[Application of Enhanced Recovery after Surgery in Interventional Treatment 
of Tracheal Malignant Tumor].

Currently, enhanced recovery after surgery (ERAS) has been widely accepted by surgery and anesthesiology all over the world, and applied in colorectal surgery, gynecology, liver surgery, breast surgery, urology and spinal surgery. But ERAS are rarely used in the field of interventional bronchoscopy. In recent years, more and more researchers have begun to explore the application of ERAS in bronchoscopic interventional therapy. This article discussed that preoperative preparation, anesthesia, intraoperative operation, postoperative observation and other aspects can influence interventional bronchoscopy.
.

ADENOID CYSTIC CARCINOMA OF DISTAL TRACHEA: A CASE REPORT.

Primary malignant tumors of the trachea are very rare with the incidence of less than two per million people per year, and only ten percent of them are adenoid cystic carcinomas. Eighty percent of all tracheal tumors are malignant. Diagnosis is usually late because the symptoms mimic other conditions such as asthma. Clinical picture may sometimes be dramatic when airway is almost closed and emergency recanalization is necessary. Diagnosis is made by chest computed tomography scan or magnetic resonance imaging. Definitive treatment is surgical resection alone or followed by radiation therapy or radiation therapy alone. Radical resection is only accomplished in about half of all cases because of the submucosal tumor growth and limited length of tracheal resection. The role of adjuvant radiation therapy in negative resection margin cases is not clear but all patients with positive resection margin benefit from radiation therapy. We present a case of a 43-year-old patient with primary adenoid cystic carcinoma of distal trachea treated by emergency bronchoscopic recanalization and resection of the tracheal tumor with end-to-end anastomosis.

Mucosa-associated lymphoid tissue lymphoma of the trachea associated with idiopathic pulmonary fibrosis: A case report and literature review.

RATIONALE: Mucosa-associated lymphoid tissue (MALT) lymphoma of the trachea is a rare disease that has been shown to be associated with chronic antigenic stimulation. There have been few reports of MALT lymphoma of the trachea in association with idiopathic pulmonary fibrosis (IPF). PATIENT CONCERNS: A 73-year-old patient visited with a 2-year history of dyspnea on exertion and productive cough, which had worsened 1 month ago. DIAGNOSES: MALT lymphoma of the trachea associated with IPF. INTERVENTIONS: After taking into consideration the age, poor performance status, and comorbidities of the patient and the extent of disease, we utilized an observational approach as a treatment strategy. OUTCOMES: The patient is well without any evidence of progression for 12 months since the initial diagnosis. LESSONS: We present a case of MALT lymphoma of the trachea associated with IPF. A common predisposing factor may exist for tracheal MALT lymphoma and IPF. As there are no randomized clinical trials focusing on tracheal MALT lymphoma, individualized treatment decision is important, and in some cases, simply monitoring the patient might be the most appropriate approach.

Treatment of primary tracheal glomus tumors: Two case reports and a literature review.

RATIONALE: Glomus tumors (GTs) are rare soft tissue neoplasms. Several treatment options have been reported for tracheal GTs including thoracotomy, bronchoscopic electrocautery, Nd: YAG laser, and cryotherapy. However, few studies have evaluated the ideal treatment for tracheal GTs. PATIENT CONCERNS: A 30-year old man who presented with cough, and expectoration for 1 month, and who had been diagnosed as having a tracheal neoplasm by cervical, and thoracic computed tomography (CT). The patient was a47 years old man. He was admitted to our hospital presenting with intermittent hemoptysis for 3 years. Thoracic CT revealed a round tumor on the right posterior tracheal wall. DIAGNOSES: Both of them were diagnosed as benign GTs. Histopathology of the tumor showed clusters of round epithelioid cells with eosinophilic cytoplasm, and uniform round to ovoid nuclei surrounding dilated capillaries. Immunohistochemical staining was positive for smooth muscle actin (SMA). INTERVENTIONS: The tracheal tumor of first patient was located at the level of C7-T1. Tumor resection was performed under fiberoptic bronchoscopy. The tracheal tumor in second patient was located in the lower trachea. Surgical tracheal resection and anastomosis were performed. OUTCOMES: Both of them achieved good results and no recurrence was seen at the final follow-up LESSONS:: We recommend choosing the most appropriate approach to manage tracheal GTs based on patients' general condition, and tumor characteristics to obtain an excellent prognosis. Our 2 cases of tracheal GT were managed by different approaches, and both achieved good results.

Unresectable squamous cell carcinoma of upper trachea with long-term survival after concurrent chemoradiotherapy.

Upper tracheal malignancies are rare, and long-term survival is even rarer, especially among the unresectable malignancies. A 66-year-old chronic smoker was diagnosed as a locally advanced, non-metastatic squamous cell carcinoma of the upper trachea. Being unresectable, he was treated with six cycles of concurrent weekly cisplatin and three-dimensional conformal radiotherapy to a dose of 60 Gy in 30 fractions over 6 weeks. Follow-up imaging at 6 and 12 months revealed no disease. Our patient is presently 36 months post-treatment and is disease free without tracheal necrosis, fistula or radiation pneumonitis but developed hypothyroidism and is presently euthyroid. Concurrent chemoradiotherapy appears safe up to 3 years at least without any necrosis and is effective in controlling local disease. Meticulous planning obviates the need for higher technology like motion management techniques or intensity-modulated radiotherapy.

Asymptomatic tracheal MALT lymphoma discovered on spirometric findings presenting with elevated respiratory resistance.

BACKGROUND: Central airway obstruction (CAO) may be caused by various etiologies. However, conventional chest X-rays are rarely diagnostic for patients with CAO. CASE PRESENTATION: We here described a 64-year-old asymptomatic female with tracheal mucosa-associated lymphoid tissue lymphoma discovered on spirometric findings during a complete physical examination. The plateau of forced expiratory flow was consistent with CAO. A decreased peak expiratory flow rate was noted at least 3 years before the diagnosis, and was attributed to an insufficient effort by the patient. Impulse oscillometric measurements, which were taken during quiet breathing and were effort-independent, suggested elevated respiratory resistance. These abnormalities completely disappeared after radiation therapy. CONCLUSION: The addition of impulse oscillometry to spirometry may be useful for screening CAO in routine health examinations.

Intratracheal inflammatory myofibroblastic tumour mimicking severe acute asthma.

A 3-year-old boy presented with severe airway obstruction which was diagnosed as asthma. He improved but had repeated episodes of severe airway obstruction. On clinical examination, he had a tracheal cough and monophonic wheezing. Imaging revealed a large lesion in the distal part of the trachea which was confirmed by bronchoscopy. The lesion was surgically removed. Histology revealed features characteristic of an inflammatory myofibroblastic tumour. Following the resection there is no recurrence of the lesion.

Implantation site-dependent differences for tracheal regeneration with induced pluripotent stem cells (iPS cells).

CONCLUSION: The histological findings and quantitative measurements demonstrated that there were differences in teratoma formation according to the site of implantation. Elucidating the mechanisms of the teratoma formation caused by the site of implantation moves the field another step closer to clinical use of induced pluripotent stem (iPS) cells for tracheal regeneration. OBJECTIVES: Our previous study demonstrated the potential for iPS cells to be used as a new cell source for tracheal regeneration. However, teratoma formation remains a major problem. Implantation site-dependent differences in teratoma formation have been reported. In this study, the teratoma-forming propensity after implantation into tracheal defects and abdominal subcutaneous tissue was examined histologically and quantitatively. METHODS: Mouse iPS cells were cultured in artificial material under various conditions. After cultivation in vitro, artificial materials with cultured iPS cells were then implanted into cervical tissue around tracheal defects and into abdominal subcutaneous tissue in nude rats. Teratoma formation was evaluated histologically and quantitatively with measurement of maximum diameter (MD). RESULTS: Teratoma was observed in 10 of 11 rats with cervical tissue around tracheal defects and in 3 of 11 rats with abdominal subcutaneous tissue implants. The average MD was 5.36 mm in the trachea and 0.97 mm in the abdomen.

Adult inflammatory myofibroblastic tumor of the trachea: case report and literature review.

Inflammatory myofibroblastic tumor of the trachea is a rare benign tumor in adults. It is mostly seen before the age of 16. We describe a 20-year-old female patient who presented with stridor. She had a fixed obstruction on spirometry, and computed tomography and bronchoscopy confirmed tracheal thickening and stenosis below the vocal cords and bronchial wall thickening at the level of the carina. Bronchoscopic biopsy confirmed an inflammatory myofibroblastic tumor. She recovered after mechanical dilatation and resection via rigid bronchoscopy, followed by corticosteroid therapy.

Detection of intraluminal tracheal metastasis of thyroid papillary carcinoma by 18F-FDG PET/CT.

We present a case of a 66-year-old female patient with thyroid papillary carcinoma. On the fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) performed for thyroglobulin elevation accompanied by negative radioiodine whole-body scan, there was an intense 18F-FDG uptake in the polypoid soft tissue invading the tracheal cartilage and extending into the lumen. Dedifferentiated tumor with high metabolic rate can be easily detected by 18F-FDG PET/CT.

Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy.

Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.

Analysis of tidal breathing flow volume loop in dogs with tracheal masses.

OBJECTIVES: To investigate whether there are any changes in the tidal breathing flow volume loop (TBFVL) in calm, non-dyspnoeic dogs with intratracheal masses. METHODS: We compared 4 dogs with intratracheal masses (group 1) with 10 healthy dogs (group 2). Routine clinical and laboratory examinations of the dogs were unremarkable, except for episodic upper respiratory obstructive signs in the dogs in group 1. Lateral radiography of the neck and thorax showed that group 1 dogs had masses that appeared to protrude into the tracheal lumen. Tracheoscopy and surgery or necropsy was performed to confirm the presence of the mass. Arterial blood gas and TBFVL analysis was carried out in all dogs to assess respiratory status. RESULTS: The shape of the TBFVL for dogs in group 1 was narrower and ovoid compared with that for the group 2 dogs. Tidal volume and expiratory and inspiratory times were significantly reduced, whereas the respiratory rate was increased for dogs in group 1 compared with dogs in group 2. Arterial blood gas analysis was unremarkable for all dogs. CONCLUSIONS: TBFVL is a non-invasive technique that is easy to perform and well tolerated by dogs. In the absence of abnormalities detected by routine diagnostic evaluations and arterial blood gas analysis in dogs with intratracheal masses, the TBFVL contributes to the definition of the physiologic status of the airways at the time of testing, and results suggests that these dogs breathe quite normally when they are calm and non-dyspnoeic.

Primary malignant melanoma of the trachea.

Tracheal melanomas represent the rarest type of extracutaneous melanomas. The clinical manifestation is similar to other tracheal tumors and ranges from symptoms of airway obstruction such as dyspnea and stridor to other nonspecific symptoms such as hoarseness, cough and hemoptysis. Bronchoscopy is required to draw the origin of the lesion biopsy is needed to establish histologic diagnosis. Treatment consists of either palliative surgery aiming at restoring the airway or tracheal resection and end to end anastmosis. We would like to present here below a rare case of tracheal melanoma and discuss the various diagnostic and therapeutic means.

Surgical treatment of patients with stenosis of the central airway due to tracheal tumours.

This study retrospectively evaluated bronchoscopic and surgical treatments for patients with central airway stenosis due to tracheal tumours. Seven patients treated by resection and reconstruction of the trachea for tracheal tumours between 1994 and 2008 were retrospectively reviewed. The most common histological finding was thyroid carcinoma (n = 3), followed by adenoid cystic carcinoma (n = 2), a metastatic thyroid tumour (n = 1), and a benign granular cell tumour (n = 1). Three of the patients required preoperative laser treatment (Nd:YAG) for recanalization. Five patients underwent end-to-end anastomosis for reconstruction. There was no postoperative mortality or morbidity such as anastomotic insufficiency of the reconstructed trachea. Three patients with a microscopic residual tumour required postoperative external radiotherapy. Surgical resection of malignant tracheal tumours is recommended not only for curative purposes, but also for reduction of the risk of smothering.

A primary tracheal carcinoid tumor masquerading as chronic obstructive pulmonary disease.

Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that he was being treated for chronic obstructive pulmonary disease. Fiberoptic bronchoscopy revealed a vegetative mass with a wide base on the posterolateral wall of the distal one-third of the trachea. Postoperative histopathological examination revealed a typical carcinoid tumor. In patients with an unexplained cough, dyspnea, infrequent hemoptysis, and normal pulmonary imaging findings, tracheal carcinoma should be suspected. In such cases, early thoracic computed tomography and bronchoscopic examination can provide a rapid diagnosis and treatment options and prevent a false diagnosis.