Radiographic and computed tomographic characteristics of intraluminal tracheal adenoma in a cat

A 13-year-old spayed female Persian cat presented with dyspnea and nasal discharge. Thoracic radiography revealed a dome-shaped soft-tissue opacity in the carina. Computed tomography confirmed a soft tissue-attenuating mass in the carina and the left and right proximal main bronchi that appeared to arise from the tracheal wall. Tracheoscopy revealed an intraluminal broad-based mass with multilobulated borders at the same location. Histopathological evaluation revealed a benign neoplastic process of the glandular epithelial lineage, which was considered an adenoma. Tracheal adenomas should be included in the differential diagnosis of tracheal masses.

Tracheal schwannoma mimicking asthma

Schwannoma in primary neurogenic tumors of the trachea is an extremely rare disease. A 21-year-old male patient with stridor was followed up with a diagnosis of asthma for two years. While no lesion was observed in the chest X-ray, tracheal schwannoma was diagnosed in the case who underwent tracheotomy due to the lesion obstructing the trachea almost completely on chest CT. The clinical findings of the patient improved ultimately in the postoperative period. We aimed to discuss the approach and follow-up of the disease with our case, although it is rare that schwannoma might be in the differential diagnosis of masses with upper airway obstruction.

Tracheal Schwannoma Presenting as Subcutaneous Emphysema and Pneumomediastinum

Primary tracheal schwannomas are rare benign tumours. This is a case report, and therefore, no specific methods or results are applicable. We here report a case of a tracheal schwannoma in an early adolescent girl presenting with subcutaneous emphysema and symptoms of airway obstruction. Tracheal resection and reconstruction by primary anastomosis were performed. Pathology confirmed the diagnosis of tracheal schwannoma. This is an unusual life-threatening presentation of a benign rare tracheal tumour with a challenging approach to management.

Benign cervical schwannoma with tracheal invasion

Schwannomas commonly develop in the cervical region, 25% - 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.

Adenoid Cystic Carcinoma Mimicking Bronchial Asthma

A 41-year-old male presented to the Department of Pulmonary Medicine, with shortness of breath for 1 year. Though on treatment for bronchial asthma, he was not responding. The chest radiograph was normal (Fig. 1). On spirometric examination, the flow-volume curve showed flattening of the expiratory limb, suggesting variable intrathoracic obstruction. Fiber-optic bronchoscopy was, hence, done and it revealed a growth in the trachea (Fig. 2). Biopsy was deferred due to the risk of bleeding. Computed tomography (CT) of the chest also showed tracheal growth (Fig. 3). The patient was planned for rigid bronchoscopy. Meanwhile, the patient presented with expectoration of a piece of that growth. Histopathological examination revealed an adenoid cystic carcinoma (Fig. 4).

Histological Validation of FDG and PSMA-Targeted PET/CT Imaging in a Rare Tracheal Adenoid Cystic Carcinoma

ABSTRACT

Adenoid cystic carcinomas are the second most common entity of tracheal malignancies, which have an overall incidence as low as only 0.2 in 100,000 persons per year. We present the case of a 64-year-old man with a histologically confirmed adenoid cystic carcinoma who sequentially underwent 18F-FDG PET/CT and 68Ga-PSMA-11 PET/CT within 1 day for staging 3 days before surgical resection of the tumor. Immunohistochemistry revealed PSMA expression of the tumor corroborating the PSMA PET findings.

Spindle cell sarcomatoid tumour of the trachea: a rare primary malignant tumour

Spindle cell carcinoma is a subtype of sarcomatoid carcinoma, which has previously been described in various anatomical locations, though rarely in the trachea.We present the case of a woman in her 70s who presented with a sore throat and stridor. Fibreoptic nasendoscopy demonstrated a tracheal mass occupying 80% of the airway from the cricoid cartilage to the third tracheal ring, infiltrating the thyroid gland. Subsequent CT demonstrated pulmonary emboli and vertebral metastasis. Biopsy of the infiltrated thyroid confirmed the diagnosis of spindle cell carcinoma. The length of the tumour and metastasis at presentation made this surgically unresectable, and she was referred for a palliative stent but died after an acute deterioration.This pathology has been reported only five times previously in the literature, with management strategies varying greatly between patients. Primary tracheal tumours are difficult to manage as, due to their rarity, there are no clear guidelines.

68 Ga-DOTA-FAPI-04 PET/CT Imaging of Tracheal Mucoepidermoid Carcinoma

ABSTRACT

A 23-year-old woman presented with a dry cough and dyspnea. Contrast-enhanced CT revealed an intratracheal space-occupying lesion with continuous homogeneous enhancement and airway stenosis. The patient then underwent 68 Ga-DOTA-FAPI-04 PET/CT, which showed increased uptake of FAPI-04 by the lesion. Postoperative pathology confirmed the lesion as tracheal mucoepidermoid carcinoma. This case reports a rare site of mucoepidermoid carcinoma and highlights the potential utility of 68 Ga-DOTA-FAPI-04 PET/CT for the diagnosis of tracheal mucoepidermoid carcinoma.

Primary adenoid cystic carcinoma of the trachea: an elusive diagnosis of chronic dyspnoea

Primary adenoid cystic carcinoma (ACC) of the trachea is a rare entity, with a 5-year survival between 50% and 80% for resectable cases and 30% in case of unresectable disease. We report a case of a primary ACC on a woman in her 70s that presented with a drawn-out history of dyspnoea. She was diagnosed with an unresectable obstructive tumour of the trachea, which required the placement of a Y-shaped stent. The patient underwent concomitant chemoradiotherapy, with partial response, and is still in follow-up, without evidence of disease progression.

Tracheal Glomus Tumor: A Case Report with CT Imaging Features

BACKGROUND AND OBJECTIVES

Glomus tumors are rare benign tumors. The majority of them affect the skin the most and are rarer in the trachea, where the glomus bodies may not be present. Only scarce reports of tracheal glomus tumors have been reported solely with case reports of relevant articles.

MATERIALS AND METHODS

A 53-year-old man, with a free previous medial history, presented to our hospital with tracheal mass which was incidentally found. He did not complain of any specific symptoms associated with the tracheal tumor. The contrast-enhanced chest computed tomography (CT) revealed an avid enhancing nodular lesion, which is similar to blood vessels, in the trachea, 3 cm above the carina level without definite airway obstruction.

RESULTS

Successful tracheal resection and end-to-end anastomosis were performed on the patients; therefore, the final post-operative pathologic findings revealed a benign tracheal glomus tumor. The follow-up CT scan four months after operation showed complete removal of the tumor.

CONCLUSION

Tracheal glomus tumors, even rare entities, could be considered as a differential diagnosis if a highly enhancing mass appears on CT images.

[Unexpected cause of tracheal obstruction: pleomorphic adenoma with lipometaplasia]

Pleomorphic adenoma of the trachea is a benign tumor, extremely rare, that generates obstructive symptoms and sometimes is confused with asthma, which delays its diagnosis. We present the case of a 40-year-old woman with history of asthma and airway obstruction, of 8-months duration. Fibrobronchoscopy showed polypoid, pedunculated lesion in first tracheal ring which occluded 80% of the lumen, that was resected. The histopathological diagnosis was pleomorphic adenoma with lipometaplasia. Treatment of these tumors consists in complete resection of the lesion and long-term follow-up due to low probability of recurrence, malignancy and metastasis.

Tracheal Lipoma Mimicking Asthma

Primary tracheal tumors are very rare and 10%-20% are benign tumors. Tracheal lipoma is extremely rare and only a few cases have been reported in the literature. A 69-year-old male patient presented to the emergency department with complaints of shortness of breath, respiratory distress, chest pain and cough. Chest CT scan showed a round mass in the topography of the trachea that almost caused airway obstruction. The lesion was resected endoscopically and the pedicle base was cauterized. Tracheal lipoma is a rare condition that should lie in the differential diagnosis of treatment-resistant asthma.

18F-FDG PET/CT of Primary Tracheal Adenoid Cystic Carcinoma

ABSTRACT

Primary adenoid cystic carcinoma in the trachea is a very rare tumor. A 40-year-old woman presented with persisting cough and wheezing over 2 months. A CT scan showed a mass in the tracheal wall. The bronchoscopic biopsy confirmed adenoid cystic carcinoma. 18F-FDG PET/CT was performed to evaluate the tracheal mass, which showed an FDG-avid mass in the right posterior tracheal wall.

A Case of Solitary Laryngotracheal Lymphoma Evaluated by 18F-FDG PET/CT

ABSTRACT

Solitary non-Hodgkin lymphoma of the trachea is extremely rare. Herein, we reported a case of solitary laryngotracheal lymphoma in a 55-year-old man. He complained of cough, tachypnea, and dyspnea. 18F-FDG PET/CT showed a hypermetabolic lesion in the subglottic larynx and upper cervical trachea. The subsequent histology and immunohistochemistry of the laryngotracheal lesion tissue confirmed the diagnosis of non-Hodgkin lymphoma (mucosa-associated lymphatic tissue lymphoma).

Tracheal Paraganglioma: A Case report and Review of the Pertinent Literature

The trachea is a sporadic origin of paraganglioma. The purpose of the present study was to identify the features of tracheal paraganglioma and reveal the effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) by reviewing both previous and current cases. In cases of tracheal tumors, we need to consider the bleeding risk associated with a biopsy, as the tumor may be paraganglioma, which is hypervascular. If a biopsy is not available, then CT and MRI can aid in making a pre-operative diagnosis. MRI in particular is useful for long-term observations.

Endotracheal, Endobronchial, and Vocal Cords Metastases From Lung Cancer Detected by 18F-FDG PET/CT

ABSTRACT

A 61-year-old man with a history of lung cancer initially treated 3 years prior presented with a new onset of cough for 1-month and 2-week hoarseness. FDG PET/CT revealed multiple hypermetabolic lesions in the endotracheal, endobronchial, and vocal cords. Subsequently, immunostaining confirmed that all lesions were metastatic squamous cell carcinomas originating from the patient's primary lung squamous cell carcinoma.

[The Postoperative Recurrence of Adenosquamous Cell Carcinoma of the Lung as a Polypoid Mass in the Tracheal Lumen;Report of a Case]

The case is 77 years old, female. She was referred to a local doctor with a chief complaint of cough and wheezing and was treated as asthma. However, symptoms did not improve and she was referred to our hospital. She had a history of right upper lobectomy for lung cancer about 2 years before, with the pathological diagnosis of adenosquamous cell carcinoma, pT1aN0M0, stage I A. Chest computed tomography (CT) scan showed a pedunculated polypoid mass almost occupying the lumen in the trachea immediately above the tracheal bifurcation, and the emergency bronchoscopic resection using a high-frequency snare under general anesthesia was performed. Postoperatively, 50 Gray of radiotherapy was added.

Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway: A case report

INTRODUCTION

Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy.

PATIENT CONCERNS

The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress.

DIAGNOSIS

A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular.

INTERVENTIONS

To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support.

OUTCOMES

We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged.

CONCLUSION

ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.

Papillary thyroid carcinoma with tracheal invasion: A case report

RATIONALE

Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. The prognostic factors of PTC include age, sex, tumor size, enlarged lymph nodes, and extrathyroidal extension. Among the extrathyroidal extension, upper aerodigestive tract (ADT) invasion by PTC is a marker of more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death.

PATIENT CONCERNS

A 61-year-old woman had a cervical mass that was slowly growing for three years. Additionally, she had haemoptysis of 1-year duration. During the month prior to her visit, she had difficulty breathing.

DIAGNOSIS

Neck ultrasonography (US) and thyroid computed tomography (CT) images both showed a well-defined calcified mass on the left lobe of the thyroid gland. Additionally, the thyroid CT revealed that part of the mass protruded into the lumen which resulted in the thickening on the left side of the trachea. Accordingly, her diagnoses were as follows: firstly, a solid mass on the left lobe of the thyroid gland with tracheal compression; and finally, the space-occupying airway lesion.

INTERVENTIONS

She underwent a bronchoscopic examination, which revealed a mass blocking most of the upper endoluminal trachea. Thus, the mass was resected at the upper tracheal segment, followed by electrotome and argon plasma coagulation treatment. She was then transferred to the Thyroid Surgery Department. Thyroid surgeons took the surgical type of bilateral subtotal thyroidectomy + exploration of bilateral recurrent laryngeal nerve + dissection of the lymph node in neck central area + circumferential sleeve resection + end-to-end anastomosis + tracheotomy in the patient.

OUTCOMES

After surgery, she recovered well without any local recurrence or distant metastasis.

LESSONS

When patients with PTC have haemoptysis, hoarseness, dyspnea, or any other symptoms, and the imaging examinations reveal a space-occupying lesion in the thyroid and airway, clinicians should focus on PTC with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.

A case of tracheal leiomyoma misdiagnosed as asthma

Primary benign tumors of trachea are rare. Of them, tracheal leiomyoma, constitutes only 1% of all benign lower respiratory tract tumors. Here, we present a case of tracheal leiomyoma who has been receiving high doses of inhaled corticosteroids and bronchodilators for a year with a misdiagnosis of asthma. As the symptoms did not resolve with an overtreatment, she has been undergone radiologic study to find a possible alternative diagnosis. The chest roentgenogram revealed an opacity in the upper mediastinum. In computed tomography, a lesion has been detected in proximal trachea, arising from the posterior wall and protruding through the lumen and almost obliterating the air column. Rigid bronchoscopy has been performed under general anesthesia due to a high risk of bleeding and the endobronchial lesion, freely moving with respiration, has been removed and cryotherapy was applied to the base of the lesion. Receiving the histopathological diagnosis of leiomyoma, the patient is now on 12th month of the follow-up without any recurrence.

Chest CT with iterative reconstruction algorithms for airway stent evaluation in patients with malignant obstructive tracheobronchial diseases

The aim of the study was to investigate the image quality of low-dose CT images with different reconstruction algorithms including filtered back projection (FBP), hybrid iterative reconstruction (HIR), and iterative model reconstruction (IMR) algorithms by comparison of routine dose images with FBP reconstruction, in patients with malignant obstructive tracheobronchial diseases.In total, 60 patients (59 ± 9.3 years, 37 males) with airway stent who are randomly assigned into 2 groups (routine-dose [RD] and low-dose [LD] group, 30 for each) underwent chest CT on a 256-slice CT (RD-group 120 kV, 250 mAs, LD-group 120 kV, 120 mAs). Images were reconstructed with filtered back projection (FBP) algorithm in the RD group, whereas with FBP, HIR and IMR algorithms in the LD group. Effective radiation dose of both groups was recorded. Image-quality assessment was performed by 2 radiologists according to structure demarcation near stents, artifacts, noise, and diagnostic confidence using a 5-point scale (1 [poor] to 5 [excellent]). Image noise and CNR were measured.The effective radiation dose of LD group was reduced 52.7% compared with the RD group (10.8 mSv ± 0.58 vs 5.1 mSv ± 0.26, P = 0.00). LD-IMR images enabled lowest image noise and best subjective image quality scores of all 4 indices, when compared with RD images reconstructed with FBP (RD-FBP) images (all P < 0.05). LD images reconstructed with and with HIR (LD-HIR) images enabled higher score in subjective image quality of artifacts (P < 0.05), whereas it showed no difference in the other subjective image-quality indices and image noise. Significant higher image noise and lower score of subjective image quality were observed in LD-FBP images (all P < 0.05).Both IMR and HIR improved image quality of low-dose chest CT by comparison of routine dose images reconstructed with FBP. Meanwhile, IMR allows further image quality improvement than HIR.

[Tracheal Resection and Primary Anastomosis for Adenoid Cystic Carcinoma Using an Extracorporeal Membrane Oxygenation]

We report a case of tracheal resection and primary anastomosis for adenoid cystic carcinoma using an extracorporeal membrane oxygenation (ECMO). A 45-year-old female was referred to our hospital because of a tracheal tumor that occupied most of the tracheal lumen. In case of airway obstruction by the tracheal tumor during anesthesia and operation, we decided to use ECMO before induction of general anesthesia. Under secure respiratory control using ECMO, tracheal resection and primary anastomosis was performed. Since histopathological examination revealed microscopically positive results at the surgical margin, postoperative adjuvant radiation therapy( 60 Gy/30 Fr) was conducted. Although a tracheal tumor is a relatively rare neoplasm, careful planning and a treatment strategy are necessary with special emphasis on the location and size of tumor. In this case, ECMO made a substantial contribution to secure respiratory control during surgery.

[Tracheal tumor treated as asthma]

Primary tumors of the trachea are very rare. In adults, the majority of them are malignant. Schwannomas are exceedingly rare benign tumors in the tracheobronchial tree. We report a case of a 37-year-old man who was hospitalized for increasing dyspnea. He had been treated for bronchial asthma for the last 4 years with no benefit. The CT scan of the chest and bronchoscopy identified a tracheal mass that was prolapsed in the left stem bronchus. The patient did not remain free of disease after endoscopic laser resection. So, surgical resection was made. The tumor was excised at its base. A segment of the left stem bronchus was removed and primary anastomosis was performed. The histopathologic diagnosis was of a benign schwannoma without malignant elements. There was no recurrence during the follow-up period. This case demonstrates that intratracheal masses should be considered in patients with dyspnea or in patients with asthma refractory to conventional therapy.

[Primary benign schwanomma in trachea]

We report a rare case of a primary schwanomma in trachea causing airway symptoms in a 78-year-old male. Benign tracheal tumours are often misdiagnosed as asthma or chronic lung disease and should be considered in patients who present with symptoms as upper airway obstruction and haemoptysis. In this case story the patient was treated with endoscopic resection of the tumour.

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.

Incidentally discovered primary malignant melanoma of the trachea

Primary malignant melanoma of the trachea is extremely rare. We report here the first case of primary tracheal malignant melanoma in the asymptomatic stage. Incidentally, this 73-year-old man was found to have a flat tumor at the upper trachea on chest computed tomography scans. The tumor was surgically resected with end-to-end anastomosis and was diagnosed to be primary malignant melanoma of the trachea. Four months after the surgical resection, cervical lymph node metastasis was found. Despite the resection of metastatic lymph nodes and six courses of chemotherapy, he died of cachexia approximately two years after the discovery of the tracheal tumor.

[Surgical and combined treatment for primary carcinoma of the trachea]

Our study was conducted in patients with primary squamous cell carcinoma of the trachea and adenoid cystic carcinoma (191) (radical surgery--90; combined treatment--101). The former pathology was relatively more aggressive. Combined treatment proved more effective as compared with surgery alone (5- and 10-year survival after surgery was 79 and 64%; combined treatment--92 and 79%, respectively).

Fine needle aspiration cytology of an endotracheal mass: report of a case with an unusual presentation of anaplastic large cell lymphoma

BACKGROUND

Anaplastic large cell lymphoma (ALCL) is an uncommon hematolymphoid neoplasm characterized by malignant lymphocytes of T-cell phenotype. It usually affects young patients and may involve a variety of tissues and organs. We herein describe a case of ALCL that presented as an endotracheal mass with associated hilar lymphadenopathy. To the best of our knowledge this is the first case in the literature arising in the trachea. In this location the diagnosis of ALCL can be especially difficult as its pleomorphic cytomorphology mimics that of a carcinoma, which is a more typical neoplasm arising in the trachea.

CASE

A 26-year-old male presented with hemoptysis and paroxysmal chest pain. Imaging revealed an endotracheal mass and multiple lytic bone lesions. Fine needle aspiration biopsy of the endotracheal mass revealed discohesive malignant cells with abundant, pale cytoplasm and cerebriform, donut-shaped and horseshoe-shaped nuclei. Immunohistochemical studies confirmed the diagnosis of ALCL.

CONCLUSION

ALCL may have an unusual presentation and involve diverse sites, including the trachea. While its cytologic features are straightforward, a high index of suspicion is necessary to ensure accurate diagnosis when it presents in unusual locations.

Removal of glomus tumor in the lower tracheal segment with a flexible bronchoscope: report of two cases

Tracheal glomus tumor is an extremely rare neoplasm resected mostly by open surgery or through rigid bronchoscopy. We report two cases presenting with polypoid masses arising from the tracheal membrane in the posterior wall of the lower tracheal segment. The tumor was removed by high-frequency electrocautery and flexible bronchoscopic argon-plasma coagulation, and follow-up bronchoscopy and chest CT did not reveal tumor recurrence 12 months after the operation. In patients with tracheal glomus tumor who have poor surgical tolerance or are not willing to receive an open surgery, flexible bronchoscopic tumor removal can be a good alternative to relieve the airway obstruction symptoms.

Cytopathologic analysis of paratracheal masses: a study of 737 cases with clinicoradiologic correlation

OBJECTIVE

To analyze the cytopathologic findings of a series of paratracheal space (PTS) masses in the context of clinicoradiologic correlation.

STUDY DESIGN

Retrospective review of our cytopathology files revealed 131 cases of PTS lesions in a 14-year period (1991-2005). Cytologic material was obtained under radiologic guidance. Radiologic findings, clinical data and subsequently performed tissue biopsies were reviewed and correlated.

RESULTS

Radiologic imaging disclosed masses in the PTS ranging from 1 to 7 cm. Of the 131 cases, 103 (79%) were deemed diagnostic. Of these, 41 (40%) revealed nonneoplastic lesions, and 62 (60%) yielded malignant neoplasms. Nonneoplastic entities included: 31 (73%) hyperplastic lymph nodes and 10 (24%) sarcoidosis. Of the malignant cases, 45 (73%) were metastatic tumors: adenocarcinoma (ACA) 19, small cell carcinoma 12, squamous cell carcinoma (SQCC) 11 and other tumors, from lung 34, esophagus 4 and other sites. Malignant neoplasms from local spread included lung non-small cell carcinoma 6, SQCC 3 and ACA 3, papillary thyroid carcinoma 3 and other 2.

CONCLUSION

Fine needle aspiration (FNA) of PTS has a high diagnostic yield (79%) with a sensitivity of 97% and specificity of 100%. The most common diagnosis is a malignant tumor (60%), with metastatic carcinoma (73%) the most common neoplasm (lung ACA the most common primary source). The most common benign entity is a hyperplastic lymph node (24%). Ancillary studies (immunoctyochemistry, fluorescence in situ hybridization and electron microscopy) were helpful and provided definitive diagnosis in 30% of the initially nondiagnostic FNA samples.

Endotracheal surgery for leiomyoma of the trachea

A 61-year-old male was found to have a tracheal tumor, which was noted at the time of screening by a chest X-ray study. The tumor arose from the membranous portion 4 cm above the carina and was proven by biopsy to be a leiomyoma. Because the disease is a benign tumor, all methods for resection, including bronchoscopic techniques, were thus considered. We performed an endotracheal operation via a window made by an incision of the cartilagenous portion, and removed the tumor through an anterior approach. This type of endotracheal operation is one of the surgical procedures for the removal of benign tracheal tumors.

Pleomorphic adenoma of the trachea

Primary pleomorphic adenoma of the trachea is rare, as only 33 cases have been previously reported worldwide since 1922. We describe a new case of primary tracheal pleomorphic adenoma that was discovered incidentally in a 78-year-old man. The tumor was excised, and the patient recovered without complication. Salivary gland tumors of the trachea should be considered in the differential diagnosis of tracheal lesions; the diagnosis is confirmed by pathologic evaluation. Patients are adequately treated with sleeve resection and primary anastomosis whenever possible.

Primary adenocarcinoma of the trachea resected using percutaneous cardiopulmonary support (PCPS)

We encountered one very rare case of primary adenocarcinoma of the trachea. The patient was a 72-year-old woman who was hospitalized immediately following significant dyspnea and mental confusion. A computed tomography scan of her chest revealed a 14x13x11 mm tumor in the trachea. After establishing artificial respiration, a tracheal tubular resection was immediately performed using percutaneous cardiopulmonary support (PCPS). A postoperative pathological examination led to the patient being diagnosed with primary adenocarcinoma of the trachea, and she was treated with adjuvant chemotherapy. Since then, for approximately 1 year and 6 months we have detected no relapse.

A 90-year-old woman with trachea-invading thyroid cancer requiring four-ring resection of cervical trachea because of airway stenosis

The patient was a 90-year-old woman with chief complaints of hemoptysis and wheezing. Cervical computed tomography (CT) scans revealed a mass (2.5x2.0 cm) in the right lobe of the thyroid. The mass was exposed into the tracheal lumen, causing marked stenosis of the airway. When examined by bronchoscopy, the maximal degree of airway stenosis was about 75% of the tracheal cross section. During surgery, a resection of the right lobe of the thyroid was combined with a resection of the second to fifth cartilage ring of the cervical trachea for the purpose of complete resection of the thyroid cancer. During the same operation, the trachea was reconstructed by end-to-end anastomosis. For 1 week after surgery, a Mini-Trach II tube was left inserted to aspirate sputum, and the neck was kept bent forward (in the position of flexion). When sleeve resection of the trachea and subsequent end-to-end anastomosis are being performed, it is essential to manipulate the trachea in a protective manner, to preserve the nourishing vessels, to perform operative manipulation aseptically, to appropriately move the trachea, and to ensure reliable suturing with the goal of minimizing the incidence of complications such as anastomotic failure and stenosis of the anastomosed area. Although the patient was in advanced old age, her postoperative course was uneventful.

Airway Leiomyoma: Imaging Findings and Histopathologic Comparisons in 13 Patients

OBJECTIVE

The aim of our study was to review retrospectively the imaging findings on tracheobronchial leiomyoma and to compare them with the pathologic findings.

CONCLUSION

Leiomyoma of the respiratory tract is located in the bronchi in two thirds of patients and in the trachea in one third. The tumor most commonly manifests on CT scans as a homogeneously enhancing airway tumor with intraluminal growth. In approximately 15% of patients, the tumor has an iceberg appearance.

A case of fibrous histiocytoma of the trachea in an infant treated by endobronchial ND:YAG laser

Fibrous histiocytomas are uncommon tracheal tumors. They generally involve only the lung parenchyma; endobronchial involvement is extremely rare. At present, surgical resection is considered the therapy of choice for definitive diagnosis and cure. Endoscopical treatment is uncommon in pediatric patients because of the technical endoscopical difficulties and the high recurrence rate of treatment by endoscopy alone. We report the first case of fibrous histiocytoma in an infant successfully treated by endoscopy and yttrium alluminum garnet (YAG)-laser.

[Solitary focal tracheal lesions. A case report]

We present a case of adenoid cystic tracheal carcinoma detected by computerized tomography (64-MDCT) with cyto-histological correlation in a patient with hemoptysis. In this article we review the differential diagnosis of solitary focal tracheal lesions as they appear in computerized tomography (CT). In this case, image methods suggested the diagnosis but underestimated the tracheal wall invasion, which was established by histologycal examination of the resected tumor.

Use of bronchoscopic electrocautery in removing an endotracheal metastasis

Bronchoscopic electrocautery is an easy, safe and rapid local method for the removal of a tracheal metastasis. Recently, we experienced a case of papillary serous carcinoma of the ovary with tracheal metastasis in a 45-year-old woman. Twelve years after the initial diagnosis of ovarian cancer, the patient presented with dyspnea. A chest CT scan showed that the trachea was nearly obstructed with a polypoid mass. The mass, later shown to be a metastatic papillary serous carcinoma, was removed by flexible bronchoscopic electrocautery with a snare. To our knowledge, this report is the first to describe the successful removal of an endotracheal metastasis of ovarian cancer using bronchoscopic electrocautery.

Tracheal resection for critical tracheal occlusion due to intraluminal tumour

Anaesthesia for tracheal resection requires careful planning by an experienced team. We report a case of urgent tracheal resection for a vascular tumor in a 41-year-old man who was a heavy smoker The tumour occupied most of his trachea. A CT reconstruction of the tumor assisted in planning. Perioperative tracheal laser therapy and cardiopulmonary bypass were not used due to concerns about excessive bleeding. Intraoperative airway management involved an upper endotracheal tube placed by the anaesthetist and a second, lower, endotracheal tube placed by the surgeon. The existing evidence for anaesthesia management of tracheal resection is currently limited to case reports. This case illustrates how preoperative imaging and careful planning can lead to a successful outcome, despite the potentially life-threatening nature of the pathology and the surgery.