A rare case of intimal sarcoma of the lower pulmonary vein in a 22-year-old male is reported.

Diagnosis was successfully achieved using Endobronchial Ultrasound-Guided Fine-needle Aspiration (EBUS-FNA) combined with rapid on-site evaluation (ROLE).

The case demonstrates the efficacy of EBUS-FNA with ROLE as a minimally invasive diagnostic tool for vascular tumors.

Comprehensive review of the current literature on the use of EBUS-FNA for diagnosing rare pulmonary and vascular neoplasms.

Highlights the importance of precise diagnostic techniques and individualized treatment plans to improve outcomes in rare and aggressive tumors like intimal sarcoma.

Intimal sarcoma of blood vessels is a rare, aggressive tumor originating from vascular endothelial cells. This report presents a 22-year-old male diagnosed with an intimal sarcoma of the lower pulmonary vein, detailing diagnosis, treatment, and prognosis information. Additionally, this report explores the application application of Endobronchial Ultrasound-Guided Fine-Needle Aspiration (EBUS-FNA) alongside with Rapid Remote Online Evaluation (ROLE) for identifying a mass-like lesion in the pulmonary vein. We emphasize the value of this technique for supporting ancillary studies like immunohistochemistry. The importance of accurate diagnostic methods and personalized treatment management to improve prognosis in rare cancers is highlighted by this thorough analysis.

Intimal sarcoma

Pulmonary vein

Intimal sarcoma diagnosis

Mediastinal tumor

EBUS-FNA

FNA

© 2025 The Author(s). Published by Elsevier Inc.