SESSION TITLE: Lung Cancer 1 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 03:15 PM - 04:15 PM INTRODUCTION: Tracheal tumors pose a diagnostic and therapeutic challenge. The diagnosis is often delayed due to the lack of specificity of the symptoms on the initial presentation. Within tracheal tumors, leiomyosarcomas are a rare entity. CASE PRESENTATION: A 66-year old man without significant past medical history was noted to have a whistle with normal breathing prompting him to present to his primary care provider. He was referred to a head and neck specialist where a flexible laryngoscopy reportedly demonstrated a polyp. No intervention was done at the time. Over the next few months, his symptoms progressed to dyspnea on exertion with activities of daily living. He also noted an abdominal mass. On imaging of his neck, a mass was noted in the subglottis and proximal trachea, occluding ~ 95% of the tracheal lumen. A 9 x 10 cm abdominal mass was also detected on physical exam and imaging of the abdomen. Given the critical nature of his airway, the patient underwent emergent rigid laser bronchoscopy with endoluminal resection of the airway mass restoring patency to his airway. Subsequently he underwent a fine needle aspiration of the abdominal mass. The tracheal mass was consistent with a leiomyosarcoma showing over 5 mitotic counts per 10-high power fields. The abdominal mass was evaluated via a fine needle aspiration and is consistent with leiomyosarcoma as well. DISCUSSION: Leiomyosarcoma is a malignancy of smooth muscle cells. They tend to occur more frequently along the retroperitoneum, omentum, mesentery and deep structures within extremities but may occur virtually anywhere in the body. Extra-thoracic sarcoma tends to metastasize to the lung with an incidence of ~ 8% at the time of diagnosis. However, our patient’s presentation was unusual as we were unable to locate any case reports of metastatic tracheal leiomyosarcoma to the retroperitoneum or vice versa. In 12 reported cases of tracheal leiomyosarcomas, endoscopic management was documented in 3 cases. Recurrence was detected in 6 years in 2 out of the 3 cases. CONCLUSIONS: Leiomyosarcomas of the trachea are an extremely rare entity with limited experience guiding management and treatment decisions. Interventions to restore patency to an obstructed airway is the first step in management. This case may be the first reported case of leiomyosarcoma metastasizing to or from the trachea. Reference #1: Uncommon Primary Tracheal Tumors Ann Thorac Surg. 2006 Jul;82(1):268-72; discussion 272-3. Reference #2: Leiomyosarcoma Of The Trachea Ann Otol Rhinol Laryngol. 1991 Apr;100(4 Pt 1):337-40. DISCLOSURE: The following authors have nothing to disclose: Fady Youssef, Rohit Godbole, Javier Longoria, Nicolas Gallegos, Grace Kim, Mohsen Davoudi No Product/Research Disclosure Information