Rare tracheal tumors and lesions initially diagnosed as isolated differentiated thyroid cancers

Surgical Treatment of Primary Tracheal Adenoid Cystic Carcinoma

Primary tracheal adenoid cystic carcinoma (TACC) occurring in the cervical trachea and invading the thyroid is very rare. Surgical resection and airway reconstruction are the main treatment methods, and other treatments include radiotherapy and endoscopic intervention. Herein, we present the case of a 74-year-old female patient with TACC. The patient underwent surgery and postoperative pathology showed that the tumor invaded the adventitia of the trachea and bilateral thyroid, where nerve involvement was observed. The patient recovered well after the operation without adjuvant therapy. Eight months after the operation, Computed tomography showed that the trachea was unobstructed and there was no recurrence.

Tracheal chondrosarcoma: A case report, systematic review, and pooled analysis

Background

Tracheal chondrosarcoma is a rare malignancy, and formal treatment guidelines have not been established due to the lack of high quality studies. Best evidence at this time is limited to case reports.

Aim

Explore the role of surgical intervention, radiation therapy, and chemotherapy, and the long‐term outcomes for these interventions for tracheal chondrosarcoma.

Methods and Results

A literature search was performed using PubMed (1959–2020) and ResearchGate (1959–2020) using medical subject heading terms “tracheal chondrosarcoma” OR “trachea chondrosarcoma.” Additional reports were identified within reviewed articles and included for review. Articles pertaining to chondrosarcomas of the lung, bronchus, larynx, or other head and neck subsites were excluded. Cases of chondromas were excluded. Thirty‐five patients with tracheal chondrosarcoma were identified in the literature since 1959. Advanced age was significantly associated with recurrent or persistent disease (p = .003). The majority (77%) of cases were treated with open surgical resection, with an open approach and negative surgical margins being significantly associated with being disease‐free after treatment (p = .001 and p < .001, respectively). Adjuvant radiotherapy was reserved for those unfit for surgery or for recurrent disease. Tumor size, extra‐tracheal extension, tumor calcification, location, and initial diagnosis were not associated with tumor recurrence.

Conclusion

Non‐metastatic tracheal chondrosarcoma can be treated by adequate surgical resection, with little to no role for adjuvant radiotherapy or chemotherapy. Open surgery and negative margins were associated with oncologic control, while advanced age was associated with recurrent or persistent disease.

A Case of Solid Variant of Adenoid Cystic Carcinoma from Trachea: A Case Report and Review of Literature

Introduction

Primary tracheal adenoid cystic carcinoma (ACC) is a rare and heterogeneous group of neoplasms arising from the respiratory tract. The solid variant of ACC is a histologically distinct subtype with an unfavorable clinical course. We report on a case of tracheal ACC with immunohistochemical and molecular analysis together with a review of the literature.

Case Report

We observed a case in which a 31-year-old male presented with a neoplasm bulging into the lumen and caused symptoms of tracheal obstruction and even hemoptysis. Cytological smears of an endobronchial fine needle aspiration revealed aggregates of basaloid cells with small to medium size, scant cytoplasm, and evenly hyperchromatic nuclei. Histologically, the tumor is characterized by a predominant compact sheet-like and nested pattern of rounded basaloid cells. Immunohistochemically, the tumor was diffusely positive for CK and CD117. CK7 and CK5/6 were focally positive in the genuine glandular structures. P63 was completely negative in the majority of neoplastic cells. Fluorescence in situ hybridization analysis revealed MYB gene rearrangement.

Conclusion

The solid variant of ACC from trachea is rare and hence poses diagnostic difficulty. Computed tomography (CT) scan and bronchoscopy help assess the extent of the disease. Histological features combined with immunophenotypic and molecular analysis aid in distinguishing this uncommon type from other round cell neoplasms. The accurate diagnosis can help expedite treatment of this highly aggressive tumor.

Tracheolaryngeal Squamous Cell Carcinoma with Extensive Mucosal Spread Without Metastasis in a Female

Tracheal tumors remain one of the most interesting and challenging respiratory tumors. Usually, with the more invasive histologic subtypes, cancer has already invaded surrounding structures at the time of diagnosis. We present an unusual case of primary tracheal squamous cell carcinoma with an extensive mucosal spread at the time of diagnosis without any invasion of surrounding organs or distant metastasis. We discuss the unique features and our treatment approach to this unusual presentation. We also discuss the various epidemiologic, diagnostic and treatment aspects of upper airways tumors of the hypopharynx, larynx, and trachea that can help patients achieve more favorable outcomes.

Case report: lenvatinib in neoadjuvant setting in a patient affected by invasive poorly differentiated thyroid carcinoma

We report a case of an elderly woman presenting with a huge cervical mass invading the tracheal lumen. Diagnosed as invasive poorly differentiated thyroid cancer, after an endotracheal biopsy, stenting and radiotherapy, it was judged eligible for total thyroidectomy, but surgery was delayed due to pulmonary thromboembolism. The patient was therefore treated with lenvatinib with a neoadjuvant intent until hemodynamic stability was obtained. Thyroidectomy and radioiodine therapy were then performed and the postdose scan revealed an area of modest uptake in the anterior part of the neck. The patient is now in a good clinical status and she continues her follow-up program without any adjuvant therapy.

Collision tumors of the larynx: A critical review

Problems related to definition of collision tumors are briefly examined in conjunction with etiology and natural history. Examples of genuine collision tumors in larynx are rare in the literature and are herein identified and tabulated. Aspects related to diagnosis and therapeutic strategies are also explored.