ABSTRACT
SESSION TITLE: Lung Cancer Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Tracheal tumor accounts for 0.4% of all tumors and only 10% of them are benign (1). We present, to our knowledge, the first case of a primary benign tracheal tumor with features of chondroid metaplasia arising from the posterior wall of the trachea. CASE PRESENTATION: 58-year-old male non—smoker with non-significant past medical history, presented to the Emergency department for COVID-19 pneumonia. CTA chest was done showing bilateral pulmonary embolism and a 12 mm polypoid tracheal mass arising from the posterior wall of the trachea extending into the lumen (Figure#1). The patient was asymptomatic prior to his COVID 19 infection;he denied any chest pain, hemoptysis, trauma, or prior intubation. After recovering from COVID-19, the patient was scheduled for an outpatient rigid bronchoscopy which revealed a tracheal polyp arising from the mid-distal posterior membranous trachea. (Figure#2). An electrocautery snare was used to simultaneously cut and cauterize the stalk using a lasso technique. The polyp was removed in its entirety without complication. Histopathology examination demonstrated a respiratory epithelium lined cyst with cartilaginous tissue, favoring chondroid metaplasia. DISCUSSION: Primary benign tracheal tumors with cartilaginous features are uncommon, especially in the posterior membrane of the trachea, which lacks cartilaginous support. Diagnosis of any benign tracheal tumor is usually delayed since most patients are asymptomatic. The majority of such tumors are found incidentally, as in this case. One of the most common benign tracheal tumors is hamartoma, which can have respiratory epithelium and cartilaginous tissue, however they do not have features of chondroid metaplasia, and are generally found in the lateral or anterior wall of the trachea. Furthermore, endobronchial lesions only account for 3% of all pulmonary hamartomas. (2) Reports of airway chondroid metaplasia are usually described in the larynx and are commonly associated with prior trauma or inflammation in the area which is not known to have occurred in this case (3). The histopathologic findings and unusual location of this tumor makes this case unique. CONCLUSIONS: The tracheal origin of this benign tumor, arising from the posterior membrane with cartilaginous features is extremely rare, and has not previously been described in the literature. Reference #1: Park CM, Goo JM, Lee HJ, Kim MA, Lee CH, Kang MJ. Tumors in the tracheobronchial tree: CT and FDG PET features. Radiographics. 2009 Jan-Feb;29(1):55-71. doi: 10.1148/rg.291085126. PMID: 19168836. Reference #2: Hurst IJ Jr, Nelson KG. Tracheal hamartoma. Chest. 1977 Nov;72(5):661-2. doi: 10.1378/chest.72.5.661. PMID: 913152. Reference #3: Orlandi A, Fratoni S, Hermann I, Spagnoli LG. Symptomatic laryngeal nodular chondrometaplasia: a clinicopathological study. J Clin Pathol. 2003 Dec;56(12):976-7. doi: 10.1136/jcp.56.12.976. PMID: 14645364;PMCID: PMC1770148. DISCLOSURES: No relevant relationships by Jorge Cedano Consultant relationship with Olympus America Please note: 8/1/21-present Added 04/18/2022 by Lucas Pitts, value=Consulting fee
ABSTRACT
Introduction: Pulmonary Hamartomas are the most common benign tumors of lungs. Hamartomas are usually asymptomatic and are incidentally diagnosed on chest imaging. Symptomatic cases usually involve endobronchial mucosa. We describe a case of a symptomatic patient who was noted to have a right upper lobe collapse by an endobronchial lesion. This lesion was confirmed to be a cartilaginous hamartoma and was definitively treated by electrosurgical by Argon plasma (APC). Description: A 37 year old obese male active smoker presented to the ER for worsening Shortness of air (SOA) for two weeks. He had dry cough for similar duration without any fevers. On physical examination he was afebrile with normal vital signs but without hypoxia and otherwise normal physical examination. Labs revealed normal white cell count. A COVID test was negative. CT chest showed an endobronchial lesion obstructing the right upper lobe (RUL) with some internal fat density measuring at least 1.5cm causing complete collapse of RUL. No mediastinal or hilar adenopathy was noted. A flexible bronchoscopy showed a pedunculated smooth lesion arising from RUL bronchus anteriorly occluding the RUL bronchus. FNA of the lesion did not show any malignant cells. Using electrosurgery by APC the lesion was removed en bloc. A histopathology showed findings of cartilaginous hamartoma. A follow up Chest X-ray showed improvement in RUL atelectasis. Discussion: Pulmonary hamartomas are the most common benign pulmonary tumors and comprise 6% of solitary pulmonary nodules. Mostly detected on chest imaging as an incidental finding however CT chest has characteristic finding of pop corn shaped calcifications, fat density. Symptomatic cases are usually endobronchial and can be definitively treated with endoscopic techniques.
ABSTRACT
Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19, chest computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. Many typical imaging features of this disease were carefully described with chest CT, as well as the collateral CT findings in the lungs and mediastinum. Here we describe the case of a patient with Covid-19 pneumonia, that collaterally had a pulmonary hamartoma in the left lung, documented at CT.