQR, 7-135). The tumors were primarily located in segmental bronchi. Seventy-five percent of tumors were polypoid with wide base while 20% displayed columnar growth patterns and 5% cases had pedunculated morphology. Pathology was consistent with leiomyomas (40.0%), hamartomas (20.0%), peripheral nerve sheath tumors (22.5%) and squamous papillomas (7.5%). Rarer tumor types occupied 10.0% of all cases. Immunohistochemical analysis was consistent with pathology.

Conclusion: Primary benign tracheobronchial neoplasms are commonly small and undetectable by CT of the chest. Coupled with nonspecific symptoms this demands a high index of suspicion including in patients with coexisting conditions such as TB. Definitive diagnosis required bronchoscopy with histologic assessment.