Tracheobronchial tumors: an eighteen-year series from Capital Hospital, Peking, China

Endobronchial Hamartoma as a Rare Cause of Recurrent Respiratory Symptoms: Case Report and Literature Review

Most of the endobronchial lesions are malignant in origin. In rare instances, benign lesions occupying the endobronchial tree can mimic malignant neoplasms on conventional imaging tests. We present a case of a middle-aged male patient who was admitted to our hospital with recurrent hemoptysis concerning for lung cancer on computed tomography (CT) of the chest. Biopsy of the mass obtained via bronchoscopy revealed a benign lesion most consistent with lipomatous hamartoma, which is known to constitute only 10% of all pulmonary hamartomas. We also present the data of a comprehensive literature review of the epidemiology, clinical symptoms, diagnosis, treatment, and prognosis of patients with endobronchial hamartomas.

Solitary bronchial squamous cell papilloma - another human papillomavirus (HPV)-associated benign tumor: systematic review and meta-analysis

Aim of the study

To perform a systematic review and formal meta-analysis of the literature reporting on HPV detection in bronchial squamous cell papillomas (SCP).

Material and methods

The literature was searched up to June 2012. The effect size was calculated as event rate (95% CI), with homogeneity testing using Cochran's Q and I² statistics. Meta-regression was used to test the impact of study-level covariates (HPV detection method, geographic origin) on effect size, and potential publication bias was estimated using funnel plot symmetry.

Results

Fifteen studies were eligible, covering 89 bronchial SCPs from different geographic regions. Altogether, 38 (42.7%) cases tested HPV-positive; effect size 0.422 (95% CI: 0.311–0.542; fixed effects model), and 0.495 (95% CI: 0.316–0.675; random effects model). In meta-analysis stratified by i) HPV detection technique and ii) geographic study origin, the between-study heterogeneity was not significant for either; p = 0.348, and p = 0.792, respectively. In maximum likelihood meta-regression, HPV detection method (p = 0.150) and geographic origin of the study (p = 0.164) were not significant study-level covariates. Some evidence for publication bias was found only among in situ hybridization (ISH)-based studies and among studies from Europe, but with a negligible effect on summary effect size estimates. In sensitivity analysis, the meta-analytic results were robust to all one-by-one study removals.

Conclusions

In formal meta-regression, the variability in HPV detection rates reported in bronchial SCPs is not explained by the HPV detection method or geographic origin of the study.

Clinical and Radiological Manifestations of Primary Tracheobronchial Tumours: A Single Centre Experience

Introduction: Tracheobronchial tumours usually cause an airway obstruction and secondary pulmonary infections. Although rare, they are an important differential diagnosis as they may mimic other conditions and diseases. This paper aims to analyse clinical, radiological and histological characteristics of the patients with tracheobronchial tumours diagnosed for a period of 7 years. Materials and Methods: In this retrospective, observational study, we carefully reviewed 65 patients who were diagnosed with tracheal and endobronchial tumours, and performed statistical analysis on the results. Results: Among these 65 patients (36 men and 29 women) with a mean age of 48.8 years (range, 15 to 75), 50 had malignant tumours while 15 had benign ones. The most common symptoms were cough, chest pain and haemoptysis. Cough was a more frequent symptom in patients with benign tumours (P <0.0014). Only 2 patients were asymptomatic. Tumours were predominantly localised in the large airways (46 in large bronchi and 2 in trachea). The most common radiological manifestation of malignant tumours was tumour mass (46%) followed by atelectasis. One third benign tumour caused atelectasis, while tumour mass and consolidation were found in 3 patients each. Computerised tomography revealed endoluminal tumour mass in 29.2% of the cases, which was more frequently found in benign than malignant tumours (47% vs 24%, respectively). On bronchoscopy, tumours were visible in 73% and 70% benign and malignant cases respectively. Conclusion: Tracheobronchial tumours should be ruled as a possible diagnosis in patients with cough, haemoptysis, dyspnoea and chest pain. The imaging techniques and histological examination of the tissue would subsequently lead to correct diagnosis and proper treatment can be administered. Key words: Bronchus, Computerised tomography, Trachea, Tumour, X-ray

Leiomyoma of the trachea

Primary tracheal tumors are rare. Approximately 1% of them are leiomyoma. Given the rarity of these lesions, optimal management has not been defined. Bronchoscopic, local surgical excision and partial tracheal resection have all been described. One report of recurrence after resection has been published. The incidence of recurrence following local excision is unknown. We report a case of an incidental tracheal leiomyoma diagnosed and treated with a combined approach.

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.

Tracheal malignant melanoma: successful outcome with tracheal resection

Primary tracheal malignant melanomas are uncommon neoplasms: only five cases have been reported. Different therapeutic approaches are described, with a short life expectancy observed. We report a case of a young woman with a primary tracheal malignant melanoma who underwent complete tracheal resection and is free of disease 4 years after surgical treatment.

Pleomorphic adenoma (benign mixed tumor) of the trachea

A 15-year-old "asthmatic" found to have a pleomorphic adenoma of the trachea was treated by staged CO2 laser excision. Primary tracheal tumors, the clinicopathologic features of mixed tumor in this rare location, and therapeutic options are briefly reviewed. Immunohistochemical stains for cytokeratin, S-100 protein, and glial fibrillary acidic protein are reliable methods of evaluating component cell types in pleomorphic adenoma, but immunohistochemical evidence has not resolved the issue of tumor histogenesis.

Flexible bronchoscopy via the laryngeal mask: a new technique

Malignant tracheal tumours often cause airway obstruction and this may be aggravated by vocal cord paralysis due to invasion of the recurrent laryngeal nerve. Conventional endoscopic techniques performed under general anaesthesia do not give a simultaneous view of vocal cord function and the distal airways. The technique of bronchoscopy via the laryngeal mask allowed full assessment of the cause of stridor in a patient with a malignant tracheal tumour that was causing airways obstruction and vocal cord paralysis.

Tracheal neurilemmoma: case report and review of the literature

We report a rare case of an intratracheal neurilemmoma which presented as advanced upper airway obstruction. The tumor was successfully excised by laryngofissure. A review of the world literature is provided.

Primary malignant tumors of the trachea. A radiologic and clinical study

Fifty-four cases (55 foci) of primary tracheal malignancies were reviewed retrospectively. Radiologic material was available in 32 cases (33 tracheal foci). The most frequent primary malignant tumor of the trachea was squamous cell carcinoma (54.5%), followed by adenoid cystic carcinoma (18%) and adenocarcinoma (9%). The radiologic appearance of the tumors could be divided into intraluminal, wall-thickening, and exophytic forms. Wall-thickening and exophytic forms in this study accounted for 62% of the tumors. This indicates that malignant tumors of the trachea tend to extraluminal invasion. Tomography and computed tomography are the most helpful methods of radiologic examination for tracheal tumors. Bronchoscopy and radiologic examination are complementary procedures. The chief advantage of imaging is the demonstration of tracheal wall thickening and extraluminal changes. Hemoptysis, dyspnea, and cough were the most common symptoms. Four cases (7%) in our series presented as thyroid tumors due to direct extension into the thyroid gland. Fifteen of the 54 cases (28%) were associated with other carcinomas of the head and neck and the lung.

Tracheal lipoma

A 50 year old man was found to have a tracheal lipoma two years after first noticing symptoms.

Polypoid neurilemmoma of the trachea: an unusual cause of major airway obstruction

Neurilemmomas (schwannomas) of the trachea are extremely rare. A case of near-total obstruction of the trachea by an intraluminal polypoid neurilemmomas is reported. Computerized tomographic imaging gave the exact localization of the polyp and the attachment of its stalk. Endoscopic excision has left the patient with an excellent prognosis and little chance of recurrence.

Clinical and pathologic characteristics in patients with tracheobronchial tumor: report of 50 patients

From January, 1961, to July, 1985, 50 patients in the Peking Union Medical College Hospital with intraluminal tracheobronchial tumors were operated on. There was no gender or age predominance either in the 24 patients with tracheal tumor or in the 26 patients with bronchial tumor. The 13 cell types found in these patients' specimens were divided into four groups: malignant, low-grade malignant, benign with tendency to recur and benign without tendency to recur. Squamous cell carcinoma and adenoid cystic carcinoma were the most common tumors of the trachea. Carcinoid and adenoid cystic carcinoma were the most common tumors of the bronchus in this group of patients. Conservative excision with postoperative irradiation may be sufficient for patients with advanced lesions of low-grade malignancy.