Diagnosis of Pulmonary Sarcoma by EBUS: Changing the Paradigm

Pulmonary artery intimal sarcoma is an extremely rare malignant tumor that is often misdiagnosed as pulmonary thromboembolism.¹ While surgical resection has traditionally been the main diagnostic approach, minimally invasive techniques such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are emerging as a safe and effective alternative.² We present the case of a 55-year-old man with a 5-month history of chronic cough and constitutional symptoms. Imaging revealed a 6 cm × 6 cm left upper lobe pulmonary mass with mediastinal invasion, extensive vascular contact with the pulmonary trunk, high metabolic activity on PET–CT (SUV 18.8) (Fig. 1A–D), and associated tumor thrombosis. Linear EBUS-TBNA was performed using a 21G needle via the left upper lobe bronchus, identifying a heterogeneous lesion with features compatible with an intravascular tumor (Fig. 1E). The procedure was completed without complications. Cytological analysis revealed a poorly differentiated high-grade sarcoma with MDM2 amplification, consistent with pulmonary artery intimal sarcoma. This case highlights the value of EBUS-TBNA as a minimally invasive diagnostic technique, particularly in patients who are not candidates for surgery, allowing definitive diagnosis while avoiding invasive procedures, with minimal complications.

Fig. 1.

(A and B) Progressive enlargement of the intimal sarcoma with tumor thrombosis within less than 2 months, initially misdiagnosed as pulmonary thromboembolism. (C and D) Increased metabolic activity of the lesion in the selected region – the distal third of the left main bronchus – guiding the puncture site for EBUS. (E) Endoscopic appearance of the pulmonary artery lesion during EBUS-TBNA before fine-needle aspiration was performed with a 21-gauge needle.

Authors’ contributions

All authors contributed substantially to the conception and design of the work, data acquisition and interpretation, drafting and critical revision of the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Ethical considerations

In accordance with institutional regulations, approval by an Ethics Committee was not required for the publication of this clinical image.

Informed consent

Informed consent was obtained from the patient.

Declaration of generative AI and AI-assisted technologies in the writing process

The authors declare that no generative artificial intelligence was used in the writing of this manuscript.

Funding

The authors declare that they have not received any funding for the preparation of this work.

Conflicts of interest

The authors declare that they have no conflicts of interest.