A TRACHEAL FIBROEPITHELIAL POLYP

Abstract

SESSION TITLE: Rare Cases in Cardiothoracic SurgerySESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 12:25 pm - 01:25 pmINTRODUCTION: Tracheal masses may be either benign or malignant in origin and may range in various sizes. Due to the variability of symptoms including cough, wheezing, and shortness of breath, diagnosis is often delayed. While chest radiograph is the initial test in those with nonspecific symptoms, there is a low sensitivity in detecting tracheobronchial pathologies. We present a case of a middle-aged woman found to have a tracheal fibroepithelial polyp.CASE PRESENTATION: This is a 59-year-old woman who initially presented to an urgent care clinic for congestion and productive cough. She was given antibiotics, however, had no relief of her symptoms. She then presented to the emergency department (ED) due to worsening shortness of breath. Her vitals were stable and exam was notable for rhonchi bilaterally on lung exam. A chest radiograph was clear (Figure 1). She was given another course of antibiotics with albuterol and discharged home. She presented one month later for persistent cough and was prescribed doxycycline and a short course of prednisone and discharged home. Another month later, she returned with ongoing cough with congestion. A chest CT revealed a 1.8 x 1.2 x 1.1cm near occlusive distal trachea lesion (Figure 2). She underwent a successful endobronchial electrocautery debridement which revealed a tracheobronchial fibroepithelial polyp (Figure 3). Both low-risk and high-risk human papilloma virus was negative.DISCUSSION: Large airway masses have a broad differential and may be benign or malignant. Regardless of the etiology, they are rare accounting for less than 0.1% of tumors. Symptoms are often nonspecific, so a chest radiograph is frequently the initial imaging obtained. Due to its low sensitivity and the fact that large airway abnormalities are often overlooked, a CT scan is the test of choice. The most common primary tracheal tumors are malignant with the majority comprised of squamous cell carcinoma then adenoid cystic carcinoma. On the benign spectrum, one may have a mucoid pseudotumor, foreign body, papilloma, or in our patient's case, a fibroepithelial polyp. They are typically found in the skin and genitourinary tract, and rarely in the trachea. Histopathologically, the polyp has normal respiratory epithelium with a dense fibrovascular stroma. It is studied to be inflammatory from either a chronic infection, foreign body aspiration, prolonged mechanical ventilation, or chronic smoke inhalation. Because they can grow, cause worsening symptoms, and have the appearance of a malignant lesion, they are generally removed. An endoscopic approach is used either by excision with forceps, argon plasma coagulation, electrocautery, or laser to completely remove the lesion.CONCLUSIONS: Due to the rarity of this lesion, no guidelines exist regarding follow up, however, reported case reports encourage a repeat bronchoscopy for surveillance after removal.Reference #1: Bedayat, A., Yang, E., Ghandili, S., Galera, P., Chalian, H., Ansari-Gilani, K., & Guo, H. H. (2020). Tracheobronchial Tumors: Radiologic-Pathologic Correlation of Tumors and Mimics. Current problems in diagnostic radiology, 49(4), 275–284. https://doi.org/10.1067/j.cpradiol.2019.04.003Reference #2: Macchiarini P. Primary tracheal tumours. Lancet Oncol 2006; 7:83–91 https://www.ajronline.org/doi/full/10.2214/AJR.12.9043#Reference #3: Murakami, Yasushi MD; Oki, Masahide MD; Saka, Hideo MD; Ise, Yuko MD Tracheal Fibroepithelial Polyp, Journal of Bronchology & Interventional Pulmonology: January 2015 - Volume 22 - Issue 1 - p 52-54 doi: 10.1097/LBR.0000000000000121DISCLOSURES: No relevant relationships by Deline da CostaNo relevant relationships by Dustin ManchesterNo relevant relationships by Nitasa Sahu SESSION TITLE: Rare Cases in Cardiothoracic Surgery SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Tracheal masses may be either benign or malignant in origin and may range in various sizes. Due to the variability of symptoms including cough, wheezing, and shortness of breath, diagnosis is often delayed. While chest radiograph is the initial test in those with nonspecific symptoms, there is a low sensitivity in detecting tracheobronchial pathologies. We present a case of a middle-aged woman found to have a tracheal fibroepithelial polyp. CASE PRESENTATION: This is a 59-year-old woman who initially presented to an urgent care clinic for congestion and productive cough. She was given antibiotics, however, had no relief of her symptoms. She then presented to the emergency department (ED) due to worsening shortness of breath. Her vitals were stable and exam was notable for rhonchi bilaterally on lung exam. A chest radiograph was clear (Figure 1). She was given another course of antibiotics with albuterol and discharged home. She presented one month later for persistent cough and was prescribed doxycycline and a short course of prednisone and discharged home. Another month later, she returned with ongoing cough with congestion. A chest CT revealed a 1.8 x 1.2 x 1.1cm near occlusive distal trachea lesion (Figure 2). She underwent a successful endobronchial electrocautery debridement which revealed a tracheobronchial fibroepithelial polyp (Figure 3). Both low-risk and high-risk human papilloma virus was negative. DISCUSSION: Large airway masses have a broad differential and may be benign or malignant. Regardless of the etiology, they are rare accounting for less than 0.1% of tumors. Symptoms are often nonspecific, so a chest radiograph is frequently the initial imaging obtained. Due to its low sensitivity and the fact that large airway abnormalities are often overlooked, a CT scan is the test of choice. The most common primary tracheal tumors are malignant with the majority comprised of squamous cell carcinoma then adenoid cystic carcinoma. On the benign spectrum, one may have a mucoid pseudotumor, foreign body, papilloma, or in our patient's case, a fibroepithelial polyp. They are typically found in the skin and genitourinary tract, and rarely in the trachea. Histopathologically, the polyp has normal respiratory epithelium with a dense fibrovascular stroma. It is studied to be inflammatory from either a chronic infection, foreign body aspiration, prolonged mechanical ventilation, or chronic smoke inhalation. Because they can grow, cause worsening symptoms, and have the appearance of a malignant lesion, they are generally removed. An endoscopic approach is used either by excision with forceps, argon plasma coagulation, electrocautery, or laser to completely remove the lesion. CONCLUSIONS: Due to the rarity of this lesion, no guidelines exist regarding follow up, however, reported case reports encourage a repeat bronchoscopy for surveillance after removal. Reference #1: Bedayat, A., Yang, E., Ghandili, S., Galera, P., Chalian, H., Ansari-Gilani, K., & Guo, H. H. (2020). Tracheobronchial Tumors: Radiologic-Pathologic Correlation of Tumors and Mimics. Current problems in diagnostic radiology, 49(4), 275–284. https://doi.org/10.1067/j.cpradiol.2019.04.003 Reference #2: Macchiarini P. Primary tracheal tumours. Lancet Oncol 2006; 7:83–91 https://www.ajronline.org/doi/full/10.2214/AJR.12.9043# Reference #3: Murakami, Yasushi MD; Oki, Masahide MD; Saka, Hideo MD; Ise, Yuko MD Tracheal Fibroepithelial Polyp, Journal of Bronchology & Interventional Pulmonology: January 2015 - Volume 22 - Issue 1 - p 52-54 doi: 10.1097/LBR.0000000000000121 DISCLOSURES: No relevant relationships by Deline da Costa No relevant relationships by Dustin Manchester No relevant relationships by Nitasa Sahu