An Uncommon Primary Tracheal Tumor Masquerading as Chronic Obstructive Pulmonary Disease: Diagnosed at Autopsy.

Primary tracheal tumors are rare neoplasms and often are hard to diagnose early due to the non-specific clinical presentations. Prolonged symptomatic treatment for these can often lead to missing out the diagnosis and can prove fatal. A 35-year-old male presented with gradually increasing breathlessness and dysphagia to solids and was being treated with bronchodilators and antibiotics. Chest computed tomography (CT) revealed an intratracheal mass in the lower part of the trachea and the patient was referred to our institution in view of a primary tracheal tumor where he expired within 10 min of admission. On autopsy, the gross findings and histological examination revealed a diagnosis of adenoid cystic carcinoma in the trachea. To conclude, primary tracheal tumors, even though rare, should be suspected in cases of refractory chronic obstructive pulmonary disease and chest CT and bronchoscopy must be done to aid correct diagnosis.

Distribución geográfica de mortalidad por tumores malignos de estómago, tráquea, bronquios y pulmón, Chile 1997-2004 / Geographical distribution of mortality caused by stomach, trachea, bronchi and lung malignant tumors in Chile

Background: Maps have played a critical role in public health since 1855, when John Snow associated a cholera outbreak with contaminated water source in London. After cardiovascular diseases, cancer is the second leading cause of death in Chile. Cancer was responsible for 22.7 percent of all deaths in 1997-2004 period. Aim To describe the geographical distribution of stomach, trachea, bronchi and lung cancer mortality. Material and methods: Mortality statistics for the years 1997-2004, published by the National Statistics Institute and Chilean Ministry of Health, were used. The standardized mortality ratio (SMR) for sex and age quinquennium was calculated for 341 counties in the country. A hierarchical Bayesian analysis of Poisson regression models for SMR was performed. The maps were developed using adjusted SMR (or smoothed) by the Poisson model. Results: There is an excess mortality caused by stomach cancer in south central Chile, from Teno to Valdivia. There is an excess mortality caused by trachea, bronchi and lung cancer in northern Chile, from Copiapó to Iquique. Conclusions: The geographical analysis of mortality caused by cancer shows cluster of counties with an excess risk. These areas should be considered for health care decision making and resource allocation.

Tendência de mortalidade do câncer de pulmão, traquéia e brônquios no Brasil, 1980-2003 / Lung cancer, cancer of the trachea, and bronchial cancer: mortality trends in Brazil, 1980-2003

OBJETIVO: Descrever a tendência da mortalidade do câncer de pulmão, traquéia e brônquios por sexo e faixas etárias no Brasil. MÉTODOS: Para essa análise, utilizou-se o banco de dados do Sistema de Informações sobre Mortalidade de 1980 a 2003. A análise de tendência de mortalidade no Brasil e em estados selecionados foi realizada com o ajuste de modelos e utilização da técnica LOWESS para suavização das taxas. RESULTADOS: No Brasil, a taxa padronizada de mortalidade por câncer de pulmão, traquéia e brônquios passou de 7,21 em 1980 a 9,36 óbitos por 100 mil habitantes em 2003. A análise das taxas de mortalidade específicas mostra redução em homens entre 30 e 49 anos e entre 50 e 59 anos. Entre os homens de 60 a 69 anos ocorreu aumento das taxas entre 1980 até 1995, seguido de declínio. Entre homens acima de 70 anos e entre mulheres em todas as faixas etárias acima de 30 anos, a tendência é de aumento das taxas em todo o período analisado. CONCLUSÕES: a redução das taxas de mortalidade entre homens mais jovens pode ser o resultado das ações nacionais para a redução da prevalência do tabagismo no país nas décadas mais recentes, reduzindo a exposição nas coortes mais jovens. A manutenção de taxas elevadas de mortalidade em populações mais idosas deve-se a experiência do tabagismo passado. Quanto às mulheres, a elevação das taxas segue tendência mundial, também em função do aumento da prevalência do tabagismo entre mulheres nos anos recentes.

OBJECTIVE: To describe the mortality trends for lung cancer, cancer of the trachea, and bronchial cancer in relation to gender and age brackets in Brazil. METHODS: Data related to mortality between 1980 and 2003 were collected from the Brazilian Mortality Database. A trend analysis of mortality was carried out, nationwide and in selected states, using the LOWESS technique for rate smoothing and model adjustments. RESULTS: In Brazil, the standardized mortality rate for lung cancer, cancer of the trachea, and bronchial cancer increased from 7.21/100,000 inhabitants in 1980 to 9.36/100,000 inhabitants in 2003. Specific mortality rates decreased in males in the 30-49 and 50-59 age brackets. In the 60-69 age bracket, the rates for males increased from 1980 to 1995 and declined thereafter. There was a trend toward higher mortality rates in males over 70, as well as in females over 30, throughout the period evaluated. CONCLUSIONS: The decrease in the mortality rates in younger males might have resulted from recent national interventions aimed at reducing the prevalence of smoking and reducing exposure in younger cohorts. High mortality rates in older populations remained constant due to prior tobacco use. Increased mortality rates in females are a worldwide trend and are attributable to the recent increase in smoking prevalence in females.

Tendência temporal e distribuição espacial da mortalidade por câncer de pulmão no Brasil entre 1979 e 2004: magnitude, padrões regionais e diferenças entre sexos / Temporal trend in and spatial distribution of lung cancer mortality in Brazil between 1979 and 2004: magnitude, regional patterns, and gender-related differences

OBJETIVOS: Descrever a tendência temporal e a distribuição espacial da mortalidade por câncer de traquéia, brônquios e pulmão no Brasil entre 1979 e 2004. MÉTODOS: Os dados de mortalidade segundo o sexo e as regiões geográficas do Brasil foram obtidos junto ao Sistema de Informações sobre Mortalidade, o qual foi criado pelo Ministério da Saúde em 1975. Os dados populacionais provêm dos censos, da contagem populacional e das estimativas intercensitárias. As taxas de mortalidade foram padronizadas pelo método direto, e as tendências foram analisadas para cada sexo e região utilizando-se o método de Prais-Winsten para regressão linear generalizada. RESULTADOS: A mortalidade por câncer de pulmão correspondeu a aproximadamente 12 por cento da mortalidade geral por neoplasias no Brasil durante o período. A tendência foi de aumento em ambos os sexos e em todas as regiões, exceto na população masculina do sudeste, cujas taxas se mantiveram estáveis entre 1979 e 2004. As maiores taxas foram observadas no sul e no sudeste. Entretanto, a região nordeste foi a que apresentou o maior aumento, seguida pelo centro-oeste e o norte. Em todas as regiões, o incremento nas taxas de mortalidade foi maior entre as mulheres. CONCLUSÕES: O aumento na mortalidade por câncer de pulmão no Brasil entre 1979 e 2004 exige medidas públicas que minimizem a exposição aos fatores de risco, sobretudo ao tabaco, e permitam maior acesso aos serviços de saúde para diagnóstico e tratamento.

OBJECTIVES: To describe the temporal trend in and spatial distribution of mortality from tracheal, bronchial, and lung cancer in Brazil from 1979 to 2004. METHODS: Mortality data by gender and geographic region were obtained from the Mortality Database created by the Ministry of Health in 1975. Demographic data were collected from the national censuses, from population counts, and from population estimates made in non-census years. Mortality rates were standardized according to the direct method, and the trends were analyzed by gender and geographic region using the Prais-Winsten method for generalized linear regression. RESULTS: Lung cancer mortality accounted for approximately 12 percent of the overall neoplasia-related mortality during the period. There was a trend toward an increase for both genders and in all regions, except for the male population in the southeast region, whose rates remained steady between 1979 and 2004. The highest rates were observed in the south and southeast regions. However, the northeast region was the one that presented the greatest increase, followed by the central-west and north regions. In all regions, the increase in mortality rates was higher in women. CONCLUSIONS: The increase in lung cancer mortality in Brazil between 1979 and 2004 requires public measures that can minimize exposition to risk factors, mainly tobacco, and allow greater access to health care facilities for diagnosis and treatment.