Neoplasms of the trachea and main stem bronchi

[Diagnosis and treatment of tracheal or bronchuotracheal adenoid cystic carcinoma]

BACKGROUND AND OBJECTIVE

Adenoid cystic carcinoma is primary bronchopulmonary carcinoma with low malignancy, and 43 patients treated in the past 50 years in our hospital were retrospectively studied. The aim of this study is to discuss the clinical symptoms, pathologic characteristic and therapeutic method of primary tracheal or bronchuotracheal adenoid cystic carcinoma.

METHODS

This study summarized total 43 patients of primary tracheal or bronchus adenoid cystic carcinoma treated in our hospital from Jan. 1958 to Dec. 2007. Among them, 40 patients were treated by surgical resection, and 3 patients were treated by fiberoptic bronchoscope's interventional treatment.

RESULTS

The 1-yr, 3-yr, 5-yr survival rates of the 43 patients above were 100% (41/41), 89.5% (34/38), 87.1% (27/31), respectively.

CONCLUSION

Primary tracheal or bronchus adenoid cystic carcinoma are rare and low malignancy carcinoma. The clinical symptoms of them are not typical. The best treatment is early detection and taking measures of operation plus radiotherapy. The other palliative treatment is fiberoptic bronchoscope's interventional treatment.

Navigating the thoracic inlet

The thoracic inlet is often seen on the "edge of the film" at computed tomography (CT); consequently, lesions affecting this structure are easily overlooked. A vascular abnormality that may be overlooked is venous thrombosis. The CT appearance of jugular vein thrombosis varies with the age of the lesion: In the acute phase, there is often loss of soft-tissue planes surrounding an enlarged, peripherally enhancing thrombus. In the chronic phase, the jugular vein appears as a tubular, nonenhancing "mass" without loss of surrounding fat planes. Intrathoracic goiters typically manifest as well-defined, markedly enhanced inhomogeneous lesions that are continuous with the cervical thyroid gland. Thyroid adenomas are typically round or oval low-attenuating lesions that enhance after contrast material administration. Thyroid carcinomas may manifest as single or multiple, irregularly shaped low-attenuating areas with or without calcification. Primary tracheal malignancies may appear as smooth or irregular, sessile or pedunculated intraluminal filling defects. Tracheomalacia manifests as destruction of the tracheal walls with soft-tissue narrowing of the tracheal lumen, whereas esophageal abnormalities manifest as thickening of the esophageal wall, dilatation of the esophageal lumen, or both. Schwannomas manifest as well-circumscribed lesions with soft-tissue attenuation that enhance after contrast material administration. Neurofibromas tend to have lower attenuation than schwannomas. Lymphangiomas typically have a cystic appearance with near water attenuation. Familiarity with the normal anatomy of the thoracic inlet as well as the CT features of related abnormalities is critical for correct diagnosis and prompt treatment.

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.

Recurrence and malignant transformation of endotracheal chondroma

An endotracheal chondroma with recurrent course and malignant transformation is described. The first chondroma recurrence appeared 5 years after the primary operation, with no histopathological signs of malignancy. A second recurrence after a further 6 years showed obvious histological evidence of malignant chondrosarcoma. A third recurrence after 1 more year metastasized to various organs and led to the patient's death 14 years from the date of primary diagnosis.

Endotracheal neurilemoma with a lymphoid cuff. An ultrastructural and immunohistochemical study

A neurilemoma occurred in the trachea of a 63-year-old woman complaining of dyspnea. Microscopically, the excised tumor was composed predominantly of cellular areas of Antoni type A tissue and had a peripheral lymphoid cuff. The schwannian origin was confirmed both immunohistochemically and ultrastructurally. This tumor without nuclear palisading and Verocay bodies differed somewhat from a conventional soft tissue neurilemoma and closely resembled a particular form of neurilemoma of the stomach, previously reported as a unique entity. Thus, this type of neurilemoma does occur in sites other than the gastrointestinal tract.

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.

Granular cell myoblastoma: rare localization in the trachea. Report of a case and review of the literature

Granular cell myoblastoma is an uncommon tumor in the respiratory tract. It usually occurs in the tongue, skin, breast, or subcutaneous tissue. When it occurs in the respiratory tract, it is usually located in the bronchus or larynx. Primary tracheal location is rare with only nine such cases reported in the literature. This report describes a 26-year-old woman with granular cell myoblastoma of the trachea. She presented with a four-year history of bronchial asthma. The tumor was surgically excised by tracheal resection and reconstruction. The patient has remained well and free of obstructive airway symptoms, without recurrence of the tumor for more than one year.