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    MeSH term: Tracheal Neoplasms
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Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Vallonthaiel AG, Jain D, Singh V, et al.
c-Myb Overexpression in Cytology Smears of Tracheobronchial and Pulmonary Adenoid Cystic Carcinomas.
Acta Cytol. 2017; 61(1):77-83 [PubMed] Related Publications
AIMS: Adenoid cystic carcinoma (AdCC) is a malignant epithelial neoplasm that occurs rarely in the lower respiratory tract (LRT). AdCC at various sites is associated with the novel fusion transcript MYB-NFIB, along with the overexpression of the Myb protein. The expression of the Myb protein in AdCC of the LRT has not been evaluated much.
STUDY DESIGN: Cases of AdCC of the LRT diagnosed on cytology or histology were retrieved from our institutional archives. c-Myb expression was analyzed on immunocytochemistry/immunohistochemistry (ICC/IHC) and was correlated with clinicopathological parameters.
RESULTS: Twenty-three samples of AdCC originating from the LRT were included in the study. Four cases were diagnosed on cytology, 3 of which had corresponding histology specimens. The remaining 19 cases had either biopsy or resection. Most of the patients presented with endobronchial mass. The mean age was 49.4 years and a male predominance was seen. ICC and IHC for c-Myb showed positivity in 75 and 59% of the cases, respectively. Western blot was used to validate IHC results.
CONCLUSION: AdCC of the LRT is rare and hence poses diagnostic difficulty. Cytology smears can be utilized for c-Myb ICC. The presence of c-Myb immunopositivity in most cases may possibly make Myb a diagnostic biomarker and a therapeutic target for personalized treatment.

Lin CH, Chao YH, Wu KH, Lin WC
Primary mucoepidermoid carcinoma at the carina of trachea presenting with wheezing in an asthmatic child mimicking an attack of asthma: A case report.
Medicine (Baltimore). 2016; 95(44):e5292 [PubMed] Related Publications
BACKGROUND: Asthma is a very common disease, but primary tracheal tumors are extremely rare in children. Wheezing is not pathognomonic, but is the typical presentation of asthma and could also be found in patients with tracheal tumors.
CLINICAL FINDINGS: This report describes a 12-year-old boy with a previous history of frequent asthma attacks and experienced responses to antiasthma treatment. He was admitted to the hospital due to persistent wheezing and progressive dyspnea. Hyperinflation in the bilateral lungs was detected on chest x-ray, but without other significant findings. Chest computed tomography revealed a mass at the carina. Tracheal mucoepidermoid carcinoma was diagnosed by histopathological assessment.
CONCLUSION: Despite the rarity of tracheal tumors, chest computed tomography scans should be performed in the first place for children presenting persistent wheezing and having poor response to antiasthma treatment to rule out the other alternative diagnosis. Coexistence of other diseases such as tracheal tumor in asthmatic patients should be considered.

Idrees F, Fatimi SH, Pervez S
Young man with dyspnoea for 6 months; presenting with subacute tracheal obstruction due to leiomyoma.
BMJ Case Rep. 2016; 2016 [PubMed] Related Publications
Tracheal leiomyoma is a rare benign tumour with less than a 100 cases reported in the literature. We report a case of leiomyoma initially presenting and being treated as asthma until it lead to life-threatening tracheal obstruction, requiring immediate surgical intervention.

Kwon JH, Jang SJ, Song JS, et al.
Liquid-based sputum cytology of bicomponent mucin-producing adenocarcinoma of the trachea with histologic comparison.
Diagn Cytopathol. 2016; 44(12):1120-1124 [PubMed] Related Publications
Primary tracheal adenocarcinomas are rare. Here, we report on the liquid-based sputum cytology of a bicomponent mucin-producing tracheal adenocarcinoma with histologic and immunohistochemical comparison. A 72-year-old man presented with dyspnea. Computed tomography revealed a lobulated mass in the mid-trachea. Sputum cytology showed clusters of atypical cuboidal cells that have pleomorphic and hyperchromatic nuclei and intracytoplasmic mucin. There were additional bland-looking components of regular clusters of cuboidal epithelial cells. These cells were initially evaluated as benign cells. Sleeve resection revealed a 3.7-cm-sized transmural mass, composed of tubulopapillary cuboidal epithelial cell structures. Half of the tumor comprised of bland-looking epithelial cells with small nuclei and eosinophilic cytoplasm; the remainder comprised of hyperchromatic cells with larger, distinct nucleoli. Direct interfaces between these components were observed, and both of these components equally displayed the characteristics of invasion and p53 expression. Two cell types in sputum cytology were retrospectively evaluated as adenocarcinomas of different grades. The patient has not shown recurrence for 8 months, postoperatively. Diagn. Cytopathol. 2016;44:1120-1124. © 2016 Wiley Periodicals, Inc.

Gurria JP, De Acosta DM, Hafezi N, et al.
Spindle cell sarcomatoid carcinoma of the trachea: first case report of surgical resection.
J Cardiothorac Surg. 2016; 11(1):128 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Primary malignant tracheal tumors are rare, accounting for approximately 0.2 % of respiratory tract tumors yearly, with squamous cell carcinomas and adenoid cystic carcinomas accounting for two-thirds of these cases. Sarcomatoid carcinomas are a group of poorly differentiated non-small cell lung carcinomas containing a component of sarcoma or sarcoma-like (spindle and/or giant cell) differentiation, categorized into five morphologic subgroups. Spindle cell sarcomatoid carcinoma is a rare variant of sarcomatoid carcinomas, consisting of only spindle-shaped tumor cells. Only one other case has been reported as a primary tracheal tumor.
CASE PRESENTATION: We present a 75-year-old male, having progressive dyspnea and cough, with a spindle cell sarcomatoid carcinoma tumor visualized on chest computed tomography scan and confirmed with biopsy.
CONCLUSIONS: Due to its low incidence, knowledge of treatment methods, prognostic factors, and etiology is limited thus approaches to eradication have widely varied. We are reporting the second published case of spindle cell sarcomatoid carcinoma of the trachea and the first reported successful outcome of definitive treatment with tracheal resection.

Andolfi M, Vaccarili M, Crisci R, Puma F
Management of tracheal chondrosarcoma almost completely obstructing the airway: a case report.
J Cardiothorac Surg. 2016; 11(1):101 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Primary malignant tracheal tumors account for only 0.2 % of all malignancies of the respiratory tract. Tracheal chondrosarcoma is a rare condition and only 17 cases have been described in the literature from 1965 to date. Herein we report the very unusual case of a patient with a tracheal chondrosarcoma, electively treated by curative surgery despite the virtually complete obstruction of the airway.
CASE PRESENTATION: We present the case of a 79-year old Caucasian man with long-lasting wheezing misdiagnosed as asthma and affected by a tracheal chondrosarcoma almost completely obstructing the airway. Videobronchoscopy and imaging investigations revealed a well-circumscribed mass arising from the cartilaginous rings of the cervical trachea with a posterior residual respiratory space of about 1 mm. Because of the mobility and flaccidity of the uninvolved pars membranacea, the tiny respiratory space slightly expanded during inspiration and expiration allowing the patient to be treated without an essential emergency procedure. Standard tracheal intubation was impossible. Rigid bronchoscopy enabled placement of a small tracheal tube distally to the tumor. Successful cervical tracheal resection and reconstruction was then performed, achieving complete tumor excision. Histologically, the mass was characterized as a low-grade tracheal chondrosarcoma. Videobronchoscopy performed 9 months after surgery showed a wide, well healed tracheal anastomosis. Ten months after surgery, the patient is alive and disease free.
CONCLUSION: Complete surgical resection is the treatment of choice for tracheal chondrosarcoma. Rigid bronchoscopy is an essential tool for diagnostic and therapeutic purposes. It allows the palliative maneuvers for obstruction relief but also, in resectable patients, the intraoperative safe and straightforward management of the obstructed airway.

Wendi C, Zongming J, Zhonghua C
Anesthesia airway management in a patient with upper tracheal tumor.
J Clin Anesth. 2016; 32:134-6 [PubMed] Related Publications
The main challenge for surgical resection of tumors located at the upper trachea is contemplate formulated plan for providing maximal surgical access to the trachea while ensuring patent airway and adequate oxygenation at the same time. In this report, we describe a patient who presented with an upper tracheal tumor located 3cm from the vocal cord and severe tracheal constriction, occluding tracheal lumen by 90%. Initial ventilation was established by implantation with a supreme laryngeal mask airway. An emergent tracheotomy and distal tracheal intubation were used to combat bleeding and subsequent airway obstruction. Eventually, tracheal tumor resection plus tracheal reconstruction via median sternotomy was successfully conducted under general anesthesia. The whole process is uneventful.

Lee DH, Yoon TM, Lee JK, Lim SC
Unusual Granular Cell Tumor of the Trachea Coexisting With Papillary Thyroid Carcinoma and Masquerading as Tracheal Invasion of Recurred Thyroid Carcinoma: A Case Report.
Medicine (Baltimore). 2016; 95(18):e3547 [PubMed] Free Access to Full Article Related Publications
This was an extremely rare case of unusual granular cell tumor of the trachea coexisting with recurrent papillary thyroid carcinoma. We initially misdiagnosed this patient as having tracheal invasion from recurrent thyroid carcinoma even after a computed tomography scan and fine-needle aspiration cytology.Clinicians should be aware of the possibility of granular cell tumor of the trachea occurring simultaneously with papillary thyroid carcinoma.

Wang SY, Wang SX, Liao JQ, Chen G
18F-FDG PET/CT and Contrast-Enhanced CT of Primary Malignant Tracheal Tumor.
Clin Nucl Med. 2016; 41(8):595-605 [PubMed] Related Publications
PURPOSE: Primary malignant tracheal tumors are rare, and their clinical presentation often resembles other diseases of the respiratory system. This study summarized F-FDG PET/CT and CE-CT findings on histologically confirmed primary malignant tracheal tumors in 13 patients.
MATERIALS AND METHODS: We retrospectively reviewed the F-FDG PET/CT and CE-CT findings of 13 patients with histologically confirmed primary tumors who had undergone PET/CT and CE-CT in the same session. The following parameters were recorded: SUVmax; SUVmax lesion/background; location, size and attenuation of the mass; mediastinal invasion; and the presence of metastases. Clinical data, bronchial endoscopy results, and surgical and histopathological findings were also collected.
RESULTS: Tracheal soft tissue lesions with increased F-FDG uptake were observed in all patients. Five squamous cell carcinomas, 5 adenoid cystic carcinomas, 2 adenocarcinomas, and 1 mucosa-associated lymphoid tumor were histopathologically observed. The maximum SUV of the malignant tracheal tumors ranged from 2.7 to 20.5 (mean ± SD, 6.8 ± 4.8; median, 5.7). All SUVmax lesion values were greater than 2.5. Homogeneous enhancement was observed in all lesions, with three exhibiting evident enhancement, nine demonstrating moderate enhancement, and one showing mild enhancement.
CONCLUSIONS: The presence of a tracheal soft tissue mass with increased F-FDG uptake is highly suggestive of a malignant tracheal tumor. F-FDG PET/CT and CE-CT can clearly demonstrate such a tumor's function and anatomical characteristics.

Ma RM, Lv L, Zheng SR, et al.
Primary ectopic substernal thyroid cancer with trachea relapse: a case report and opinions of management.
World J Surg Oncol. 2016; 14:94 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Ectopic substernal thyroid is a rare symptom of thyroid disease that entirely results from the developmental defects at early stages of thyroid embryogenesis and during its descent. Cases were seldom reported as primary ectopic substernal thyroid cancer, especially those with severe local invasion and tracheal relapse.
CASE PRESENTATION: In this report, the patient presented odynophagia and a sense of progressing swallowing obstruction. She underwent total thyroidectomy and lump resection. However, she refused to use postoperative radioactive iodine or take adjuvant external-beam radiotherapy, except for thyroid hormone replacement therapy. Tracheal relapse was observed after 6 months. Tracheal stent was used to reconstruct the airway twice.
CONCLUSIONS: Trachea invasion might be a worse independent predictor of prognosis than any others and should be given particular attention. Furthermore, tracheal stent might be a palliative option for patients with tracheal relapse.

Guibert N, Mazieres J, Didier A, et al.
Tracheal Glomangioleiomyoma Treated by Multimodal Interventional Bronchoscopy.
Ann Thorac Surg. 2016; 101(4):1591-4 [PubMed] Related Publications
Glomus tumors of the trachea are particularly rare, and their management is usually based on sleeve resection with end-to-end anastomosis. Glomangiomyoma represents the rarest histologic subtype and has been observed only once in the trachea. We describe the first case of tracheal glomangiomyoma treated by multimodal interventional bronchoscopy.

Tan TH, Lee BN
Primary Squamous Cell Carcinoma of Trachea Arising 4 Years After Radioiodine Treatment of Papillary Carcinoma of Thyroid.
Clin Nucl Med. 2016; 41(5):e259-60 [PubMed] Related Publications
Primary squamous cell carcinoma (SCC) of the trachea is rare. Here, we presented a rare case of primary SCC of the trachea arising 4 years after radioiodine (RAI) treatment of papillary carcinoma of the thyroid. In this case, concomitant uptake of I-RAI and F-FDG was demonstrated in the thyroidal mass with tracheal invasion, which mimicked mixed well-differentiated and dedifferentiated thyroid carcinoma. The diagnosis of SCC of the trachea was made only after tracheal biopsy. This case illustrates that FDG-avid thyroid bed lesion, in the presence of thyroid carcinoma, may not necessarily be related to the thyroid pathology.

Jaramillo S, Rojas Y, Slater BJ, et al.
Childhood and adolescent tracheobronchial mucoepidermoid carcinoma (MEC): a case-series and review of the literature.
Pediatr Surg Int. 2016; 32(4):417-24 [PubMed] Related Publications
Tracheobronchial mucoepidermoid carcinomas (MEC) are rare in the pediatric population with literature limited primarily to case reports. Here we present our institutional experience treating MEC in three patients and review the literature of 142 pediatric cases previously published from 1968 to 2013. Although rare, tracheobronchial MEC should be included in the differential diagnosis in a child with recurrent respiratory symptoms. Conservative surgical management is often sufficient to achieve complete resection and good outcomes.

Fabre D, Fadel E, Mussot S, et al.
Autologous tracheal replacement for cancer.
Chin Clin Oncol. 2015; 4(4):46 [PubMed] Related Publications
Surgical research has failed during fifty years to find an ideal substitute for the trachea after extended resection. All the prostheses could erode the adjacent structures or lead to infection or obstructive issues. Innovation in surgery development has been improved using novel techniques of plastic surgery. During the last ten years, we have developed a technique using free fasciocutaneous flaps. This allows us to construct tubes for tracheal replacement. The most accurate flap used for this technique is the forearm free flap (FFF). Reinforcement of the flap with autologous strips of cartilage harvested from the last ribs offers sufficient resistance to respiratory pressure. This technique is also completely autologous without any stent in the tracheal lumen. From 2004 to 2015 we have already reconstructed the trachea of 16 patients for 12 primary tracheal neoplasms [including 9 adenoid cystic carcinoma (ACC) and 3 squamous cell carcinoma (SCC)], 3 secondary tracheal Neoplasms and one for benign lesion. This article describes the indications, determination of resectability, patient selection, subheading for surgery, postoperative management and results of this technique.

Hassan M, Quraeshi S, Zubairi AB
A rare cause of recurrent wheeze and seizures.
BMJ Case Rep. 2015; 2015 [PubMed] Related Publications
A 34-year-old woman presented with recurrent attacks of breathlessness and seizures. The patient's condition worsened during the course of her hospital stay, as a result of which she had to be intubated twice. Radiological studies showed a mass in the trachea and the subsequent biopsy of the mass revealed an infiltrating carcinoma with morphological features of adenoid cystic carcinoma.

Lonie SJ, Ch'ng S, Alam NZ, Wright GM
Minimally Invasive Tracheal Resection: Cervical Approach Plus Video-Assisted Thoracoscopic Surgery.
Ann Thorac Surg. 2015; 100(6):2336-9 [PubMed] Related Publications
Tracheal resection for adenoid cystic carcinoma (ACC) is a well-documented procedure. Surgical resection of these lesions offers patients the greatest potential chance of survival. Midtracheal tumors are usually resected through a maximally invasive sternotomy or thoracotomy. We report a midtracheal resection of a symptomatic ACC in a 25-year-old man by video-assisted thoracoscopic hilar release and suprasternal anastomotic approaches. The patient's recovery was complicated by chylothorax and pneumonia.

Abu Saleh WK, Aljabbari O, Ramchandani M
Mucoepidermoid Carcinoma of the Tracheobronchial Tree.
Methodist Debakey Cardiovasc J. 2015 Jul-Sep; 11(3):192-4 [PubMed] Free Access to Full Article Related Publications
Primary salivary type lung cancers are extremely rare intrathoracic malignancies. Mucoepidermoid tumor is one of the salivary gland tumors that originates from submucosal glands of the tracheobronchial tree. These are very slow-growing low-grade malignant tumors. Surgery is the mainstay of treatment and rarely requires adjuvant therapy. In this case report we describe a 65-year-old woman who presented with a solitary cough yet on further investigation was found to have a mucoepidermoid tumor originating from the hilum of the left lung.

Chun KA
Case Reports on the Differentiation of Malignant and Benign Intratracheal Lesions by 18F-FDG PET/CT.
Medicine (Baltimore). 2015; 94(44):e1704 [PubMed] Free Access to Full Article Related Publications
Malignant tracheal tumors (primary and secondary) are rare and benign tumors of the tracheobronchial tree are also rare. Few reports have been issued on the F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) findings of tracheal tumors or benign nontumorous tracheal lesions, which have been mainly studied by computed tomography (CT). The author reports 2 cases of intratracheal lesions with quite different F-FDG PET/CT findings. The first case was of a 73-year-old woman with colon cancer treated by hemicolectomy and subsequent adjuvant chemotherapy. Follow-up F-FDG PET/CT after 6 years revealed a hypermetabolic fungating mass (SUVmax: 5.8) in the distal trachea and biopsy confirmed intratracheal metastasis. The second case involved a 61-year-old man with tongue cancer who underwent mouth floor mass excision and right supraomohyoid neck dissection with submental flap reconstruction. Tracheal lesion was incidentally found during a F-FDG PET/CT follow-up study conducted 1 year later. A benign intratracheal condition with low FDG uptake (SUVmax: 1.2) and the lesion was not visualized by neck CT 4 months later. F-FDG PET/CT uptake was helpful in differentiating benign and malignant intratracheal lesions.

Chun RH, McCormick ME, Martin T, et al.
Office-Based Subglottic Evaluation in Children With Risk of Subglottic Hemangioma.
Ann Otol Rhinol Laryngol. 2016; 125(4):273-6 [PubMed] Related Publications
PURPOSE: Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children.
RESULTS: Since 2003, 5 children with IH of the V3 cutaneous distribution and 3 children with PHACE syndrome underwent OLAE. Average age of presentation was 2.75 months. Two children had stridor at initial evaluation, and 1 child had subglottic hemangioma. This child was evaluated serially with OLAE to monitor disease progression and treatment response. A total of 10 upper tracheoscopies were performed on the 8 patients without respiratory complications.
CONCLUSION: An airway evaluation is essential to evaluate and manage this high-risk population. Typically, operative endoscopy requires general anesthesia. However, in these high-risk children, we have performed OLAE without sedation to evaluate the trachea. High-speed recording and playback is essential in this method. Our series demonstrates that awake OLAE is possible and may be a safe technique to evaluate and monitor disease progression in these high-risk patients. These patients avoided general anesthesia and delay in diagnosis and did not incur any complications during or after OLAE.

Wang H, Xie J, Tan Y, Jiang J
Glomus tumor of the trachea: a rare case report.
Int J Clin Exp Pathol. 2015; 8(8):9723-6 [PubMed] Free Access to Full Article Related Publications
A tracheal glomus tumor is extremely rare. There were approximately 18 reported cases before in China. Here we report a 48-year-old male with glomus tumor of the trachea. The computed tomography (CT) scan of the chest showed a nodulein the basalsegmentof right lower lobe, focal uplift in the left-posterior wall of the trachea, measured 1.5×1.2×1.0 cm. Microscopically, the tumor tissue was rich with vessels, shaped flake-nest, and the tumor consisted of a sheet of uniform cells surrounding the vascular spaces. Immumohistochemical staining were positive for SMA, vimentin, collagen IV, CD34, the Ki-67 proliferation activity was low (<1%), and were negative for Syn, CgA, S-100, AE1/AE3 and EMA. PSA staining showing clear cell borders. With a review of the literature, the clinical, pathological characteristics and treatment modalities of this rare tumor are discussed.

Yang H, Yao F, Tantai J, et al.
Resected Tracheal Adenoid Cystic Carcinoma: Improvements in Outcome at a Single Institution.
Ann Thorac Surg. 2016; 101(1):294-300 [PubMed] Related Publications
BACKGROUND: Primary tracheal cancer comprises a heterogeneous and rare group of neoplasms. Management of patients with primary tracheal carcinoma at our institution has improved in recent years.
METHODS: This retrospective review included patients with localized primary tracheal adenoid cystic carcinoma treated surgically at our institution between January 1995 and December 2014. Patients were classified according to the timing of first operation: "early years" operation was performed between January 1995 and December 2002, and subsequent "recent years" operation was associated with improved management and a focus on early diagnosis.
RESULTS: The proportion of patients with tracheal malignancy who underwent operation for adenoid cystic carcinoma increased with time. Patients in the recent group were significantly younger than those in the early group at diagnosis (49.3 ± 7.8 years versus 45.7 ± 9.4 years; p = 0.042), and the resected tumor size and tracheal lengths tended to be smaller (28.2 ± 7.6 mm versus 30.3 ± 7.0 mm; p = 0.161) and shorter (32.1 ± 7.7 mm versus 34.4 ± 6.7 mm; p = 0.123). The use of postoperative radiotherapy in patients with R1 resection was also managed more effectively in the recent group compared with the early group (90.6% versus 65.0%; p = 0.009). Five- and 10-year overall survival rates in the early and recent groups were 86.4% and 90.8%, and 31.8% and 61.2%, respectively (p = 0.084), and the corresponding 5- and 10-year disease-free survival rates were 39.7% and 75.3%, and 9.9% and 21.2%, respectively (p = 0.025).
CONCLUSIONS: There have been improved outcomes of adenoid cystic carcinomas. Early diagnosis, experienced surgical treatments, and postoperative adjuvant radiotherapy for patients with positive margins may contribute to the improved survival of patients with primary tracheal adenoid cystic carcinoma.

Braham E, Zairi S, Mlika M, et al.
Malignant glomus tumor of trachea: a case report with literature review.
Asian Cardiovasc Thorac Ann. 2016; 24(1):104-6 [PubMed] Related Publications
Glomus tumors of the trachea are extremely rare and generally benign, with very few cases of malignant transformation reported in literature. We present the case of a 74-year-old man explored for cough and dyspnea. Bronchoscopy showed a polypoid mass arising from the posterolateral tracheal wall. Computed tomography demonstrated a mid-tracheal tissular mass obliterating the tracheal lumen. Resection and anastomosis of the trachea were performed. The histological and immunohistochemical findings were consistent with malignant glomus tumor.

Jiang L, Chen S, Li Y, et al.
Primary tracheal and bronchial lymphoma displayed on 18F-FDG PET/CT imaging.
Clin Nucl Med. 2015; 40(12):965-6 [PubMed] Related Publications
A 46-year-old woman presented with cough for over 20 days, unrelieved by anti-inflammation treatment. Diffuse wall thickening and mildly luminal stenosis of the lower trachea and both main bronchi were observed on chest CT examination. The pathology after bronchoscopy confirmed non-Hodgkin lymphoma (mucosa-associated lymphatic tissue, MALT). FDG PET/CT was performed to evaluate the extent of the disease, which demonstrated the abnormal FDG accumulation in the diffusely thicken wall of trachea and bronchi, without lymph nodes and other extranodal tissue involvement.

Luo M, Duan C, Qiu J, et al.
Diagnostic Value of Multidetector CT and Its Multiplanar Reformation, Volume Rendering and Virtual Bronchoscopy Postprocessing Techniques for Primary Trachea and Main Bronchus Tumors.
PLoS One. 2015; 10(9):e0137329 [PubMed] Free Access to Full Article Related Publications
PURPOSE: To evaluate the diagnostic value of multidetector CT (MDCT) and its multiplanar reformation (MPR), volume rendering (VR) and virtual bronchoscopy (VB) postprocessing techniques for primary trachea and main bronchus tumors.
METHODS: Detection results of 31 primary trachea and main bronchus tumors with MDCT and its MPR, VR and VB postprocessing techniques, were analyzed retrospectively with regard to tumor locations, tumor morphologies, extramural invasions of tumors, longitudinal involvements of tumors, morphologies and extents of luminal stenoses, distances between main bronchus tumors and trachea carinae, and internal features of tumors. The detection results were compared with that of surgery and pathology.
RESULTS: Detection results with MDCT and its MPR, VR and VB were consistent with that of surgery and pathology, included tumor locations (tracheae, n = 19; right main bronchi, n = 6; left main bronchi, n = 6), tumor morphologies (endoluminal nodes with narrow bases, n = 2; endoluminal nodes with wide bases, n = 13; both intraluminal and extraluminal masses, n = 16), extramural invasions of tumors (brokethrough only serous membrane, n = 1; 4.0 mm-56.0 mm, n = 14; no clear border with right atelectasis, n = 1), longitudinal involvements of tumors (3.0 mm, n = 1; 5.0 mm-68.0 mm, n = 29; whole right main bronchus wall and trachea carina, n = 1), morphologies of luminal stenoses (irregular, n = 26; circular, n = 3; eccentric, n = 1; conical, n = 1) and extents (mild, n = 5; moderate, n = 7; severe, n = 19), distances between main bronchus tumors and trachea carinae (16.0 mm, n = 1; invaded trachea carina, n = 1; >20.0 mm, n = 10), and internal features of tumors (fairly homogeneous densities with rather obvious enhancements, n = 26; homogeneous density with obvious enhancement, n = 1; homogeneous density without obvious enhancement, n = 1; not enough homogeneous density with obvious enhancement, n = 1; punctate calcification with obvious enhancement, n = 1; low density without obvious enhancement, n = 1).
CONCLUSION: MDCT and its MPR, VR and VB images have respective advantages and disadvantages. Their combination could complement to each other to accurately detect locations, natures (benignancy, malignancy or low malignancy), and quantities (extramural invasions, longitudinal involvements, extents of luminal stenoses, distances between main bronchus tumors and trachea carinae) of primary trachea and main bronchus tumors with crucial information for surgical treatment, are highly useful diagnostic methods for primary trachea and main bronchus tumors.

Scarlata S, Graziano P, Lucantoni G, et al.
Endoscopic treatment of primary benign central airway tumors: Results from a large consecutive case series and decision making flow chart to address bronchoscopic excision.
Eur J Surg Oncol. 2015; 41(10):1437-42 [PubMed] Related Publications
BACKGROUND: Benign tracheo-bronchial neoplasms are rare, but potentially dangerous conditions with life threatening consequences. Tumor removal should be pursued by methods minimizing the procedural stress. The role of endoscopic treatment, as an alternative to open surgery, remains controversial.
OBJECTIVES: report the twelve-years endoscopic experience in Rome, Italy. Fifty-seven benign tracheo-bronchial tumors were diagnosed and 130 tracheo-bronchial resections by rigid bronchoscopy performed.
METHODS: we identified histotypes associated with higher recurrence rate and assessed their relationship with gender, age and tracheo-bronchial location. We provided data on safety and complications and suggested a decision making flow chart to address the patients to endoscopic resection.
RESULTS: complete eradication after a single procedure without recurrence at 2 years was obtained in 63.1% of cases (36/57). Need of a second intervention within few months but no further recurrence at follow up was seen in a further 8.8% (5/57). Histotypes associated with recurrence were papillomas and inflammatory polyp. Seven patients (12.3%) were addressed to surgery because of multiple recurrence. Ten patients (17.5%) were lost at follow up. In case of recurrence, the bronchial biopsy was always repeated and no malignant transformation was observed. No major complications, pneumothorax or pneumomediastinum occurred.
CONCLUSIONS: endoscopic treatment of benign tracheo bronchial tumors is safe and effective, provided that the procedure is carefully and systematically planned. The rate of eradication is satisfactory and the incidence of complications negligible. This will encourage this approach as first line treatment especially in patients, frequently elderly people, having increased surgical risk due to concomitant respiratory failure or major comorbidities.

Qiu J, Lin W, Zhou ML, et al.
Primary small cell cancer of cervical trachea: a case report and literature review.
Int J Clin Exp Pathol. 2015; 8(6):7488-93 [PubMed] Free Access to Full Article Related Publications
UNLABELLED: Primary small cell carcinoma of trachea is even more uncommon and only a few cases have been reported. Our search revealed only 90 cases in the English-language literatures.
CASE REPORT: we report a case of cervical tracheal small cell cancer. A 67-year-old male presented with over 2-month history of cough and dyspnea. CT and MRI revealed a 1.0 cm × 2.5 cm intraluminal, irregular soft tissue mass in the upper trachea, approximately 2.5 cm below the glottis. A bronchoscopic examination disclosed a large tumor in the cervical trachea and the lesion occupied more than 60% of the tracheal lumen. Cytological examination suggested some poorly differentiated carcinoma cells. The patient received concurrent chemoradiotherapy and did not perform surgery. One week after CCR, the patient occurred difficulty in breath and tracheal stent was implanted. The symptom was improved markedly. Four days after implant of tracheal stent, the patient presented irritable cough and hemoptysis. The amount of bleeding was about 300 ml. The hemorrhage stopped by treatment of vasoconstrictor and fresh plasma. However, two days later, hemoptysis was continuing even if treatment of vasoconstrictor and fresh plasma. The patient and relatives waived the further therapies. The patient died of massive hemoptysis one week out of hospital.
CONCLUSIONS: The tracheal small cell cancer is rare. The optimal treatment is unclear. In general, the strategy is introduced concurrent chemoradiotherapy following as small cell lung cancer. In cervical trachea, we suggest that surgical resection should be performed followed by postoperative adjuvant therapy.

Kadota N, Shinohara T, Machida H, et al.
Asymptomatic tracheal MALT lymphoma discovered on spirometric findings presenting with elevated respiratory resistance.
BMC Res Notes. 2015; 8:223 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Central airway obstruction (CAO) may be caused by various etiologies. However, conventional chest X-rays are rarely diagnostic for patients with CAO.
CASE PRESENTATION: We here described a 64-year-old asymptomatic female with tracheal mucosa-associated lymphoid tissue lymphoma discovered on spirometric findings during a complete physical examination. The plateau of forced expiratory flow was consistent with CAO. A decreased peak expiratory flow rate was noted at least 3 years before the diagnosis, and was attributed to an insufficient effort by the patient. Impulse oscillometric measurements, which were taken during quiet breathing and were effort-independent, suggested elevated respiratory resistance. These abnormalities completely disappeared after radiation therapy.
CONCLUSION: The addition of impulse oscillometry to spirometry may be useful for screening CAO in routine health examinations.

Kitada M, Yasuda S, Ishibashi K, et al.
Leiomyoma of the Trachea: a case report.
J Cardiothorac Surg. 2015; 10:78 [PubMed] Free Access to Full Article Related Publications
We present a surgical case of a rare primary tracheal tumor. In a 44-year-old asymptomatic man, computed tomography (CT), performed as part of health check-up, revealed a tumor measuring 1.5 cm in diameter in the mediastinal trachea. Biopsy failed to yield a definitive diagnosis, but the tumor tended to grow rapidly; therefore, surgery was performed. Five tracheal rings were resected through median sternotomy, followed by interrupted suture with 3-0 absorbable thread. The postoperative course has been favorable with no evidence of recurrence. The pathological diagnosis was leiomyoma. We report this case with literature review.

Kesrouani A, Dabar G, Rahal S, Ghorra C
Treatment of tracheal mucoepidermoid carcinoma by argon plasma coagulation during pregnancy.
Int Surg. 2015; 100(5):927-9 [PubMed] Free Access to Full Article Related Publications
Mucoepidermoid carcinoma of the tracheobronchial tree is a rare airway tumor (<1% of all lung tumors). In adults, the majority of primary tracheal tumors are malignant. Management during pregnancy is complex and requires weighing maternal and fetal prognosis. Reported cases describe surgical resection following cesarean section. We report the first case to be treated by Argon-Plasma Coagulation (APC) in pregnancy. A 35-year-old Caucasian woman G1P0, at 27 weeks of gestation was admitted to the emergency department because of hemoptysis and severe dyspnea. Bronchoscopy and biopsies diagnosed primary tracheal mucoepidermoid carcinoma. Following an episode of tracheal bleeding, she was intubated. After thorough explanations to the family and obtaining informed consent, therapeutic bronchoscopy, under general anesthesia using a rigid bronchoscope, was performed. The tumor was cored out with the tip of the bronchoscope and removed with an alligator forceps. The tumor bed was coagulated with APC. The obstetrical team was ready to intervene in case of maternal emergency. Immediate follow-up was good, and she left the hospital 4 days later. She delivered at 39 weeks of gestation by cesarean section because of dystocia. Five years later, the patient is doing well without any signs or symptoms of recurrence. Pediatric follow-up is normal. Argon Plasma Coagulation for treatment of mucoepidermoid tracheal carcinoma is feasible during pregnancy. Reporting this case could lead to less aggressive management of mucoepidermoid carcinoma in pregnant patients.

He WX, Song N, Liu M, Jiang GN
Bronchoplastic closure as an alternative approach for tracheal reconstruction following resection of a massive tracheal tumour.
Interact Cardiovasc Thorac Surg. 2015; 21(2):263-5 [PubMed] Related Publications
A 47-year old woman presented with large cell carcinoma with extensive lengthwise and circumferential invasion of the lower trachea. End-to-end anastomosis by suture lines alone may be impossible and even harmful, following tumour resection with such extensive tracheal involvement. Thus, we performed a successful tracheal reconstruction with bronchoplastic closure without complications or recurrence at 12-month follow-up. This case highlights the use of this technique for the closure of massive airway defects.

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