Tracheal Tumors Research Articles

Carcinogenic and inflammatory effects of plutonium-nitrate retention in an exposed nuclear worker and beagle dogs

Purpose: Plutonium-nitrate has a moderately rapid translocation rate from the lung to blood stream. Previous studies have shown an unexpected retention of soluble plutonium in the beagles and human case studied here. The inflammatory responses that may be associated with long-term exposure to ionizing radiation were characterized. These pathways include tissue injury, apoptosis, and gene expression modifications. Other protein modifications related to carcinogenesis and inflammation and the various factors that may play a role in orchestrating complex interactions which influence tissue integrity following irradiation were investigated.Materials and methods: We have examined numerous lung samples from a plutonium-exposed worker, a human control, and a variety of plutonium-exposed beagle dogs using immunohistochemistry and quantitative Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR).Results: The exposed human showed interstitial fibrosis in peripheral regions of the lung, but no pulmonary tumors. Beagles with similar doses were diagnosed with tumors in bronchiolo-alveolar, peripheral and sub-pleural alveolar regions of the lung. The terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay showed an elevation of apoptosis in tracheal mucosa, tumor cells, and nuclear debris in the alveoli and lymph nodes of the beagles but not in the human case. In both the beagles and human there were statistically significant modifications in the expression of Fas ligand (FASLG), B-cell lymphoma 2 (BCL2), and Caspase 3 (CASP3).Conclusions: The data suggests that FASLG, BCL2, CASP3 and apoptosis play a role in the inflammatory responses following prolonged plutonium exposure. Utilizing these unique tissues revealed which pathways are triggered following the internal deposition and long-term retention of plutonium-nitrate in a human and a large animal model.

A Case of Tracheal Adenoid Cystic Carcinoma in a Worker Exposed to Rubber Fumes

BackgroundPrimary tracheal tumors occur infrequently, accounting for less than 0.1% of all tumors. Adenoid cystic carcinoma (ACC) is the second most common type of malignancy of the trachea after squamous cell carcinoma (SCC). Little has been reported on the risk factors for tracheal ACC. The purpose of this study is to describe a case of tracheal ACC in a patient who had been exposed to rubber fumes, and to review the relationship between tracheal ACC and rubber fumes.Case reportA 48-year-old man who had been experiencing aggravation of dyspnea for several months was diagnosed as having ACC of the trachea on the basis of a pathologic examination of a biopsy specimen obtained via laser microscopy-guided resection. The patient had been exposed to rubber fumes for 10 years at a tire manufacturing factory where he worked until ACC was diagnosed. His job involved preheating and changing rubber molds during the curing process.ConclusionACC of both the trachea and the salivary glands show very similar patterns with regard to histopathology and epidemiology and are therefore assumed to have a common etiology. Rubber manufacturing is an occupational risk factor for the development of salivary gland tumors. Further, rubber fumes have been reported to be mutagenic. The exposure level to rubber fumes during the curing process at the patient’s workplace was estimated to be close to or higher than British Occupational Exposure Limits. Therefore, tracheal ACC in this case might have been influenced by occupational exposure to rubber fumes.

Common Blind Spots on Chest CT: Where Are They All Hiding? Part 1—Airways, Lungs, and Pleura

W533 tracheal or endobronchial lesions. Malignant lesions may present as endoluminal nodules, subtle wall thickening (Fig. 1), or irregular contour of the lumen. Tracheal tumors such as adenoid cystic carcinoma and squamous cell carcinoma can have submucosal spread, which can be difficult to detect or be underestimated on CT. The accurate detection and description of the extent of the tumor is, however, essential for surgical planning. Endobronchial metastases can be seen most frequently in patients with primary renal cell, breast, and colorectal cancers and melanoma. The most common primary bronchial tumors include squamous cell carcinoma and carcinoid tumors. Benign entities such as broncholith, endobronchial hamartoma, and aspirated foreign bodies can also cause significant complications such as recurrent atelectasis or pneumonia. Intraluminal secretion or mucus plug can mimic central airway lesions. However, secretion usually appears smoothly marginated and focal, often along the dependent aspect of the airways. Tiny air bubbles can sometimes be visualized within secretion. Comparison with prior imaging is helpful because a persistent intraluminal opacity is more suggestive of a true lesion. Repeat imaging in prone position or after coughing can also help in differentiating secretions from endoluminal lesions.

Adenoid Cystic Carcinoma of the Upper Trachea: A Rare Neoplasm

Primary malignant tracheal tumors are not common and adenoid cystic carcinoma (ACC) of trachea is rare. We report an extremely rare case of ACC of proximal trachea, which was diagnosed in a 42-year-old male who presents with 6-month history of dyspnea. Lateral skiagram of neck, computed tomography, and magnetic resonance imaging revealed a broad-based polypoidal soft tissue mass arising from posterior wall of the proximal trachea. Biopsy confirmed the diagnosis of ACC. The patient was treated by surgical resection followed by radiotherapy and is on regular follow-up. Follow-up at 18 months post-treatment showed no local recurrence or distant metastases. The literature on tracheal ACC is reviewed. Image findings are briefly discussed.

A rare large tracheal glomus tumor with postoperative haematemesis.

Glomus tumors are uncommon benign tumors which usually arise from the distal portion of the digits. A tracheal glomus tumor with large size is extremely rare. We present a case of a large tracheal glomus tumor that was resected using posterolateral thoracotomy and successful primary reconstruction of the trachea was achieved. Severe haematemesis happened after the patient was discharged. An emergency exploratory thoracotomy was performed but no signs of anastomotic bleeding were observed, while intraoperative gastroscopy revealed plenty of blood and blood clots in the patient's stomach. Medical treatments targeting hemorrhage of upper digestive tract were given and the patient finally recovered.

About a submucosal tracheal tumor

The authors report the case of 46-year-old man with recurrent hemoptysis. Bronchoscopy revealed a submucosal tumor protruding into the tracheal lumen. Transbronchial biopsy failed to obtain a conclusive diagnosis; only surgery allowed complete resection of the tumor and confirmed the diagnosis of tracheal mucoepidermoid carcinoma. We discuss the unusual submucosal presentation of this tumor, and the contribution of surgery for diagnosis and therapy.

Tracheal and Airway Neoplasms

Neoplasms of the trachea are uncommon, accounting for only 0.2% of all respiratory malignancies in the United States. 1 The incidence of primary tracheal cancer is estimated to be 1 in every 1,000,000 persons per year. Cancers of the bronchi occur approximately 400 times more frequently than tracheal cancer. The majority, 90%, of tracheal tumors in adults are malignant with squamous cell carcinoma (SCC) and adenoid cystic carcinoma (ACC) being the most common. Most of the airway tumors in children are benign. 2,3 Given the rarity of these neoplasms and their nonspecific clinical presentations, the diagnosis is often delayed by months or even years. Increased awareness and detection of airway neoplasms by radiologists is, therefore, of paramount importance in the care of these patients.

Successful Tracheal Replacement in Humans Using Autologous Tissues: An 8-Year Experience

Fifty years of surgical research using synthetic materials and heterologous tissues failed tofind a good, durable replacement for the trachea. We investigated autologous tracheal substitution (ATS) without synthetic material or immunosuppression. For ATS, we used a single-stage operation to construct a tube from a forearm free fasciocutaneous flap vascularized by radial vessels that was reanastomosed to internal mammary vessels and reinforced by rib cartilages interposed transversally in the subcutaneous tissue. Tracheal resections 7 to 12 cm long (mean, 11 cm) were done to treat 8 primary tracheal neoplasms, including 5adenoid cystic carcinomas (ACC) and 3 squamous cell carcinomas (SCC); 3secondary tracheal neoplasms, including 1 thyroid carcinomas and 2 lymphomas; and 1postintubation tracheal destruction after a long history of stenting. Transitory tracheotomy was associated to the absence of mucociliary clearance. ATS has been performed in 12 patients since 2004, with additional resections in 4 patients, comprising 1 carinal resection alone, 1 associated with lobectomy, and 2 pharyngolaryngectomies. All patients were extubated on postoperative day 1. Eight patients are alive at a mean of 36 months (range, 2 to 94 months) postoperatively, with no respiratory distress. The 2 patients with ATS and carinal resections died of pulmonary infection. No airway collapse has been detected by endoscopy, dynamic computed tomography scan, or spirometry. Two patients still have a tracheotomy because the procedure was performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency recently required a distal, short stent. ATS is a good, durable, tracheal substitutionthat resists respiratory pressure variationsbecause of transverse rigidity, without any immunosuppression.

Two tracheal BALT lymphoma patients successfully treated with chemotherapy including rituximab

Bronchus-associated lymphoid tissue (BALT) lymphoma of the trachea, an important differential diagnosis for tracheal tumors, is a rare disease with characteristic bronchoscopic findings. In this study, we reviewed 2 cases of patients who were symptomatic at the time of diagnosis, with tumors in the trachea and left main bronchus, putting them at high risk for asphyxia. Chemotherapies including rituximab were administered, and complete remission was confirmed in both cases. Because tracheal tumors often have a pernicious course, it might be beneficial to initiate a chemotherapeutic treatment regimen instead of adopting the "wait-and-see" approach in patients with symptomatic tracheal BALT lymphoma.

Autologous tracheal replacement: From research to clinical practice

Despite numerous attempts, synthetic materials and heterologous tissues failed to replace durably the trachea. Autologous tracheal substitution (ATS) without synthetic material or immunosuppression was investigated to replace extended tracheal defect. We present our experience regards to this innovative challenge. After a previous research study, we developed a novel reconstruction technique for extended tracheal defects on animals. Through a single stage operation, a tube from a forearm free fascio-cutaneous flap vascularized by radial vessels is re-anastomosed to cervical vessels. This flap is reinforced by rib cartilages interposed transversally in the subcutaneous tissue. It provides also a reliable ATS. Twelve patients benefits from an extended tracheal resections, 7-12 centimeter (mean 11 cm) long. Indications were eight Primary tracheal Neoplasms (including 5 adenoid cystic carcinoma [ACC] and 3 squamous cell carcinoma [SCC]), three secondary tracheal neoplasms (including 1 thyroid carcinoma and 2 lymphoma) and one post-intubation tracheal destruction after long history of stenting. Daily bronchoscopy and transitory tracheotomy was associated due to absence of mucociliary clearance. The research work leads to present the first described animal model for tracheal resection and replacement with an autologous conduit. It was constructed from costal cartilages and a pediculed cervical skin flap. From 2004 to 2012, 12 patients have had ATS with associated resections in four cases. All patients were extubated on the first postoperative days; eight patients are alive at 2 to 94 months (mean=36) postoperatively, with no respiratory distress. The two patients with ATS after resection extended to the carina died due to pulmonary infection. No airway collapse has been detectable, either by endoscopy, dynamic CT scan or spirometry. Two patients still have a tracheotomy because performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency required recently a distal and short stent. ATS is actually a good, durable tracheal substitute that can resist respiratory pressure variations because of their transverse rigidity without any immunosuppression. The limits of this technique are probably, chronic respiratory insufficiency and cartilage calcifications. Research to develop a method for lining the neo-trachea with ciliated respiratory epithelium is needed.

Diagnosing obstructive respiratory diseases using exhaled aerosol fingerprints: A feasibility study

In this study, the feasibility of breath tests with inert tracer aerosols has been assessed to diagnose obstructive respiratory diseases. The hypothesis is that each airway structure has a signature exhaled aerosol pattern (aerosol fingerprint), which can be used to detect and localize airway structure modifications due to the diseases. The objective of this study was to evaluate the sensitivity of exhaled aerosol patterns to geometrical variations in four mouth–lung models with computational modeling. Specifically, one benign and three malign conditions were considered, which include a tracheal carina tumor, a bronchial tumor, and asthma. Aerosols ranging from 0.4μm to 10μm were simulated to be inhaled under normal breathing conditions and then exhaled, with exhaled distributions being recorded at the mouth of the computational model. Large eddy simulations coupled with a well-tested Lagrangian tracking model were used to simulate the respiratory airflow and aerosol dynamics. Apparent discrepancies in exhaled aerosol distributions were observed among the four models. Each structure abnormality gave a unique aerosol pattern that was clearly suggestive of the disease location and extent. For any given disease, this pattern persists for different particle sizes considered. Results of this study show that aerosol-fingerprint based breath tests are sensitive and robust enough to be a practical tool for diagnosis of specific lung diseases, and can disclose clues about the site and severity of the disease. Personalized delivery protocol can be devised that precisely targets medications at the disease site with severity-relevant dosage.

Mucinous adenocarcinoma of trachea: a rare case of primary tracheal tumor

A primary tracheal tumor is not common, but adenocarcinoma is particularly rare. We describe a case of primary tracheal mucinous adenocarcinoma misdiagnosed as asthma in a 17-year-old girl. Computed tomography revealed an intraluminal partially obstructing mass in the mid portion of the trachea. A sleeve resection of the involved trachea with primary anastomosis was performed, followed by adjuvant radiotherapy. After 23 months of follow-up, there has been no recurrence.

Tracheal Adenoid Cystic Carcinoma Treated by Repeated Bronchoscopic Argon Plasma Coagulation as a Palliative Therapy

Primary tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies. Adenoid cystic carcinoma (ACC) is the most common tumor, accounting for about 30% of primary tracheal tumors. It is often difficult to manage these tumors surgically, due to its expansion and submucosal invasion, and furthermore, due to the patient's condition. Thus, it is essential to perform palliative treatment in order to maintain the airway through and to control the progress. Herein, we report a case of ACC treated by repeated bronchoscopic argon plasma coagulation (APC) as palliative therapy.A 71-year-old Japanese male was referred to our hospital's emergency department for dyspnea. Bronchoscopic examination revealed expanded intraluminal obstructive bronchial tumors from the left bronchus to right. The patient had undergone bronchoscopic APC treatment several times. The obstruction was improved, and no worsening was seen for 26 months. Repeated bronchoscopic APC as a palliative therapy is promising and useful therapy without heavy adverse reactions to control the tumor growth.

Rigid Bronchoscopy and Mechanical Debulking in the Management of Central Airway Tumors

Treatment options for central airway tumors include surgery, radiotherapy, and in those with inoperable or emergent airway obstruction, therapeutic bronchoscopy. Herein, we report our experience with the exclusive use of rigid bronchoscope in the management of central airway tumors. Retrospective review of charts of patients who underwent rigid bronchoscopy and mechanical coring for the management of central airway (trachea and mainstem bronchi) tumors over a period of 2 years. "Successful" outcome was defined as procedure leading to reduction of luminal obstruction to <50% and improvement of respiratory distress. "Unsuccessful" outcome was defined in cases where the luminal obstruction could not be reduced by ≥50% or there was lack of improvement in the clinical status of the patient. During the study period, 30 patients with symptomatic central airway tumors were encountered. Of these, 23 patients underwent 31 rigid bronchoscopic procedures. Respiratory failure was present in 15 (65.2%) patients. Adenoid cystic carcinoma was the most common primary tracheal tumor, whereas squamous cell carcinoma was the most common secondary tracheobronchial tumor. The procedure was successful in 19 (82.6%) patients. Complications were encountered in 10 of the 31 (32.3%) rigid bronchoscopies. There was no procedural mortality. Rigid bronchoscopy and mechanical debulking as a sole therapy is an effective and safe procedure for airway obstruction resulting from tracheobronchial tumors.

Clinical manifestation and management of primary malignant tumors of the cervical trachea

To explore clinical manifestation and therapies of primary malignant tumors of the cervical trachea, we retrospectively reviewed 31 patients with primary cervical tracheal malignant tumors diagnosed in the last 15 years by means of clinical manifestation, fiberoptic endoscopy, CT scanning and histopathological examinations. All of them were hospitalized and treated at the Second Xiangya Hospital, Central South University. Of them, 4 underwent emergent tracheotomy under local anesthesia, 9 were inserted with a laryngeal mask airway, 18 underwent tumorectomy under general anesthesia with endotracheal intubation, and of them 11 had tracheotomy during surgery. Of those 31 patients, tracheal malignant tumors in 9 cases were resected via laryngeal and retrograde tracheal incisions under endoscope; the tumors in 13 cases were excised via sleeve trachea resection and end-to-end anastomosis; those in 8 were removed by tracheofissure, and the tumor in 1 case was not excised surgically. Among the 30 resected patients, 20 patients received both radiotherapy and chemotherapy; 6 received radiotherapy only, and 4 did not receive any adjuvant therapies. During follow-up between 2 and 11 years, among 31 patients, there was no recurrence in 24 cases. Among the 7 deceased patients, 1 displayed multiple tracheal chondrosarcoma, 4 displayed adenoid cystic carcinoma, and 2 displayed squamous cell carcinoma. Emergency lower tracheotomy is necessary only when patients with tracheal, malignant tumors are in a critical condition. Sleeve trachea resection is the optimal therapy for tracheal malignant tumors. However, in the treatment of tracheal malignant tumors adjacent to the larynx or the involved trachea is over 6 cm in length, other surgeries shall be performed. Postoperative adjuvant radiotherapy and chemotherapy can achieve the same therapeutic effect as sleeve trachea resection.

The squamous cell carcinoma case that received long-term COPD treatment

Cesitli benign ve malign patolojilerden olusan primer tra­keal tumorler oldukca nadir gorulurler. Malign trakeal tu­morlu hastalar bazen astma ve kronik obstruktif akciger hastaligi (KOAH) gibi tikaniklik yapan akciger hastalikla­rini taklit edebilirler ve herhangi bir iyilesme olmaksizin uzun sure bu tur hastaliklarin tedavisini alabilirler. Bu ne­denle bu tumorler trakeobronsial agac tikanikligi bulgula­ri gosteren hastalarin ayirici tanisina dahil edilmelidirler. Bu olgu sunumunda, uzun sure kronik obstruktif akciger hastaligi tanisi nedeniyle tedavi goren ve son zamanlarda artan sikayetleri hastaliginin alevlenmesi olarak deger­lendirilen, yaklasik 3 ay takiplerinde duzelme olmayinca bronkoskopik olarak endotrakeal kitle lezyonu saptanarak tumorun bronkoskopik rezeksiyonu sonrasi tam klinik iyi­lesme gozlenen skuamoz hucreli endotrakeal karsinom olgusu sunulmustur.

Rare Tracheal Tumors and Lesions Initially Diagnosed as Isolated Differentiated Thyroid Cancers

Thyroid carcinoma with tracheal invasion is uncommon; however, this is significantly more prevalent than primary tracheal tumors. Rare tracheal tumors at the level of the thyroid can be misinterpreted as invasive thyroid cancer upon initial diagnosis. We present a series of tumors within the tracheal wall that were initially misdiagnosed as isolated, but aggressive, thyroid cancer, and later diagnosed to be different histopathologic entities. The series consisted of four women and five men, all but two age 60 or older, who were initially diagnosed with tracheal invasion from differentiated thyroid carcinoma (DTC). Eight had obstructive airway symptoms and one experienced gagging and choking sensations. Preoperatively, the patients underwent fine-needle aspiration (FNA) and imaging studies. A complete resection of the involved airway in combination with the thyroid gland was performed in all patients. In this series of patients, the final diagnosis was tracheal stenosis, recurrent laryngeal nerve schwannoma, papillary thyroid carcinoma (PTC) with benign intratracheal thyroid tissue, adenoid cystic carcinoma, and squamous cell carcinoma, each in one patient. Two patients had a tracheal chondrosarcoma, and two patients had collision tumors (PTC with laryngeal squamous cell carcinoma). All patients were misunderstood preoperatively as having isolated DTC with aggressive involvement of the trachea. An accurate diagnosis in these cases was difficult due to misleading FNA readings, thought due to the FNA needle passing through the thyroid before reaching the trachea or a tumor that abuts both structures on imaging. Primary tracheal tumors and a nontumorous lesion, as well as benign thyroidal masses, mimicked invasive thyroid carcinoma in this preoperative setting. Various entities other than thyroid cancer can masquerade as invasive thyroid cancer. In patients with an FNA showing thyroid tissue or suggesting PTC, but also have obstructive or other airway symptoms, physician awareness is needed to consider the distinct possibility of a primary tracheal lesion. Obtaining the correct preoperative diagnosis is essential for accurate surgical planning for patients with tracheal tumors.

Cryosurgery for the Immediate Treatment of Acute Central Airway Obstruction

Central airway obstruction commonly occurs in thoracic malignancies. Treatment is usually palliative but may be significantly challenging. Several endoscopic interventions are available to establish airway patency; however, their use is sometimes limited by certain factors like availability and high oxygen requirement. Cryosurgery has been established as a safe and effective technique for treatment of malignant airway obstruction, but its use has been limited to being adjunctive to other modalities and to low-grade stenosis. This is mainly due to the delayed effect and inability to achieve immediate airway patency. We report the successful use of this technique as stand-alone modality in a tracheal tumor with severe obstruction leading to acute respiratory failure. Immediate recanalization was achieved resulting in rapid resolution of symptoms.

A Case of Tracheal Hamartoma Resected with Loop Electrocautery

The authors report on the case of a 67-year-old man with longstanding breathlessness, which was eventually attributed to a fixed mass in the upper third of the trachea causing upper airway obstruction. The lesion was amenable to loop electrocautery resection via flexible bronchoscopy that led to prompt resolution of patient symptoms. Biopsy was consistent with tracheal hamartoma, an exceedingly rare benign tracheal tumor. All the cases of tracheal hamartomas in the literature to date, the application of electrocautery and other methods of interventional bronchoscopy for resection of selected tracheal tumors are discussed.

Implantation of stent under local anesthesia for the treatment of tracheal obstruction due to primary tracheal neoplasm: report of five cases

Implantation of stent under local anesthesia for the treatment of tracheal obstruction due to primary tracheal neoplasm: report of five cases