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.

Pulmonary sparing for resection of adenoidcystic carcinoma involving the tracheal carina and the right main bronchus: A case report.

A 40 year old female underwent successful pulmonary sparing resection of an adenoidcystic carcinoma (ACC) of the tracheal carina involving the right main bronchus with a size of 3 cm. The operative technique: A right thoracotomy was performed. The trachea and main bronchi were dissected. The left main bronchus was transected about 1 cm from the carina. The airway management was intermittent conventional ventilation via the operative field. The right bronchus was transected at the upper lobe and the intermediated bronchus 1.0 cm from the tumor margin. Finally the trachea was transected 1 cm above the tumor margin. The proximal end of the trachea was anastomosed end to end to the distal left main bronchus. The intermediate bronchus was incised vertically and 2/3 of the circumferential distal end of the upper lobe bronchus was anastomosed end to side to the incisional line of the intermediate bronchus. Then the neo-bronchial orifice of the right bronchus was anastomosed end to side to the lateral wall of the trachea 1 cm above the previous tracheal anastomosis. The patient recovered well from the operation and was discharged within 2 weeks after the operation. Early postoperative fiberoptic bronchoscopy revealed adequated anastomotic bronchial lumens and minimal granulation tissue at the left bronchial anastomosis.

Study on clinical manifestations and treatment of primary cervical tracheal malignant tumor of children / 临床耳鼻咽喉头颈外科杂志

Objective:To study the clinical manifestations and treatment of the primary cervical tracheal malig-nant tumor of children. Method:Five cases diagnosed as primary tracheal malignant tumor with fibrolaryngoscopy, CT scan and pathology were retrospectively analyzed and reviewed. Extraction of malignant tumor was performed with tracheoscope and nasal endoscope after emergent tracheotomy below the tumor in 4 cases, and tracheotomy after intubation in 1 case. After operation, 4 children received radiotherapy, and 1 case received laser therapy add radiotherapy. Result:Five cases were followed up for three to eight years, and no recurrence was found. Conclu-sion: There was no specific manifestation in early tracheal malignant tumor, but it was critical and emergent during symptoms appear. Imaging examination was a very invaluable dignosis method. Optimal and effective therapeutic protocol is tracheostomy under local anesthesia to keep upper airway patency followed by surgical extraction and radiotherapy. It was not appropriate to have tracheal wall resection for children.

A Case of Metastatic Tracheal Tumor From Ovarian Carcinoma / 결핵

Tracheal tumors are uncommon comprising less than 0.1% of all malignancies. Metastatic tracheal tumors, especially form the extrathoracic sites, are exceedingly rare. Ovarian cancer tends to metastasize to the serous cavities and the lymph nodes. One large autopsy study reported tracheal involvement in 1% of patients who had died from ovarian cancer. Other studies have not mentioned tracheal involvement at all. Since the main symptoms of cough, hemoptysis, or wheezing are nonspecific, patients may be initially treated for other conditions including asthma or bronchitis. Here we describe a metastatic tracheal tumor from an overain carcinoma that was initally treated for bronchial asthma.

General Anesthetic Experience of Resection & Anastomosis in a Distal Tracheal Tumor: A case report / 대한마취과학회지

A tracheal mass was detected in a woman who complained progressive cough and dyspnea developed 3 months ago. Tumor was located just 1 cm above carina almost obstructing the tracheal lumen and it was mobile with respiration. Curative tracheal resection & anastomosis was attempted with a right thoracotomy approach. In this patient, complete tracheal obstruction by the mass can occur during the induction of the anesthesia and the pre-resection period; therefore, we made cardiopulmonary bypass available before the induction. We successfully maintained the airway and provided the adequate ventilation during that critical period without using cardiopulmonary bypass. Here we report this case with a literature review.

Primary Adenoid Cystic Carcinoma of the Trachea / 대한이비인후과학회지

Primary adenoid cystic carcinoma of the trachea is rare and its diagnosis and management have still some controversies. In patients with dyspnea, tracheal mass is not usually considered and differential diagnosis of primary tracheal tumor should be ruled out. From 1989 to 1995, eight cases of adenoid cystic carcinoma of the trachea were diagnosed and managed in our clinics. Among these cases, differential diagnosis with thyroid carcinoma was difficult in two cases and in one case, the primary diagnosis was bronchial asthma. Most of patients underwent tracheal resection and end to end anastomosis or total laryngectomy with postoperative radiation therapy. The overall result of these series showed mean disease free survival period of 39 months and recurrence rate of 50%. The purpose of this article is to describe the clinical and radiological findings of adenoid cystic carcinoma of the trachea and give helps in differential diagnosis of tracheal mass.

High Frequency Jet Ventilation in Tracheal Tumor Surgery / 대한마취과학회지

A 38-year old male patient underwent tracheal reconstruction because of a tracheal tumor. A CT scan showed that the mass was located 5 cm above the carina, the size was 2x1.5cm, and there was a 50% narrowing of the stenotic segment. After endotracheal intubation (1.D. 8mm), a pediatric suction catheter (lenght:40cm, diameter: 2mm) was inserted with a stylet at the side of the tube to pass the stenotic segment with fiberoptic bronchoscopic guidance. Conventional ventilation with an inhalation agent was performed and HFJV was started just prior to the tracheal incision. A driving gas pressure of 1 kg/cm, respiratory rate of 120/min., I:E ratio fo 1:1, and Fio2 of 1.0 were applied through the suction catheter. Ten minutes after HFJV, PaCO2showed 50mmHg. Hypercabia was relieved by increasing the driving gas pressure from 1kg/cm(2) to 1.5 kg/cm(2). HFJV was performed for one and a half hours. During the procedure, blood gas analyses were perfomed frequently and all results revealed an adequate ventilatory status. After completing the end to end anastomosis, conventional ventilation was started until surgery was ended. The patient's course proceeded uneventfully and he was discharged 13 days after surgery.