Compromiso tumoral de vía aérea en pediatría / Pediatric airway compromise by tumors

Los tumores traqueo bronquiales son extremadamente infrecuentes en la edad pediátrica e incluyen lesiones benignas y malignas. Por la baja frecuencia en niños y sintomatología respiratoria inespecífica, la sospecha diagnostica es habitualmente tardía. El tratamiento de elección en la mayoría de ellos es la resección quirúrgica abierta, sin embargo, la remoción endoscopia podría estar indicada es casos muy seleccionados con histología benigna y de localización accesible.

Tracheobronchial tumors are extremely rare in children and include benign and malignant lesions. Due to the low frequency in children and nonspecific respiratory symptoms, diagnostic suspicion is usually late. The treatment of choice in most of them is open surgical resection, however, endoscopy removal could be indicated in highly selected cases with benign histology and accessible location.

Adenoid cystic carcinoma of the trachea

Primary malignant neoplasms of the trachea are very rare and there is limited information available on this subject. Adenoid cystic carcinoma is a slow-growing malignant tracheal tumor and the best method of treatment is surgical resection. This study was conducted to evaluate patients with adenoid cystic carcinoma of the trachea who underwent surgical treatment. In this descriptive study, 9 patients treated for adenoid cystic carcinoma from 1995 to 2007 at the Mashhad Ghaem Hospital and Tehran Imam Khomeini Hospital were assessed. There were 9 patients [3 males and 6 females] with a mean age of 56.3 years. Dyspena and stridor were the most common presenting symptoms [88.8%]. All patients underwent rigid bronchoscopy and biopsy. The most common site of involvement was the lower third of trachea [44.4%]; 77.7% of patients underwent surgical resection. Death occurred in one patient after tracheal resection due to aspiration pneumonia [14.2%]. Postoperative radiotherapy was performed in 28.4% of patients because of positive surgical margin and in 22.2% due to inappropriate location of the tumor after bronchoscopic ablation. During a three-year follow up, one patient [11.1%] had tumor recurrence. Resection with post-operative radiotherapy was performed for him. The three-year survival was 88.8%. Because of the nature of adenoid cystic carcinoma of the trachea, surgical resection is the best method of treatment. But if surgical margins are positive post-operative radiotherapy will be necessary. In patients who are not candidates for resection, radiotherapy can be an effective alternative treatment

Plasmocitoma solitario de tráquea / Solitary plasmocytoma of the trachea

Los tumores primarios de tráquea son infrecuentes, y la tráquea es un sitio sobre todo infrecuente para la presentación del plasmocitoma extramedular. Reportamos un caso de plasmocitoma extramedular de tráquea en un paciente de 49 años con síntomas de obstrucción de la vía aérea. Se efectuó la resección del tumor traqueal; el estudio histopatológico reveló plasmocitoma extramedular. Investigaciones complementarias excluyeron la presencia de mieloma múltiple. El paciente recibió tratamiento con radioterapia y no se registraron recurrencias

Primary malignant tumors of the trachea: the Tata Memorial Hospital expeience

Primary tumors of the trachea are extremely rare. Treatment methods vary considerably and few studies have sought to provide adequate guidelines. This study reviews the records of patients treated for tracheal cancer at the Tata Memorial Hospital [TMH], Mumbai, India. Subjects and Fifteen patients with primary tracheal malignancies were identified in the TMH database during the period from 1983 to 2000. They were predominantly males [87%] belonging to an older age-group [67% above 40 years]. Common presenting symptoms were cough, hoarseness, hemoptysis and indications of airway obstruction. Squamous cell carcinoma was the commonest histologic subtype [40%] followed by adenoid cystic carcinoma [27%]. Ten patients received radical treatment. One patient underwent surgery [resection and anastomosis] and received postoperative radiotherapy. Another was explored but was found to be unresectable and was 1 of 2 patients treated with chemotherapy and radiotherapy. Laser resections and radiotherapy were used in 2 patients while 4 patients were managed with radiotherapy alone. One patient was treated elsewhere. The majority of patients [8/9] were treated with locoregional fields and doses ranging from 40 to 60 Gy [median 50 Gy]. Two patients also received intraluminal brachytherapy, 1 as part of initial treatment and another for recurrence. Only 5 patients treated at TMH [5/9] achieved local control of their disease. Follow-up times ranged from 1 month to 134 months, median of 38 months. Distant metastases were identified in 4 patients [bone n = 1 and lung n = 3]. Median survival was 38 months. Overall survival at 5 years was 37% by Kaplan-Meier method, but this figure should be treated with caution since only 6 patients had a follow-up of more than 2 years. Tracheal cancer is a rare malignancy. Radiation therapy is a reasonably effective modality for unresectable disease

Traqueopatía osteocondroplástica Presentación de un caso / Osteocondroplastic tracheobronchopathy

La traqueobroncopatía osteocondroplástica o traqueopatía osteoplástica es una enfermedad benigna de origen desconocido caracterizada por el depósito de tejido osteocartilaginoso en la submucosa del tracto respiratorio inferior provocando una estrechez de la vía aérea. Presentamos aspectos relevantes de esta patología y un caso clínico de un paciente, que al ser sometido a un procedimiento quirúrgico por parte de otorrinolaringología, se detecta una alteración de la vía aérea durante la inducción anestésica

Abordaje del carcinoma de tiroides invasivo a traqueolaringe y grandes vasos / Surgical approach to carcinoma of the thyroid invasive to upper airways and major vessels

El cancer de tiroides que invade localmente el componente aerodigestivo o vascular tiene una incidencia relativamente baja, usualmente sin sintomas preoperatorios que sugieran el grado de su extension. Se requiere una alta sospecha clinica para establecer el diagnostico preoperatorio, asi como el conocimiento de las modalidades terapeuticas ante su hallazgo intra-operatorio, con el ánimo de realizar el esquema terapeutico optimo para cada circunstancia, con bajas tazas de morbilidad, mortalidad y recurrencia. Se informa un estudio retrospectivo realizado en el Hospital de Caldas en los pacientes con cancer tiroideo invasivo a laringotráquea y grandes vasos manejados por el grupo de Cirugia de Cabeza y Cuello entre agosto de 1994 y junio de 2000. Se analizo sintomatologia previa asociada, el abordaje diagnostico, el esquema terapeutico aplicado segun el grado de invasion, la recidiva local regional y a distancia, la morbilidad y la mortalidad. Se proponen algunas recomendaciones para cada caso.

Carcinoma adenóide cístico da traquéia / Adenoid cystic carcinoma of trachea

Os tumores primário da traquéia säo raros e ocorrem em 0,2 por 100.000 pessoas por ano. O carcinoma adenóide cístico é o segundo tipo mais comum de neoplasia da traquéia e por sua história natural única deve ser estudado separadamente. Os autores apresentam um caso da neoplasia e fazem revisäo da literatura