Tracheopathia osteoplastica: a study of the minimal lesion

Clinicopathological Features and Management Principles of Tracheobronchopathia Osteochondroplastica - A Scoping Review

Tracheobronchopathia osteochondroplastica (TO) is an orphan disease of the tracheobronchial tree without any known etiological attributes. There are several case reports published on this condition, yet the available information about the TO is discrete and of little clinical value. This scoping review is the first large-scale review on TO that collates individual patient data from the published case reports and descriptively analyses the clinicopathological features of this unique condition along with its management approaches and therapeutic outcomes. The objective was to synthesize comprehensive literature review on TO that can aid clinical practice and further research. An electronic search conducted in five large databases, including PubMed, EMBASE, CINAHL, CENTRAL, and Web of Science, for the published articles of TO yielded 1072 items. After screening, the individual patient data of 371 TO cases from 228 eligible articles were included and analysed in this scoping review.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03998-6.

Clinical Characteristics of Tracheobronchopathia Osteochondroplastica: A Retrospective Study of 33 Patients

Introduction

Tracheobronchopathia osteochondroplastica (TO) is a relatively rare benign tracheobronchial disease, which is often misdiagnosed or missed. To date, there is no specific treatment for TO. The aim of this study was to investigate the clinical manifestations, imaging features, bronchoscopy results, pathological findings, and diagnostic points of TO.

Patients and methods

A total of 33 patients diagnosed with TO were enrolled. Clinical data were collected using retrospective methods in the period from January 2021 and November 2022. Descriptive analysis was used.

Results

Patients included 17 (51.5%) male and 16 (48.5%) female, with a median age of 54 years. The main clinical manifestations included cough in 15 cases, fever in 6 cases, chest tightness in 4 cases, haemoptysis in 3 cases, and chest pain in 4 cases. The time from the onset of symptoms to diagnosis was 1 week to 96 months. Some patients were diagnosed with other lung diseases, including 16 patients with tuberculosis, 2 patients with lung cancer, 3 patients with nontuberculous mycobacteriosis, 3 patients with tuberculous pleurisy, 2 patients with bronchiectasis, and 1 patient with pneumonia. Chest computed tomography (CT) scan demonstrated calcified nodules in 10 (30.3%) patients. In bronchoscopy, entire tracheal involvement was found in 21 (63.6%) patients, 12 (36.4%) patients were found to have involvement of only part of the trachea. The patients were divided into three groups according to the bronchoscopic presentation, the largest proportion was stage II (19/33), followed by stage I (8/33) and stage III (6/33). Histopathological findings showed squamous metaplasia, cartilaginous, and bony tissues.

Conclusion

TO is a slowly progressing disease with non-specific clinical symptoms and a low positive rate of imaging diagnosis, making it susceptible to misdiagnosis and missed diagnosis. The disease needs to be diagnosed by combining imaging features, fiberoptic bronchoscopy, and pathological findings.

Tracheobronchopathia osteochondroplastica: clinical, bronchoscopic, and comorbid features in a case series

Background

Tracheobronchopathia osteochondroplastica (TO) is a rare condition of unknown etiology. TO is characterized by submucosal nodules, with or without calcifications, protruding in the anterolateral walls of the trachea and proximal bronchi. The objective of this study was to describe TO features and associated comorbidities in a series of patients.

Methods

Patients suffering from TO were retrospectively included by investigators from the Groupe d’Endoscopie Thoracique et Interventionnelle Francophone (GETIF). Demographic, clinical, comorbidities, bronchoscopic, functional, and radiological characteristics, and outcomes were recorded and analyzed.

Results

Thirty-six patients were included (69% male with a mean of 65 ± 12 years). Chronic symptoms were described by 81% of patients including cough (74%) and dyspnea on exertion (74%). TO was associated with COPD in 19% of the cases and gastroesophageal reflux disease in 6%. A mild to severe airflow obstruction was present in 55% of the cases. CT scan showed tracheal submucosal nodules in 93% of patients and tracheal stenosis in 17%. Bronchoscopy identified TO lesions in the trachea in 65% of the cases, and 66% of them were scattered. A bronchoscopic reevaluation was performed in 7 cases, 9 ± 14 months [1–56] after initial diagnosis, and showed the stability of lesions in all cases. Three patients underwent interventional bronchoscopic treatment.

Conclusion

The diagnosis of TO relies on typical bronchoscopic findings and can be evoked on a CT scan. Histologic diagnosis can be useful in atypical cases for differential diagnosis. Given its low consequences in terms of symptoms, lung functions, and evolution, no treatment is usually required.

A rare case of hemoptysis

A 39-year-old nonsmoker male presented with complaints of cough with recurrent mild hemoptysis. Computed tomography of thorax showed nodular lesions on the right lateral wall of trachea. Fiber-optic bronchoscopy revealed multiple nodular lesions on the right lateral wall of lower one-third of trachea. Histopathological examination of biopsy specimen from the nodules was suggestive of tracheobronchopathia osteochondroplastica which is an uncommon airway disorder.

Tracheobronchopathia Osteochondroplastica Associated with Fibrotic Interstitial Lung Disease

Tracheobronchopathia osteochondroplastica (TPO) is a very rare, benign disorder involving the lumen of the trachea-bronchial tree. However, its etiology is unknown. In our first case, observation for several years showed that TPO worsened as interstitial lung disease was aggravated. In the second case, the lung parenchymal lesion on computed tomography (CT) was found to be compatible with interstitial lung abnormality (ILA). We believe that our cases suggest a common pathogenetic relationship between TPO and fibrotic interstitial lung disease. TGF-β is likely a common factor in the pathogenesis of TPO and fibrotic interstitial lung disease.

Clinical course of tracheobronchopathia osteochondroplastica

Background

Tracheobronchopathia osteochondroplastica (TPO) is characterized by the presence of diffuse cartilaginous or bony submucosal nodules that lead to airway lumen narrowing. So far, there was no study in South Korea analysing a large number of TPO patients. We aimed to elucidate its treatment strategy and clinical course by analysing the characteristics of TPO patients.

Methods

In this retrospective study, we reviewed the clinical data of 40 patients diagnosed with TPO by bronchoscopy between October 1997 and April 2019 at a single referral hospital.

Results

Of the 40 patients, 26 (65.0%) were male and the median age was 63.0 years. The most common symptom was cough (n=12, 30%). Pulmonary function test (PFT) revealed an obstructive pattern in 10 (25.7%) patients. Chest computed tomography (CT) scan showed 23 (62.6%) patients with diffuse narrowing and calcified nodules. In bronchoscopy, the entire trachea was found to be involved in 30 (75.0%) patients and airway narrowing was identified in 6 (15.0%) patients. Endobronchial biopsies were obtained from 15 patients and the most common findings included typical cartilaginous and bony tissues (n=14, 93.3%). Since most patients were asymptomatic or had mild symptoms, they did not undergo any specific treatment. Of the 19 symptomatic patients, 2 (5.0%) patients received laser therapy for treating tracheal stenosis.

Conclusions

TPO is a slowly progressing disease and is well managed with conservative therapies. Although TPO shows a distinctive pattern by bronchoscopy, it follows a benign clinical course.

Tracheobronchopathia Osteochondroplastica: Five Cases Report and Literature Review

Tracheobronchopathia osteochondroplastica (TO) is a rare disease. Here, we report 5 TO cases treated at our hospital. Bronchoscopy showed typical multiple firm and glossy nodules in all the 5 cases. Conservative treatment effectively alleviated the symptoms. Tracheobronchopathia osteochondroplastica is a manageable disease. Awareness in clinicians is critical to avoid unnecessary treatment in patients with TO.

Tracheobronchial Calcification in Members of a Fixed Population Sample

The Radiation Effects Research Foundation (formerly, Atomic Bomb Casualty Commission; ABCC) was established in April 1975 as a private non-profit Japanese Foundation, supported equally by the Government of Japan through the Ministry of Health and Welfare, and the Government of the United States through the National Academy of Sciences under contract with the United States Department of Energy. Accepted 4 December 1988.

In a review of the chest radiographs of 1 152 consecutively examined subjects, 10 cases (0.87%) of extensive tracheobronchial calcification were identified. In addition, 51 subjects having this coded diagnosis were identified among 11758 members of a fixed population sample. Sixty of these 61 subjects were women. Tracheobronchial calcification usually appeared after the age of 60. The subjects' clinical and other radiologic diagnoses were reviewed and tracheobronchial calcification appeared to have no clinical significance. Histologic findings in autopsied cases showed the calcifications and ossificiations to be in the cartilaginous rings themselves. However, the reason for the overwhelming prevalence of this entity in women remains to be resolved.

An Unusual Cause of Respiratory Distress: Solitary Tracheopathia Osteochondoplastica-A Rare Entity

Tracheobronchopathia osteochondroplastica (TPO), a rare disorder of obscure etiology, is characterized by multiple osseous and cartilaginous nodules in the submucosa of the trachea and main bronchi. This entity commonly presents as diffuse involvement of the trachea, main bronchus or both, but a localized involvement of the airway mucosa is rare. Most of these cases are asymptomatic, and are detected incidentally on intubation, radiological imaging, or bronchoscopy performed for other indications, or on autopsy. We present the case of a 30-year-old man diagnosed with a solitary TPO.

Vocal Hoarseness and a Subglottic Mass

We report a patient with tracheopathia osteoplastica (TPO), a rare or perhaps underrecognized disorder, detected in approximately 1 in every 2000 to 5000 patients who undergo bronchoscopy. TPO is marked by proliferation of bony and cartilaginous spurs leading to airway stenosis. Multiple submucosal cartilaginous and osseous nodules can develop in the respiratory tract and may involve the entire trachea and mainstem bronchi. Symptoms may range from a completely silent condition to life-threatening respiratory failure and diagnosis is made based on radiological and bronchoscopic findings. Although the etiology has not been established, TPO can be familial and is sometimes associated with chronic inflammation, such as seen with rheumatic diseases. This case highlights the need for understanding TPO so that it can be differentiated from potentially serious conditions such as necrotizing granulomatous diseases, invasive infections, and cancer.

Tracheobronchopathia osteochondroplastica: a review of the literature

BACKGROUND

Tracheobronchopathia osteochondroplastica (TBPOCP) is an uncommon benign condition affecting the lumen of tracheobronchial tree and characterized by abnormal chondrification and ossification. TBPOCP is more frequent than it has been reported, as it can be asymptomatic or present with non-specific respiratory symptoms.

AIMS

In this article, we provide a review of the English literature on the condition and discuss its clinical features, general principles, diagnostic approaches and current treatment recommendations for TBPOCP.

METHODS

We searched for all papers indexed in Science Citation Index and Science Citation Index - Expanded by using Thomson Reuters Web of Knowledge Web of Science software.

RESULTS

We reviewed a total of 72 scientific publications.

CONCLUSION

In order to highlight, diagnosis, treatment and treatment outcomes of TBPOCP, further review articles and large case series about this orphan disease are needed.

[Tracheopathia osteoplastica. A 100-year-old mystery]

Tracheopathia osteoplastica is a very rare disease of the tracheobronchial tree with unknown origin and etiopathogenesis. The characteristic features are intramucosal nodules in the tracheal and/or bronchial mucosa. The clinical symptoms are unspecific and in most of the cases are consequences of airway stenosis. A collective of patient cases (4 tracheobronchial biopsies and 16 autopsy cases) was established to study the histology of tracheopathia osteoplastica and consisted of surgical pathology specimens (biopsies) and autopsy material. The study revealed two different types of tracheal ossification and nodule formation: (1) degenerative changes with nodule formation and ossification (tracheopathia osteoplastica tuberosa) and (2) diffuse degeneration of the tracheal cartilage with ossification of the outer third of the cartilaginous rings (tracheopathia osteoplastica peripherica). The histological changes indicate that tracheopathia osteoplastica is a type of sclerosing tracheopathy but the degenerative focus is at an unusual place (in the middle of the cartilage). No type of new cartilage formation was found in any of the cases.

Tracheobronchopathia osteochondroplastica presenting as a single dominant tracheal mass

Tracheobronchopathia osteochondroplastica is a rare, benign disorder of upper airways characterized by multiple submucosal metaplastic cartilaginous and bony nodules arising from the tracheal cartilage. We report an unusual presentation of tracheobronchopathia osteochondroplastica as a single dominant nodule arising from the anterior tracheal rings in a young adult man who presented with wheezing and symptoms of airway obstruction. The differential diagnosis of cartilaginous and bony endotracheal lesions is discussed.

Tracheopathia chondro-osteoplastica--an unusual cause of stridor

OBJECTIVES

A case of tracheopathia chondro-osteoplastica causing sub-glottic stenosis is described.

STUDY DESIGN

Case report and literature review.

MATERIALS AND METHODS

A 37-year-old man presented with a 15-year history of gradually worsening dyspnoea and stridor due to sub-glottic stenosis. His medical and radiographic records were reviewed. This patient's presentation, histopathological findings and radiology images are presented and discussed.

RESULTS

Histopathological evaluation of microlaryngoscopy biopsy specimens, taken during laser debulking of the stenosis, confirmed the presence of tracheopathia chondro-osteoplastica.

CONCLUSIONS

This is the first reported case of sub-glottic stenosis caused by tracheopathia chondro-osteoplastica which required an urgent tracheostomy.

Laryngo-tracheo-bronchopathia chondro-osteoplastica

Two cases of laryngo-tracheo-bronchopathia chondro-osteoplastica (LTBCOP) are discussed regarding the pathogenesis of the disease. Our observations support the belief that chronic irritation of the perichondrium in the region of subglottis, trachea and bronchi plays an important role in the aetiology of this disease.

Tracheopathia osteochondroplastica

The case of a male, 61 years of age, presenting with occasional hemoptysis and shortness of breath (duration of 1 year) is reported. Congestive heart failure was presumed and supported by chest x-ray and echocardiography. The patient improved with diuretic and angiotensin converting enzyme (ACE) inhibitor therapy, but continued to experience cough and occasional hemoptysis. Bronchoscopy revealed numerous firm nodular projections within the trachea with distribution along the cartilaginous rings. Tracheopathia osteochondroplastica (TPO) was diagnosed. TPO is an uncommon, benign, but slowly progressive disease of unknown etiology. It is characterized by endoluminal projection of cartilaginous and bony nodules arising in the submucosa of the trachea. Involvement may extend to lobar or segmental bronchi. TPO should be considered in cases where cough, dyspnea, persistent pulmonary infection, hoarseness, or recurrent hemoptysis remain after appropriate treatment of other presumptive underlying causes.

Tracheobronchopathia osteoplastica: incidental finding at tracheal intubation

Subglottic papillomatous growths were observed on routine tracheal intubation for a scheduled colorectal procedure. Fibreoptic bronchoscopy revealed that the lesions extended down to the carina and into the main bronchi. The diagnosis of tracheobronchopathia osteoplastica was made after subsequent bronchoscopy and biopsy in the post-operative period. A brief review of this rare benign condition is given.

Tracheobronchopathia osteochondroplastica

A case of tracheobronchopathia osteochondroplastica (TO) was diagnosed in a 68-year-old male with prolonged cough. A bronchoscopy revealed multiple nodular excrescences along the anterolateral wall of the trachea and main bronchi. Tissue specimens showed pronounced change of bronchial cartilage with massive mineralization diagnostic for TO. The literature on the subject is reviewed here. The aetiology and pathogenesis is unknown. The severity of TO range from no symptoms to severe dyspnoea, haemoptysis or pneumonitis. Treatment is seldom necessary. However, in severe cases, bronchoscopic removal of obstructing excrescences and surgery has been performed with therapeutic effect. Differential diagnosis of nodular excrescences includes amyloidosis, endobronchial sarcoidosis, calcificating lesions of tuberculosis, papilomatosis and tracheobronchial calcinosis. Awareness of the condition as a differential diagnosis to neo-plasms is important, to avoid unnecessary surgery or chemotherapy.

Localized tracheopathia osteoplastica of the subglottis

Tracheopathia osteoplastica is a benign dysplasia of the tracheobronchial tree which rarely presents clinical problems especially when localized. We present a case which caused an unexpected difficulty in intubation and was subsequently removed endoscopically using the CO2 laser.

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: familial occurrence

Tracheopathia osteoplastica is an unusual disease characterized by cartilaginous or bony projections into the tracheobronchial lumen, with sparing of the posterior membranous portion of the tracheobronchial tree. The cause of this disorder is unknown. The diagnosis is seldom made because of the chronic and asymptomatic nature of the condition. More than 90% of the cases are diagnosed at postmortem examination. Symptoms may include dyspnea, coughing, hemoptysis, hoarseness, and wheezing. Tomography of the trachea may reveal beaded calcification of the tracheobronchial cartilages. Bronchoscopy is diagnostic. Histologically, the abnormal growths show heterotopic bone formation. No known treatment is available. We describe two female patients, one with hemoptysis and another with asthmalike symptoms, in both of whom bronchoscopy established the diagnosis of tracheopathia osteoplastica. The first patient had recurrent episodes of pneumonia attributable to bronchial obstruction by bony projections. In the second patient, removal of large lesions that obstructed the upper part of the trachea relieved the dyspnea. Of interest is the fact that the first patient was the biologic mother of the second. To our knowledge, this constitutes the first report of familial occurrence of tracheopathia osteoplastica.

Tracheobronchopathia osteochondroplastica presenting as right middle lobe collapse. Diagnosis by bronchoscopy and computerized tomography

Tracheobronchopathia osteochondroplastica (TO) is a rarely described disorder which historically has not been frequently recognized antemortem. Studies by computerized tomography (CT) and bronchoscopy now permit a definitive antemortem diagnosis and can obviate a more invasive diagnostic evaluation. We describe two cases of TO presenting as right middle lobe collapse, discuss the clinical and pathologic features, and outline an approach to its evaluation using CT and bronchoscopic study.

Tracheopathia osteochondroplastica. A cause of unexpected difficulty in tracheal intubation

A 60-year-old man presented for aortocoronary saphenous vein grafting; tracheal intubation was found to be difficult before surgery. Bronchoscopy at the time suggested tracheal carcinoma, but subsequent biopsy of the trachea demonstrated tracheopathia osteochondroplastica. The condition is described and its implications for anaesthetists are discussed.