The role of endoscopic ultrasound in the staging of tracheal neoplasm: a brief review

SUMMARY Our case report shows the complexity of dealing with tracheal tumors, highlighting the importance of the method used for staging. In this report, endoscopic ultrasound (EUS) was crucial to identify the involvement of the esophageal muscular propria in a tracheal tumor and change the surgical planning of the case. Staging this kind of tumor represents a challenge for physicians. There is no evidence in the literature on which methods represent the gold standard for T staging.

RESUMO Neste relato de caso mostramos a complexidade em lidar com tumores traqueais, destacando a importância do método usado para estadiamento. Neste relato, a ecoendoscopia (EUS) foi fundamental para identificar o envolvimento da camada muscular própria esofágica por um tumor traqueal e alterar o planejamento cirúrgico do caso. O estadiamento desse tipo de tumor representa um desafio para os médicos. Não há evidências na literatura sobre quais métodos representam o padrão ouro para o estadiamento T.

Tracheal polyp treated with endobronchial electrocautery.

Fibroepithelial polyps of trachea are extremely rare. Here, we report a case of tracheal polyp in a 40-year-old woman that was managed successfully with endobronchial electrocautery with a review of the relevant literature.

Mucosa-associated lymphoid tissue lymphoma of the trachea: case report / Linfoma do tecido linfoide associado à mucosa de traqueia: relato de caso

CONTEXT: Mucosa-associated lymphoid tissue (MALT) lymphomas are most commonly found in the stomach, lungs, orbital soft tissue, salivary glands and thyroid. Involvement of the trachea is extremely rare. CASE REPORT: This report describes a rare case of MALT lymphoma of the trachea in a 71-year-old woman who presented with a one-year history of coughing, dyspnea, hoarseness and weight loss. There was an infiltrative lesion in the mid-trachea. The anatomopathological diagnosis was only made from the fifth endoscopic biopsy attempt. Immunochemotherapy consisting of rituximab, cyclophosphamide, vincristine and prednisone (R-COP) induced complete remission of the symptoms and endoscopic lesion. CONCLUSIONS: MALT lymphoma of the trachea is extremely rare and indolent disease. It has to be considered in the differential diagnosis of airway lesions. It is crucial to obtain an anatomopathological diagnosis from a specialized pathologist. Immunochemotherapy with R-COP induced complete remission of the disease.

CONTEXTO: Linfomas de tecido linfoide associado à mucosa (TLAM) são mais comumente encontrados no estômago, pulmões, órbita, glandulas salivares e tireoide. O envolvimento da traqueia é extremamente raro. RELATO DE CASO: Relato de caso raro de linfoma TLAM de traqueia, em mulher de 71 anos com tosse, dispneia, rouquidão e emagrecimento há um ano. Detectou-se lesão infiltrativa na porção média da traquéia. O diagnóstico anatomopatológico só foi obtido na biópsia do quinto procedimento endoscópico. A imunoquimioterapia R-COP (rituximabe, ciclofosfamida, vincristina e prednisona) induziu remissão completa dos sintomas e da lesão endoscópica. CONCLUSÕES: Linfoma TLAM de traqueia é uma doença indolente e extremamente rara, que deve ser considerada no diagnóstico diferencial das lesões de vias aéreas. O diagnóstico anatomopatológico por um patologista experimentado é fundamental. Imunoquimioterapia com R-COP levou à remissão completa da doença.

Lipoma de traqueia simulando doença pulmonar obstrutiva / Tracheal lipoma mimicking obstructive lung disease

Os tumores de traqueia são raros e podem ser de difícil diagnóstico, por mimetizarem outras afecções pulmonares de caráter obstrutivo, como asma e DPOC. Relatamos um caso de lipoma de traqueia em uma paciente que fora tratada para asma e DPOC, sem resposta adequada, até apresentar complicações infecciosas. A presença do tumor foi sugerida por TC de tórax e confirmada por fibrobroncoscopia. A paciente foi submetida à ressecção endoscópica do tumor; porém, evoluiu para o óbito por pneumonia e choque séptico.

Tracheal tumors are rare and can be difficult to diagnose due to their capacity to mimic other obstructive lung diseases, such as asthma and COPD. We report the case of a female patient with a tracheal tumor. She had previously been treated for asthma and COPD, with little response to the treatment. The onset of infectious complications prompted further investigation. Chest CT images suggested the presence of a tumor, which was confirmed by fiberoptic bronchoscopy. The tumor was endoscopically resected. However, the patient evolved to death due to pneumonia and septic shock.

Primary tracheal schwannoma

Primary neurogenic tumors of trachea are extremely uncommon and account for only about 9% of all neoplasms of trachea. Tracheal schwannoma is among the rarest of them and there is no unanimity of opinion regarding its treatment. We report a 30 year-old woman with symptoms of airway obstruction due to primary tracheal schwannoma. She was suffering from cough and exertional dyspnea. She was admitted to the thoracic surgery ward with stridor and hemoptysis and underwent rigid bronchoscopy and biopsy. The patient then underwent primary tracheal resection and anastomosis through a cervicomediastinal approach. The diagnosis was made through histopathological examination as schwannoma

Solitary Fibrous Tumor of the Trachea: CT Findings with a Pathological Correlation

We present the multidetector CT findings with a pathologic correlation for the case of a solitary fibrous tumor located in the trachea. The MDCT revealed a well-circumscribed intraluminal mass arising from the trachea, with strong nodular enhancement in the periphery of the mass. The enhancement pattern of the mass corresponded histopathologically to a focal hypocellular area in the center and prominent blood vessels along the periphery of the mass. We also present volume-rendered and virtual bronchoscopic images of this rare submucosal tracheal tumor.

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

Unusual malignant tracheal tumour presenting with acute airway obstruction.

A 25-year-old male presented with features of acute airways obstruction. He was diagnosed to have a lower tracheal mass with near total tracheal obstruction and complete obstruction of the left main bronchus. The tumour was resected successfully using a two-step method of ventilation. Histopathology of the mass revealed it to be a spindle cell sarcoma. Subsequently, local irradiation and systemic chemotherapy was given.

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

Tracheal lymphoepithelioma-like carcinoma: a case report.

Lymphoepithelioma like carcinoma is rare in locations other than nasopharynx. We report the second case of this tumour in trachea, in a young female patient, who was managed with concomitent surgery, radiotherapy and chemotherapy. The patient is disease free in the one-year follow up. The tumour presented difficulties during intubation for general anaesthesia and during surgery. Association with Epstein-Barr virus was not found in our case.

Condrosarcoma de la vía aérea superior / Chondromosarcoma of the upper air way

Antecedentes: La forma habitual del cáncer de las vías aéreas superiores es el carcinoma epidermoide. Se estiman en 250 los tumores cartilaginosos de laringe comunicados hasta la fecha, de los cuales el 28 por ciento son condrosarcomas verdaderos. En tráquea sólo se conocen 10. Objetivo: Comunicar 2 nuevos casos y recoger la experiencia acumulada en nuestro medio. Lugar de aplicación: Hospital Público oncológico. Diseño: Retrospectivo. Población: 1 paciente portador de condrosarcoma de laringe y otro de tráquea. Método: Cirugía. Resultados: Uno falleció con múltiples metástasis a los 52 meses y otro vive libre de enfermedad a 1 año de seguimiento. Conclusiones: Se trata de una patología rara cuyo único tratamiento con intención curativa es la cirugía. La controversia surge con la extensión de ésta en laringe, donde la laringectomía parcial es propuesta por varios autores. La radioterapia tiene poco campo. El pronóstico depende del grado, el tamaño y el margen de resección

Pseudotumor inflamario en tráquea / Inflamatory pseudotumor of the trachea

El pseudotumor inflamario es una lesión no neoplásica localizada usualmente en el parénquima pulmonar y muy raramente en la tráquea(1); de etiología desconocida, generalmente considerada como un proceso reactivo (3), compuesto por una variedad de células inflamatorias y mesenquimales entre las cuales se encuentran células plasmáticas, histiocitos, linfocitos, mastocitos y células mesenquimales fusiformes. Esta variabilidad celular le ha dado un número cambiante de nombres según el tipo celular que predomine (2). El caso presentado es el de un hombre joven de 19 años con un cuadro de obstrucción respiratoria alta debido a una masa tumoral en tráquea a quien luego de la resección se le hace el diagnóstico de pseudotumor inflamatorio de tráquea, el primero reportado en la literatura mundial

Pleomorphic adenoma of the trachea: a case report

An unusual tracheal tumor was found in a 50 year old male who was admitted due to mild dyspnea on exertion. Simple chest X-ray showed an abnorma mass shadow in the trachea and computerized chest tomogram revealed a tumor in the mid 1/3 of the trachea obstructing 80% of the lumen. Through a right thoracotomy incision, resection of a 2.5 cm segment of the trachea with end-to-end anastomosis was done and microscopic findings showed many cystic spaces with myxomatous hyalinous stroma. It was diagnosed as a pleomorphic adenoma of the trachea.

Carcinoma adenóide cístico de traquéia: relato de caso / Adenoid cystic carcinoma of the trachea: report of a case

Apresenta-se um caso de carcinoma adenóide cístico (cilindroma) de traquéia e discutem-se características clínicas e morfológicas