Tracheal Tumors Research Articles

Sonographic Diagnosis of a Tracheal Extramedullary Plasmacytoma

Solitary extramedullary plasmacytoma (EMP) is a rare tumor constituting 4% of all plasma cell neoplasms. It may occur in any reticuloendothelial system containing organs but is found most frequently in the head and neck regions, which are rich in lymphoid tissue. The most common sites of origin are the subepithelial tissues of mucous membranes of the oronasopharynx and paranasal sinuses.1-5 Sonography has no role in the evaluation of tracheal lesions. We report a case of tracheal plasmacytoma that was discovered during a sonographic examination of the neck for goiter. The interesting aspect of this case is the presentation of a rare tracheal tumor diagnosed by a sonographic examination.

Resection of the Tracheal Carina in an Eight-Year-Old Child: A Case Report

An 8-year-old girl, who had been mechanically ventilated for 2 days, was referred to our clinic with total atelectasis of the right lung. Bronchoscopic examination showed an endobronchial mass lesion which was located on the right side of the carina. Carinal resection was performed and the patient was discharged on postoperative day 7. We presented this case report because of the rarity of tracheal tumors in childhood and to discuss the recommended surgical technique for pediatric carinal resection.

Anesthetic management of a 9‐year‐old child undergoing resection of a tracheal tumor

Primary tracheal tumors in children are rare. We report the anesthetic management of a 9-year-old child undergoing resection of a midtracheal tumor obstructing approximately 73% of the tracheal lumen. To prepare for any possible airway emergency during the induction and maintenance of anesthesia, we ascertained preoperatively that a mini-tracheotomy tube could be inserted at the distal portion of the tracheal lesion. Oxygenation and ventilation were adequately maintained throughout the period of anesthesia. Anesthetic management for tracheal tumor resection should reflect the location of the tumor and the degree of tracheal obstruction.

Primary carcinomas of the trachea: Natural history, treatment and results

AbstractPrimary tracheal tumors are rare. Understanding of the disease is limited and the optimal management has not been determined. To discover its natural history, and to confirm the efficacy of our treatment, we retrospectively analyzed the treatment outcome of 40 patients who were treated in our hospitals. Twenty‐eight patients were male and 12 female, with a median age of 47 years. Fifteen patients had adenoid cystic carcinoma (ACC), 14 squamous cell carcinoma, eight adenocarcinoma, two small cell carcinoma, and one mucoepidermoid carcinoma. Thirty‐two of the 40 patients underwent surgical resection and postoperative radiotherapy. Six patients were treated with radiotherapy only and two patients with surgical resection alone. The median survival time was 3.3 years. The survival rates at 1 year, 5 years and 10 years were 86, 59, and 29%, respectively. Four patients were found to develop secondary primary carcinomas in five locations. In conclusion, surgical resection and adjuvant radiotherapy was an effective mode of treatment for locally advanced tracheal carcinoma. Although late local recurrence after the first course of treatment was a feature of this tumor, excellent long‐term palliation was commonly achieved after a 2nd course of treatment.

呼吸器科領域 直腸癌術後気管転移に対しマイクロ波凝固療法（ＭＣＴ）が有効であった１例

The case is a 67-year-old female who was treated with low anterior resection for rectal cancer in April 1998. Two years later, metastasis to lung was diagnosed and we performed left upper lobectomy. In another three years after the treatment, tracheal tumor was found. We diagnosed it was metastasis of past rectal cancer because the histological findings were similar to metastasis of past rectal cancer to lung. We performed microwave tissue coagulation (MTC) to the tracheal metastasis. The tumor was easily cauterized and removed. Two years have passed after the latest treatment and the tracheal metastasis of carcinoma has been favorably controlled. We concluded that microwave coagulation therapy (MCT) was a very effective method as a partial treatment for metastatic tracheal tumor.

A Case of Tracheal Adenoid Cystic Carcinoma Presenting with Diffuse Goiter

A goiter is among the most common presenting symptoms of patients with thyroid diseases and is usually caused by intrinsic thyroid problems. While direct invasion of the trachea by aggressive thyroid tumors is a well-known phenomenon, the reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland, presenting with a goiter is very rare. Here, a case of a tracheal adenoid cystic carcinoma (ACC), presenting with a diffuse goiter, is reported. A 47-year-old woman presented with slowly growing anterior neck swelling. A physical examination showed a diffuse firm goiter. The patient was euthyroiditic, and serum negative for thyroid autoantibodies. Thyroid ultrasonography and neck CT revealed a doughnut-shaped mass, encircling the trachea and displacing the thyroid anteriorly. Ultrasonography-guided fine needle aspiration (FNA) was compatible with an ACC, and a subsequent surgical resection confirmed the diagnosis. Although the occurrence of a tracheal ACC invading the thyroid is rare, this case highlights the need to be aware of unusual lesions arising in the region of the thyroid. This knowledge will help in making the correct cytological diagnosis when these lesions are sampled by FNA (J Kor Soc Endocrinol 20:273～277, 2005).

Endobronchial Laser Ablation of a Tracheal Schwannoma

Abstract:Primary tracheal schwannomas, also known as neurilemmomas, are extremely rare tracheal tumors. These benign tumors, which originate from the peripheral nervous system, occur as primary bronchial tumors and rarely progress to malignancy. Endobronchial tumor resection is a useful technique in

Diagnostic et traitement d’une tumeur bénigne de la trachée : un schwannome

Schwannomas are extremely rare benign tumours in the tracheo-bronchial tree. A rigid bronchoscopy was performed in a fifty-six-year-old woman with clinical features of atypical asthma. It permitted total resection and histological examination of a tracheal tumour. It was identified as a benign schwannoma. Using this case report as an illustration, and an analysis of the world literature, the clinical, investigative, histological and therapeutic aspects of tracheo-bronchial schwannoma are discussed. Dyspnoea seems to be the most frequent initial symptom. Investigations, including flexible bronchoscopy, failed to reach a diagnosis. In the past, thoracic surgery was the gold standard treatment, but nowadays, rigid bronchoscopy would be the first choice technique for endo-tracheal or endo-bronchial tumours allowing both histological analysis and complete resection.

Tracheal adenoid cystic carcinoma masquerading asthma: A case report

BackgroundTracheal tumors are often misdiagnosed as asthma and are treated with inhaled steroids and bronchodilators without resolution.Case PresentationHere, a patient with tracheal adenoid cystic carcinoma who had been previously diagnosed with difficult asthma was reported. The possibility of the presence of localized airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction, was obtained.ConclusionThe presenting case report emphasizes the fact that not all wheezes are asthma. It is critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy, localized obstructions should be ruled out before establishing the diagnosis of asthma.

Tracheal Myxoma: A Rare Benign Tracheal Tumor

Benign tracheal tumors are rare. We describe a 39-year-old man who underwent resection of a tracheal myxoma, a previously unrecognized benign tracheal neoplasm. He presented with a 9-month history of wheezing, cough, and dyspnea on exertion. Treatment with bronchodilators and corticosteroids administered by inhalation and systemically did not diminish his symptoms. Pulmonary function tests showed a pattern of airflow limitation consistent with variable extrathoracic obstruction. Chest radiography and computed tomography revealed a tracheal mass. Tracheal resection of the tumor with reconstruction was curative. The patient is free of disease 7 years after surgery.

Rare tracheal chondroid hamartoma masquerading as asthma in a 14-year-old girl

Tracheal hamartomas are rare in all age groups and have not been previously described in adolescence. To report the first case of a tracheal chondroid hamartoma presenting as exercise intolerance and wheezing and previously misdiagnosed and treated as asthma. Symptoms, pulmonary function tests, chest x-ray examination, chest computed tomography, and histologic examination of the specimen were performed. The pulmonary function tests obtained throughout several years revealed progressive decreases (approximately 30% of predicted) in peak expiratory flow and forced expiratory volume in 1 second (approximately 50% of predicted). The inspiratory and expiratory flow-volume curve suggested a fixed central airway obstruction. Both the chest x-ray examination and computed tomography revealed an intraluminal tracheal tumor that was surgically excised. Histologic examination revealed a chondroid hamartoma. Rare benign primary tracheal tumors, including chondroid hamartoma, can present in adolescence with asthma-like symptoms for years and should be considered in the differential diagnosis, especially in the setting of appropriately abnormal spirometry or when asthma is very difficult to control.

Tracheobronchial Adenoid Cystic Carcinoma: A Clinicopathologic Study of 14 cases

To investigate the clinicopathologic features of primary tracheobronchial adenoid cystic carcinoma (ACC), and to examine kit protein (CD117) expression, and a possible correlation between the histologic grade and Ki-67 positivity. Retrospective 10-year study (from 1992 to 2001). Referral center for interventional pulmonology. Fourteen patients referred to our institution for laser resection of tracheal or endobronchial tumors. Twelve patients were treated primarily by laser resection via bronchoscopy with subsequent radiation therapy. The remaining two patients had tracheal resection with postoperative radiation and radiation therapy alone. Fourteen patients (5 men and 9 women) had an average age of 44 years at diagnosis (age range, 29 to 57 years). Five of 14 patients were smokers (average smoking history, 28.5 pack-years), 8 were nonsmokers, and the smoking history was unknown in 1 patient. Major symptoms at presentation included cough (57.1%), dyspnea (71.4%), and hoarseness (14.3%). Two patients (14.3%) presented with respiratory failure. Eleven patients (78.6%) had one or more recurrences, and 4 patients (28.6%) had metastases, primarily to the lungs. The average time to either recurrence or metastasis was 4.6 years after the initial diagnosis. Five patients (35.7%), all of whom had recurrences and/or metastasis during the course of their disease, died of their disease (average time, 8.2 years). Thirteen of 13 cases stained for CD117 were positive in the tumor cell cytoplasm with membranous accentuation. Our cases included 8 grade I tumors, 4 grade II tumors, and 2 grade III tumors, which did not correlate with the degree of Ki-67 positivity. Tracheobronchial ACCs in our study were more common in women and nonsmokers who presented with nonspecific respiratory symptoms and followed a clinical course generally comparable to that of tumors in the salivary glands. CD117 expression was present in all cases tested, and Ki-67 stain results did not correlate with the tumor grade.

Glomus Tumor of the Trachea: Value of Multidetector Computed Tomographic Virtual Bronchoscopy

Glomus tumor of the trachea is extremely rare. We report a case of tracheal glomus tumor in a 39-year-old man who presented with hemoptysis. The diagnosis was made after bronchoscopic biopsy of a tumor involving the posterior wall of the upper trachea. Thin-section multidetector computed tomography of the chest was performed before surgical resection, with multiplanar re-formations and 3-dimensional virtual bronchoscopic reconstruction. Tracheal sleeve resection with reconstruction was successful, and pathological studies confirmed complete resection and the diagnosis of glomus tumor. The patient was disease-free 3 months postoperatively. To our knowledge, this is the first reported case in which additional computed postprocessing was used to help evaluate the extent of such a tumor.

Chondrosarcoma arising in the trachea: a case report and review of the literature

Chondrosarcoma arising in the trachea: a case report and review of the literature

Granular cell tumors of the tracheobronchial tree

ObjectiveTo describe the population-based incidence and clinical characteristics of granular cell tumors of the tracheobronchial tree. MethodsAll newly registered tracheobronchial granular cell tumors in the Dutch Network and National Database for Pathology for 10 consecutive years (1990-1999) were identified. The histologic diagnosis was confirmed and patient demographics, management, and follow-up data were analyzed. ResultsThirty-one tumors were registered in 30 patients (12 male patients and 18 female patients; mean age 51 years; range 11-84) in a population of approximately 15 million. Tracheal tumors were identified in 11 patients and bronchial tumors in 19 patients (1 patient had 2 tumors). About half of the patients were asymptomatic. In the majority of the patients (61%) the granular cell tumor was an incidental finding during workup for lung carcinoma. Tracheal granular cell tumors were more frequent in women, whereas bronchial granular cell tumors showed no sex predilection. In the lung these tumors occurred more often in the upper (10 tumors) than in the lower lobes (3 tumors). There was no preference for either side. Four patients with tracheal and 4 with bronchial granular cell tumors were treated with surgery and remain in complete remission. Four bronchial granular cell tumor patients were treated locally with neodymium/yttrium-aluminum-garnet laser or electrocautery and are in complete remission or have stable residual disease. In 3 patients no residual disease was found after biopsy. Of all granular cell tumor patients 17 received no treatment for a variety of reasons, but none of these patients died in the follow-up period because of the granular cell tumors. ConclusionTracheobronchial granular cell tumor is a benign tumor with a good prognosis. In symptomatic patients surgical intervention is the first choice of treatment, but local treatment is a reasonable option and gives successful results.

Animal models for tracheal research

Tracheal research covers two main areas of interest: tracheal reconstruction and tracheal fixation. Tracheal reconstructions are aimed at rearranging or replacing parts of the tracheal tissue using implantation and transplantation techniques. The indications for tracheal reconstruction are numerous: obstructing tracheal tumors, trauma, post-intubation tissue reactions, etc. Although in the past years much progress has been made, none of the new developed techniques have resulted in clinical application at large scale. Tissue engineering is believed to be the technique to provide a solution for reconstruction of tracheal defects. Although developing functional tracheal tissue from different cultured cell types is still a challenge. Tracheal fixation research is relatively new in the field and concentrates on solving fixation-related problems for laryngectomized patients. In prosthetic voice rehabilitation tracheo-esophageal silicon rubber speech valves and tracheostoma valves are used. This is often accompanied by many complications. The animal models used for tracheal research vary widely and in most publications proper scientific arguments for animal selection are never mentioned. It showed that the choice on animal models is a multi-factorial process in which non-scientific arguments tend to play a key role. The aim of this study is to provide biomaterials scientists with information about tracheal research and the animal models used.

O-196 High frequency electrical knife through fibrobronchoscope in treatment of tracheal tumor with large airway obstruction

O-196 High frequency electrical knife through fibrobronchoscope in treatment of tracheal tumor with large airway obstruction

Progressive experience in tracheal stenting with self-expandable stents.

We experienced an unacceptably high 21% complication rate with the stainless steel Gianturco stent: a 68-month mean follow-up (range: 37-96 months) of 23 patients revealed three stent fractures and two migrations. Consequently, we began using nitinol mesh stents (Ultraflex) for fibrous stenoses and silicone-covered prostheses (Rush) for proliferative tracheal tumors. The extractable nitinol stent, made from alloy with thermal memory, was palliatively used in 15 patients with fibrous tracheal stenosis; the mean follow-up currently covers 21 months (range: 1-60 months). The silicone-covered prosthesis was used for two patients with inoperable tracheal tumor; follow-up covers 4 months and 2 months, respectively. The prostheses were positioned under visual guidance via the endoscopic approach. The median forced inspiratory volume in 1 s (FIV1) improved from 2.1 l/s (IQR: 0.7-2.4) to 3.2 l/s (IQR: 0.9-3.4) (P=0.018, Wilcoxon signed rank test). The median ratio of peak inspiratory flow (PIF 50%) to peak expiratory flow (PEF 50%) was 1.0 preoperatively (IQR: 0.8-1.5) and 1.8 postoperatively (IQR: 0.6-6.3). Between months 1 and 12, six granulomas developed. Five were treated with antibiotics and steroid aerosol inhalation therapy and one required CO2 laser vaporization. On day 10, one stent migration was observed. The migrated stent was substituted. To date, no stent fracture has been observed. Nitinol and silicone-covered prostheses can be proposed for the palliative treatment of fibrous tracheal stenoses and tracheal tumors, respectively.

Changes in biomarkers from space radiation may reflect dose not risk

This presentation evaluates differences between radiation biomarkers of dose and risk and demonstrates the consequential problems associated with using biomarkers to do risk calculations following radiation exposures to the complex radiation environment found in deep space. Dose is a physical quantity, while risk is a biological quantity. Dose does not predict risk. This manuscript discusses species sensitivity factors, tissue weighting factors, and radiation quality factors derived from relative biological effectiveness (RBE). These factors are used to modify dose to make it a better predictor of risk. At low doses, where it is not possible to measure changes in risk, biomarkers have been used incorrectly as an intermediate step in predicting risk. Examples of biomarkers that do not predict risk are reviewed. Species sensitivity factors were evaluated using the Syrian hamster and the Wistar rat. Although the frequency of chromosome damage is very similar in these two species, the Wistar rat is very sensitive to radiation-induced lung cancer while the Syrian hamster is very resistant. To illustrate problems involved in using tissue weighting factors, rat trachea and deep lung tissues were compared. The similar level of chromosome damage observed in these two tissues would predict that the risk for cancer induction would be the same. However, even though large numbers of deep lung tumors result from inhaled radon, under the same exposure conditions there has never been a tracheal tumor observed. Finally, the Relative Biological Effectiveness (RBE) used to generate “quality factors” that convert exposure and dose from different types of radiation to a single measure of risk, is discussed. Important risk comparisons are done at very low doses, where the response to the reference radiation has been shown to either increase or decrease as a function of dose. Thus, the RBE and the subsequent risk predicted is more dependent on the background response of the endpoint and the shape of the dose response to the reference radiation than it is on the radiation type of interest.A large study using micronuclei as biomarkers following exposure to different energies of mono-energetic neutrons, x-rays and gamma rays delivered at very low doses (0.0 to 0.10 Gy) is reported. As additional biomarkers of risk involved in critical steps in the carcinogenic process are developed, it may become possible to base risk estimates on biological change rather than the radiation energy deposition or dose.

Primary choriocarcinoma of the lung

J Thorac Cardiovasc Surg 2003;125:193-6