Bony metaplasia in trachea and bronchi

Malfunction of airway basal stem cells plays a crucial role in pathophysiology of tracheobronchopathia osteoplastica

Understanding disease-associated stem cell abnormality has major clinical implications for prevention and treatment of human disorders, as well as for regenerative medicine. Here we report a multifaceted study on airway epithelial stem cells in Tracheobronchopathia Osteochondroplastica (TO), an under-detected tracheobronchial disorder of unknown etiology and lack of specific treatment. Epithelial squamous metaplasia and heterotopic bone formation with abnormal cartilage proliferation and calcium deposits are key pathological hallmarks of this disorder, but it is unknown whether they are coincident or share certain pathogenic mechanisms in common. By functional evaluation and genome-wide profiling at both transcriptional and epigenetic levels, we reveal a role of airway basal cells in TO progression by acting as a repository of inflammatory and TGFβ-BMP signals, which contributes to both epithelial metaplasia and mesenchymal osteo-chondrogenesis via extracellular signaling and matrix remodeling. Restoration of microenvironment by cell correction or local pathway intervention may provide therapeutic benefits.

Tracheobronchopathia osteoplastica (TO), is an underreported affliction characterized by squamous metaplasia and heterotopic bone formation in trachea and bronchi. Here the authors apply functional, as well as genome-wide transcriptional and epigenetic profiling to identify airway basal cells dysfunction underlying TO.

Tracheobronchopathia Osteochondroplastica: A Case Report Illustrating the Importance of Multilevel Workup Clinical, Endoscopic and Histological Assessment in Diagnosis of an Uncommon Disease

Patient: Male, 62

Final Diagnosis: Tracheobronchopathia osteochondroplastica

Symptoms: Cough

Medication: —

Clinical Procedure: —

Specialty: Pulmonology

Giant primary amyloidoma of the tonsil

A case of giant amyloidoma in the left tonsil with extensive osseous metaplasia and a scanty and patchy monoclonal population of IgG Kappa plasma cells, is presented. Localized tumoral amyloidosis is a rare, benign tumour of the upper aerodigestive tract. Organ-limited amyloidosis has been shown to be confined to various systems but, since the lesion was first described, only four cases situated in the tonsils have been reported in the English literature, and none of these had either osseous metaplasia or a monoclonal population of IgG Kappa plasma cells.

Tracheobronchopathia osteochondroplastica

Tracheobronchopathia osteochondroplastica is an unusual disease of obscure causation characterized by cartilaginous or bony outgrowths into the lumen of the tracheobronchial tree. Our retrospective review of 15 patients, 8 of whom were women, revealed a mean age of 63.5 years. The most common symptoms were cough (66%), hemoptysis (60%), dyspnea on exertion (53%), and wheeze (30%). Thirteen percent of the patients were asymptomatic. Chest radiography was not helpful in the diagnosis. Tracheal tomography revealed typical beaded intraluminal calcification in 4 of the 12 patients tested. Mirror laryngoscopy initially revealed the abnormalities in 30% of the patients, and bronchoscopy confirmed the diagnosis and determined the extent of the disease in all patients. Even though upper airway involvement has been thought to be uncommon, 40% of our patients demonstrated abnormalities of the larynx and upper trachea. Histologic confirmation of heterotopic bone formation was obtained in 60% of the patients. Pulmonary function tests showed mild obstructive lung disease. There were no deaths directly attributable to the disease. Treatments attempted included cryotherapy, laser excision, external beam irradiation, and bronchoscopic removal of the obstructing lesions.

Tracheopathia osteoplastica: a study of the minimal lesion

We describe the pathological findings in a case of tracheopathia osteoplastica (TPO) of minimal extent. Although described clinically such minimal lesions have not been previously studied pathologically. Our observations lend strong support to the view-point that the nodules of TPO develop as ecchondroses of the tracheal cartilage rings. It is anticipated that TPO of minimal extent will be increasingly identified clinically and diagnosed on biopsy specimens.

Tracheopathia osteoplastica: report of four cases

We describe 4 florid examples of tracheopathia osteoplastica (TPO) discovered incidentally at autopsy. The sparsity of previously reported cases of TPO from Australia possibly reflects a lack of awareness of this entity rather than its true incidence. The more recent literature concerning the etiopathogenesis, pathology and clinical complications of this uncommon condition is reviewed. In our view TPO is a distinct entity and does not represent a late stage of diffuse tracheal amyloidosis.

Heterotopic ossification in a lymph node with metastatic follicular carcinoma of thyroid: a case report

Metastasis of follicular thyroid carcinoma in a cervical lymph node associated with heterotopic ossification in a 34-year-old white female is presented. Pertinent gross and microscopic pathology is described and the literature is reviewed briefly. Bone formation in thyroid neoplasm has not been reported previously, except for bone metastases of medullary carcinoma.

Amyloid in localised deposits and plasmacytomas of the respiratory tract

Clinical and histological features of 25 cases with amyloid deposits in the respiratory tract are described. The false cord is the commonest single site of such "primary" amyloid involvement. Evidence of extensive involvement and replacement of seromucinous glands by amyloid was seen in each case. Fourteen cases of plasmacytoma with "secondary" amyloid deposits are also described. The nose and nasopharynx were principally involved as with respiratory tract plasmacytomas in general but a similar association of the amyloid with seromucinous glands was also seen. Electron microscopy showed early involvement of the basal lamina of the duct of a seromucinous gland by amyloid in one case. Possible reasons for the association of amyloid precursors in respiratory tract amyloid with seromucinous glands are given.