Bronchoscopic resection of an Endobronchial Carcinoid Tumor during Early IVF Twin Pregnancy: A Case Report

Inside the human chest, the airways function as a complex network of tubes that carry oxygen deep into the lungs. Occasionally, a rare type of slow-growing tumor can form within these tubes. These growths, known as carcinoid tumors, are made of specialized cells that usually develop very gradually. Because they grow so slowly, they often remain hidden for years, only revealing themselves when they become large enough to block airflow or cause bleeding. When a person coughs up blood, it is a serious warning sign that something is obstructing or irritating these delicate passages. While doctors can usually manage these tumors with surgery, the situation becomes incredibly delicate when the patient is pregnant. The primary goal shifts from simply removing a growth to protecting two lives at once: the mother and the developing baby. This balance is especially critical in the early weeks of pregnancy, when the fetus is most vulnerable to the effects of anesthesia and major surgical stress.

This story begins with a thirty-three-year-old woman who was carrying twins conceived through in vitro fertilization, a process that often involves significant emotional and medical investment. She was thirteen weeks into her pregnancy when she arrived at the hospital with a four-year history of coughing up small amounts of blood. The bleeding was intermittent, lasting only a day or two every few months, but it was persistent enough to cause concern. Along with the bleeding, she felt a constant sense of fullness in her chest and throat. Doctors had previously seen a mass in her right main airway on a scan taken five months before she became pregnant, but the nature of the growth had not been confirmed. The challenge was clear: she needed a diagnosis and treatment for a tumor that was likely bleeding easily, yet any procedure carried risks for her twin pregnancy.

The medical team decided on a careful, minimally invasive approach. Instead of opening the chest for a major operation, they chose to remove the tumor directly through the airway using a flexible tube with a camera, a procedure known as bronchoscopy. The patient was placed under general anesthesia, but the team used a modified plan designed to keep the procedure as short and safe as possible. Throughout the operation, an obstetrician monitored the heartbeats of both fetuses using ultrasound, ensuring that the babies remained stable while the mother was asleep. The doctors inserted a breathing tube and used a specialized tool to snare the smooth, oval-shaped mass located in the right main bronchus. The tumor was removed in two pieces, and the area was washed with cold saline to clear away any blood clots. The entire procedure lasted two hours, and the doctors confirmed that the airway was clear and no active bleeding remained.

Once the tissue was removed, pathologists examined it under a microscope to determine exactly what they were dealing with. The growth was identified as an atypical pulmonary carcinoid tumor, a specific type of neuroendocrine cancer. The cells were organized in neat clusters with a rich network of blood vessels, but they showed no signs of the rapid, chaotic growth or cell death often seen in more aggressive cancers. The markers on the cells confirmed their origin, and the rate at which they were dividing was low. This finding was crucial because it suggested that while the tumor needed to be removed, it was not an immediate emergency requiring a massive, life-altering surgery right then and there.

The success of this case relied on a strategy of staging the treatment. The doctors removed the visible part of the tumor to stop the bleeding and clear the airway, effectively acting as a bridge to keep the patient safe until after the baby was born. They postponed the definitive, more extensive surgery that would ensure the tumor was completely gone until after the twins were delivered. This decision was driven by the desire to avoid the risks of major surgery and prolonged anesthesia during the first trimester, a period when the developing brains of the fetuses are particularly sensitive. By using a precise, minimally invasive technique, the team managed to resolve the immediate threat of bleeding and obstruction without compromising the pregnancy. The patient woke up from the procedure without complications, and the twins remained healthy, demonstrating that with a coordinated team and careful planning, even rare and complex medical challenges can be managed safely for both mother and child.