A 42-year-old former smoker woman (30 pack-years) presented to the Emergency Department with acute onset of dyspnea, cough and fever. The patient had no comorbidities and the physical exam was within normal limits. In order to exclude a pulmonary thromboembolism, a computed tomography angiography was performed, revealing bilateral hilar and mediastinal lymphadenopathy and various areas of ground glass of both the inferior lobes. Several blood tests were done in order to exclude an infectious disease; the tests were negative, including QuantiFERON-TB Gold test. Bronchoscopy showed a marked thickening of the tracheal carina extending for a few millimeters to the medial aspect of both mainstem bronchi (Fig. 1).
Histopathology examination of the bronchial biopsies performed in this area revealed sheets of epithelioid cells with eosinophilic granular cytoplasm, positive for S100 and NSE and negative for CAM5.2 (Fig. 2; Fig. 3), consistent with a diagnosis of GCT. An endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the lymph node stations #4R, #7 and #11Rs was performed and the cytopathological examination suggested their "reactive" nature by showing a predominance of lymphocytes. Culture of bronchoalveolar lavage (BAL) for common bacteria, fungi and mycobacteria proved negative. The tumor was ablated with Nd:YAG laser (Fig. 4) during rigid bronchoscopy under general anesthesia and the patient is currently free of disease 12 months after treatment.