Bronchoscopy demonstrated a whitish tumour mass in the left main stem bronchus which occluded the lumen.The mucosa of the right bronchus just distal to the carina looked irregular. Biopsies were taken of the tumour in the left main bronchus and of the irregular right bronchial mucosa. The histological features of the tumour in the left bronchus showed normal respiratory epithelium without pseudoepitheliomatous hyperplasia. Underlying the epithelial surface were granular cells with small dark nuclei, large fusiform cells with elongated nuclei, and other cells with eosinophilic cytoplasm (fig 2); features compatible with the diagnosis of a granular cell myoblastoma. Histological examination of the specimen from the right main bronchus revealed an infiltrating, moderately well-differentiated squamous carcinoma.The treatment of this patient was problematic. The proximity of the squamous tumour to the carina contraindicated surgical therapy, leaving radiotherapy as the alternative. The myoblastoma could have been removed via a transthoracic bronchotomy, by endobronchial resection, pneumonectomy, or lobectomy.

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