Feng J, Mao T, Zhao Y, et al.
Endotracheobronchial neurofibroma treated by right carinal pneumonectomy.
Ann Thorac Surg. 2013; 95(2):e35-7 [PubMed]

Neurofibromas arising from the trachea and bronchus are relatively rare. We report the case of a 42-year-old woman who came to our hospital with severe shortness of breath. Right sleeve pneumonectomy was performed, and neurofibroma was confirmed by pathologic examination. In a search of the world literature, 28 cases of endotracheobronchial neurofibromas were found. The literature is reviewed.

Loaiza-Bonilla A, Rossi F, Alkhalil B
Tracheal carcinoid presenting as refractory cervicalgia in a postpartum patient: correlation versus epiphenomenon.
Ear Nose Throat J. 2012; 91(9):E11-4 [PubMed]

Primary tracheal carcinoid tumor is an extremely rare disorder that has been reported only occasionally in the medical literature. We report a case of a 36-year-old African American woman who presented to the emergency department complaining of persistent neck pain for the preceding week. She was 2 weeks postpartum and had no significant medical history. Laboratory workup was unremarkable. Computed tomography and magnetic resonance imaging showed a polypoid mass in the trachea. After bronchoscopy and laser ablation of the mass were performed, the final diagnosis of carcinoid tumor was made. To our knowledge this is the first reported case of this tumor in a postpartum patient. Further studies regarding the interactions between the natural history of carcinoid tumors and pregnancy are warranted. Their infrequency, clinical features, and pathophysiology make tracheal carcinoid tumors a formidable and interesting diagnostic challenge.

Sindhwani G, Rawat J, Chauhan N, Mishra SK
Tracheal polyp treated with endobronchial electrocautery.
Indian J Chest Dis Allied Sci. 2012 Apr-Jun; 54(2):123-5 [PubMed]

Fibroepithelial polyps of trachea are extremely rare. Here, we report a case of tracheal polyp in a 40-year-old woman that was managed successfully with endobronchial electrocautery with a review of the relevant literature.

Rich JT, Gullane PJ
Current concepts in tracheal reconstruction.
Curr Opin Otolaryngol Head Neck Surg. 2012; 20(4):246-53 [PubMed]

PURPOSE OF REVIEW: Many patients require tracheal reconstruction either for tracheal stenosis/malacia or following tumor extirpation. However, such patients can be debilitated following failed conventional treatments. Recent advances in tissue engineering and vascularized composite grafts are accelerating the field of tracheal reconstruction. This article reviews new clinical concepts for tracheal reconstruction.
RECENT FINDINGS: Novel treatments include composite autografts, allografts, chimeric autografts and allografts, tissue-engineered grafts, prosthetic scaffolds, and the use of free-tissue vascularized carriers.
SUMMARY: New procedures for tracheal reconstruction hold much promise for treating difficult tracheal disorders and improving the quality of life for affected patients. Many of the techniques reviewed herein are single case series and require further investigation and validation.

Exley R, Bernstein JM, Brennan B, Rothera MP
Rhabdomyosarcoma of the trachea: first reported case treated with proton beam therapy.
J Laryngol Otol. 2012; 126(9):966-9 [PubMed]

OBJECTIVE: We report a case of rhabdomyosarcoma of the trachea in a 14-month-old child, and we present the first reported use of proton beam therapy for this tumour.
CASE REPORT: A 14-month-old girl presented acutely with a seven-day history of biphasic stridor. Emergency endoscopic debulking of a posterior tracheal mass was undertaken. Histological examination revealed an embryonal rhabdomyosarcoma with anaplasia. Multimodality therapy with surgery and chemotherapy was administered in the UK, and proton beam therapy in the USA.
CONCLUSION: Only three cases of rhabdomyosarcoma of the trachea have previously been reported in the world literature. This is the first reported case of treatment of this tumour with proton beam therapy. Compared with conventional radiotherapy, proton beam therapy may confer improved long-term outcome in children, with benefits including reduced irradiation of the spinal cord.

Li W, Hua W, Yan FG, et al.
Adenoid cystic carcinoma of trachea: a case report and review of literature.
Chin Med J (Engl). 2012; 125(12):2238-9 [PubMed]

Primary tracheal tumors are relatively rare. Here we report one case of primary adenoid cystic carcinoma of the trachea which was ever misdiagnosed as asthma and hysteria. In this case, the pulmonary function test was normal, and firstly no obvious abnormalities were found in laryngoscopy, bronchoscopy and CT scan of chest. Later a sagittal and coronal reconstruction CT scan of trachea showed a mass situated in the subglottic trachea. Lastly a laryngoscopy was again done after a tracheal incision and showed a small mass in the posterior wall of the subglottic trachea, and tumor ablation was performed. In addition, we reviewed the literature of primary tracheal tumors and summarized the epidemiology, presenting features, available therapeutic options of the disease.

Salcedo N, Saez M, Bragulat B, Saurina C
Does the effect of gender modify the relationship between deprivation and mortality?
BMC Public Health. 2012; 12:574 [PubMed]

BACKGROUND: In this study we propose improvements to the method of elaborating deprivation indexes. First, in the selection of the variables, we incorporated a wider range of both objective and subjective measures. Second, in the statistical methodology, we used a distance indicator instead of the standard aggregating method principal component analysis. Third, we propose another methodological improvement, which consists in the use of a more robust statistical method to assess the relationship between deprivation and health responses in ecological regressions.
METHODS: We conducted an ecological small-area analysis based on the residents of the Metropolitan region of Barcelona in the period 1994-2007. Standardized mortality rates, stratified by sex, were studied for four mortality causes: tumor of the bronquial, lung and trachea, diabetes mellitus type II, breast cancer, and prostate cancer. Socioeconomic conditions were summarized using a deprivation index. Sixteen socio-demographic variables available in the Spanish Census of Population and Housing were included. The deprivation index was constructed by aggregating the above-mentioned variables using the distance indicator, DP2. For the estimation of the ecological regression we used hierarchical Bayesian models with some improvements.
RESULTS: At greater deprivation, there is an increased risk of dying from diabetes for both sexes and of dying from lung cancer for men. On the other hand, at greater deprivation, there is a decreased risk of dying from breast cancer and lung cancer for women. We did not find a clear relationship in the case of prostate cancer (presenting an increased risk but only in the second quintile of deprivation).
CONCLUSIONS: We believe our results were obtained using a more robust methodology. First off, we have built a better index that allows us to directly collect the variability of contextual variables without having to use arbitrary weights. Secondly, we have solved two major problems that are present in spatial ecological regressions, i.e. those that use spatial data and, consequently, perform a spatial adjustment in order to obtain consistent estimators.

Nureki S, Miyazaki E, Fujisaki H, et al.
Incidentally discovered primary malignant melanoma of the trachea.
Intern Med. 2012; 51(13):1743-6 [PubMed]

Primary malignant melanoma of the trachea is extremely rare. We report here the first case of primary tracheal malignant melanoma in the asymptomatic stage. Incidentally, this 73-year-old man was found to have a flat tumor at the upper trachea on chest computed tomography scans. The tumor was surgically resected with end-to-end anastomosis and was diagnosed to be primary malignant melanoma of the trachea. Four months after the surgical resection, cervical lymph node metastasis was found. Despite the resection of metastatic lymph nodes and six courses of chemotherapy, he died of cachexia approximately two years after the discovery of the tracheal tumor.

Gamalski S, Munoz J, Diaz-Kuan A, Wollner I
Germ cell tumour of the trachea.
BMJ Case Rep. 2012; 2012 [PubMed]

A 28-year-old man presented with stridor and dyspnoea. Imaging showed a tracheal mass with severe narrowing of the subglottic airway. Histopathology was consistent with non-seminomatous germ cell tumour. The patient underwent cricotracheal resection and reconstruction of the trachea with tracheostomy. Subsequent positron emission tomography demonstrated new right upper lobe nodules. Postoperative chemotherapy was initiated using the VIP regimen (etoposide, ifosfamide and cisplatin). After four cycles of chemotherapy, CT of the thorax showed interval resolution of most of the pulmonary nodules. Thoracoscopy with right upper and lower lobe wedge resections was performed to remove the residual disease. The patient is currently disease-free and undergoing continued surveillance to assess for clinical, biochemical or radiographical evidence of disease recurrence.

Stevic R, Milenkovic B, Stojsic J, et al.
Clinical and radiological manifestations of primary tracheobronchial tumours: a single centre experience.
Ann Acad Med Singapore. 2012; 41(5):205-11 [PubMed]

INTRODUCTION: Tracheobronchial tumours usually cause an airway obstruction and secondary pulmonary infections. Although rare, they are an important differential diagnosis as they may mimic other conditions and diseases. This paper aims to analyse clinical, radiological and histological characteristics of the patients with tracheobronchial tumours diagnosed for a period of 7 years.
MATERIALS AND METHODS: In this retrospective, observational study, we carefully reviewed 65 patients who were diagnosed with tracheal and endobronchial tumours, and performed statistical analysis on the results.
RESULTS: Among these 65 patients (36 men and 29 women) with a mean age of 48.8 years (range, 15 to 75), 50 had malignant tumours while 15 had benign ones. The most common symptoms were cough, chest pain and haemoptysis. Cough was a more frequent symptom in patients with benign tumours (P <0.0014). Only 2 patients were asymptomatic. Tumours were predominantly localised in the large airways (46 in large bronchi and 2 in trachea). The most common radiological manifestation of malignant tumours was tumour mass (46%) followed by atelectasis. One third benign tumour caused atelectasis, while tumour mass and consolidation were found in 3 patients each. Computerised tomography revealed endoluminal tumour mass in 29.2% of the cases, which was more frequently found in benign than malignant tumours (47% vs 24%, respectively). On bronchoscopy, tumours were visible in 73% and 70% benign and malignant cases respectively.
CONCLUSION: Tracheobronchial tumours should be ruled as a possible diagnosis in patients with cough, haemoptysis, dyspnoea and chest pain. The imaging techniques and histological examination of the tissue would subsequently lead to correct diagnosis and proper treatment can be administered.

Ishida I, Oura H, Niikawa H, Handa M
Non-circumferential tracheal resection with muscle flap reconstruction for adenoid cystic carcinoma.
Gen Thorac Cardiovasc Surg. 2012; 60(9):603-6 [PubMed]

Circumferential airway resection with primary anastomosis has been widely adopted as a treatment for adenoid cystic carcinoma (ACC) of the trachea. However, carinal resection is a complicated procedure with high mortality and morbidity rates. We describe a technique of non-circumferential tracheal resection performed to treat ACC arising from the lower membranous trachea adjacent to the carina. The tumor was resected while preserving the tracheo-carinal cartilage. A silicone Y-stent was placed at the bifurcation to ensure airway patency before closing the defect. The airway defect, measuring 4 × 2.5 cm, was closed using an autologous pericardial patch and pedicled latissimus dorsi muscle flap. These procedures were technically easy, and no postoperative airway complication occurred.

Ozkan E, Araz M, Soydal C, et al.
Detection of intraluminal tracheal metastasis of thyroid papillary carcinoma by 18F-FDG PET/CT.
Clin Nucl Med. 2012; 37(6):e160-1 [PubMed]

We present a case of a 66-year-old female patient with thyroid papillary carcinoma. On the fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) performed for thyroglobulin elevation accompanied by negative radioiodine whole-body scan, there was an intense 18F-FDG uptake in the polypoid soft tissue invading the tracheal cartilage and extending into the lumen. Dedifferentiated tumor with high metabolic rate can be easily detected by 18F-FDG PET/CT.

Papiashvilli M, Ater D, Mandelberg A, Sasson L
Primary mucoepidermoid carcinoma of the trachea in a child.
Interact Cardiovasc Thorac Surg. 2012; 15(2):311-2 [PubMed] Article available free on PMC after 01/08/2013

Mucoepidermoid carcinoma of the trachea is a rare tumour, especially in the paediatric population. We report the case of a 9-year-old boy with mucoepidermoid carcinoma of the trachea that was preoperatively diagnosed as an intraluminal polypoid mass arising from the trachea and extending into the right main bronchus. A complete resection of the tumour with reconstruction and end-to-end anastomosis of the trachea was performed. The patient is now, 24 months after surgery, free of disease.

Thomas R, Christopher DJ, Thangakunam B, Samuel R
Tracheal schwannoma as a mimic of bronchial asthma.
Singapore Med J. 2012; 53(5):e95-6 [PubMed]

Primary tracheal tumours are rare and less frequently observed than bronchial tumours. Primary neurogenic tumours of the trachea as schwannomas or neurilemmomas are extremely uncommon. We report a tracheal schwannoma in a female patient who presented with breathlessness and wheeze, and she was being treated for asthma. Flexible bronchoscopy revealed a large pedunculated tracheal mass and biopsy confirmed schwannoma. She was treated with laser ablation with partial reduction of the tumour. Subsequently, she was lost to follow-up, although resection of the tumour with tracheal reconstruction was planned.

Bonner Millar LP, Stripp D, Cooper JD, et al.
Definitive radiotherapy for unresected adenoid cystic carcinoma of the trachea.
Chest. 2012; 141(5):1323-6 [PubMed]

Adenoid cystic carcinoma is a rare malignancy that usually originates in the salivary glands of the head and neck but has rarely been known to originate in the trachea. This histology has a predilection for perineural invasion and a tendency for both local and distant recurrences. While surgical resection is the mainstay of treatment of tracheal adenoid cystic carcinoma, tumor size, location, and patient comorbidities may preclude surgery, and the optimal nonsurgical management remains undefined. In the absence of locoregional lymph node metastases, we recommend highly conformal radiotherapy alone to a dose of 80 Gy. We report on two patients with unresectable disease who were treated with definitive radiotherapy: one using conventional photons and one treated with a combination of photon and proton beams. Both patients were treated to a dose of 80 Gy with acceptable toxicities and objective clinical and radiographic response. The patient treated with conventional photons has no evidence of recurrent disease at 5 years; the patient treated with protons has continued evidence of response without evidence of disease recurrence 11 months after treatment.

Metzdorff MT, Seaman JC, Opperman DA, et al.
Tracheal paraganglioma: an unusual neoplasm of the upper airway.
Ann Thorac Surg. 2012; 93(5):1717-9 [PubMed]

Paraganglioma of the trachea is a rare neoplasm, with fewer than 15 cases reported. A 40-year-old man presented with stridor and hemoptysis. Bronchoscopy demonstrated a tumor of the posterior trachea and biopsy initially suggested typical carcinoid. The patient underwent surgical resection uneventfully and made a good recovery. Final pathology disclosed the tumor to be a paraganglioma based on immunohistology. The pathophysiology and treatment of this tumor are discussed.

Delaere PR
Tracheal transplantation.
Curr Opin Pulm Med. 2012; 18(4):313-20 [PubMed]

PURPOSE OF REVIEW: This review discusses the important advances in the reconstruction of airway wall defects resulting from stenosis and tumor resection.
RECENT FINDINGS: Recent insights concerning regeneration, revascularization, and transplantation of the trachea are presented. The current study reviews tracheal transplantation as a new treatment modality.
SUMMARY: This will enable wider application of tracheal allotransplantation for patients in need of complex reconstructive surgery for airway defects that are not amenable to standard methods of repair. Ongoing research suggests that tracheal allotransplantation may become available as a new treatment modality. Additional data are needed to define optimal withdrawal of immunosuppressants without loss of airway lumen.

Shenoy AM, Burrah R, Rao V, et al.
Tracheal resection for thyroid cancer.
J Laryngol Otol. 2012; 126(6):594-7 [PubMed]

INTRODUCTION: Thyroid cancers infiltrating the upper aerodigestive tract are not uncommon. The management of these cases can be demanding, with a high level of surgical skill required to achieve adequate primary resection and reconstruction.
MATERIALS AND METHODS: This study was a single institution series of seven patients, managed over two years, who underwent tracheal resection for advanced thyroid cancer. All patients were older than 45 years (range, 45-65 years) and were predominantly male (six of seven). All patients presented to us with a swelling in the neck. Fine needle aspiration cytology detected thyroid cancer in all patients. None of the patients required a tracheostomy prior to surgery; however, they all had varying levels of airway compromise. One patient had lung metastasis at presentation. In all patients, the airway was successfully secured with fibre-optic assisted intubation prior to surgery. All patients underwent a total thyroidectomy with tracheal resection and anastomosis. Montgomery's suprahyoid release was utilised to achieve adequate laryngeal drop. None of the patients required a tracheostomy in the post-operative period. All patients received adjuvant therapy with either radioiodine ablation and/or radiotherapy.
CONCLUSION: Tracheal resection and primary reconstruction is a feasible surgical procedure for patients with thyroid cancer infiltrating the upper aerodigestive tract, with good clinical outcomes. However, the morbidity of the procedure mandates careful case selection, airway management and meticulous surgical technique.

Magliari ME, Aquino RT, Gonçalves AL, et al.
Mucosa-associated lymphoid tissue lymphoma of the trachea: case report.
Sao Paulo Med J. 2012; 130(2):126-9 [PubMed]

CONTEXT: Mucosa-associated lymphoid tissue (MALT) lymphomas are most commonly found in the stomach, lungs, orbital soft tissue, salivary glands and thyroid. Involvement of the trachea is extremely rare.
CASE REPORT: This report describes a rare case of MALT lymphoma of the trachea in a 71-year-old woman who presented with a one-year history of coughing, dyspnea, hoarseness and weight loss. There was an infiltrative lesion in the mid-trachea. The anatomopathological diagnosis was only made from the fifth endoscopic biopsy attempt. Immunochemotherapy consisting of rituximab, cyclophosphamide, vincristine and prednisone (R-COP) induced complete remission of the symptoms and endoscopic lesion.
CONCLUSIONS: MALT lymphoma of the trachea is extremely rare and indolent disease. It has to be considered in the differential diagnosis of airway lesions. It is crucial to obtain an anatomopathological diagnosis from a specialized pathologist. Immunochemotherapy with R-COP induced complete remission of the disease.

Siesling S, van der Zwan JM, Izarzugaza I, et al.
Rare thoracic cancers, including peritoneum mesothelioma.
Eur J Cancer. 2012; 48(7):949-60 [PubMed]

Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies.

Hotomi M, Sugitani I, Toda K, et al.
A novel definition of extrathyroidal invasion for patients with papillary thyroid carcinoma for predicting prognosis.
World J Surg. 2012; 36(6):1231-40 [PubMed]

OBJECTIVES: Extrathyroidal invasion is one of the most significant risk factors for patients with papillary thyroid carcinoma (PTC). The purpose of this study was to evaluate a novel definition of extrathyroidal invasion for patients with PTC as a method for predicting a patient's prognosis.
METHODS: The prospective study was conducted for consecutive 930 patients with primary PTC who received surgery during 1993-2009. We defined only patients who had preoperative recurrent laryngeal nerve palsy or patients in whom the tumor had invaded to the mucosa of the trachea and/or esophagus as Ex3. Patients with minimal invasion were classified as Ex1, and patients with massive invasion, when we could shave off the tumors, were classified as Ex2. Patients without extrathyroidal invasion were classified as Ex0.
RESULTS: Patients classified Ex3 showed significantly shorter disease-free survival (p = 0.03) and disease-specific survival (p = 0.007) than patients classified Ex2. The time to recurrence at resection sites was shorter in patients classified Ex3 than in patients classified Ex2 (p = 0.02). The time to death due to distant metastasis of patients classified Ex3 was significantly shorter than that of patients classified Ex2 (p = 0.02). Within the patients classified Ex3, disease-specific survival of patients with invasion to other nearby structures was shorter than that of patients with invasion to only recurrent laryngeal nerve (p = 0.008).
CONCLUSIONS: The degree and site of invasion is an important prognostic factor for PTC. Our novel classification of extrathyroidal invasion is valuable in predicting the prognosis of PTC.

Xu Q, Deng Y, Fu S, et al.
A novel tracheobronchial reconstruction for right upper lung carcinoma involving the lower trachea: preliminary results.
Ann Thorac Surg. 2012; 93(4):1070-4 [PubMed]

BACKGROUND: We developed a novel technique for tracheobronchial reconstruction after resection of carcinoma of the right upper lung involving the right main bronchus and lower trachea. Preliminary results of the technique are reported.
METHODS: Between December 2007 and October 2011, 9 patients underwent treatment with our new technique. The right upper lobe was resected together with the involved right main bronchus and right lateral wall of the lower trachea. Closure of the trachea was started at the level of the carina and continued upward, leaving an oval opening at the upper end of the tracheal defect, to which the bronchus intermedius was reimplanted. The sutured lower trachea became the extension of the left main bronchus.
RESULTS: The procedure was completed successfully in all 9 patients. Two patients underwent partial carinal resection, 2 underwent replacement of the superior vena cava by interposition graft, 2 underwent partial resection of the superior vena cava, and 1 underwent partial resection of the esophageal wall. There were no perioperative deaths. No major complications, including dehiscence, stenosis, and adult respiratory distress syndrome, were observed. Arrhythmia occurred in 2 patients, and vocal cord paresis and pneumonia occurred in 1 patient. One patient died 31 months after operation, and 1 patient was lost to follow-up 28 months after operation, without tumor recurrence. The other 7 are alive to date.
CONCLUSIONS: Despite this being a small series and short follow-up, this tracheobronchial reconstruction shows encouraging preliminary results with low mortality and morbidity, and could be an alternative to other methods for the treatment of carefully selected patients with advanced carcinoma of the right upper lobe.

Dewan RK, Kesieme EB, Ramchandani R
Surgical treatment for tracheobronchial carcinoid tumors: a 16-year experience.
Asian Cardiovasc Thorac Ann. 2012; 20(1):53-7 [PubMed]

We conducted a 16-year retrospective review of 31 cases of tracheobronchial carcinoid tumors treated in our institution between 1995 and 2011, to determine their characteristic features and outcome of management. There were 12 men and 19 women. The most common presenting symptoms were cough and hemoptysis (71%) with a mean duration of 4 years. Preoperative bronchoscopy confirmed the diagnosis in 80% of patients. Right-sided tumors accounted for 60% of cases. Most tumors arose from the mainstem bronchi. Histologic analysis revealed typical carcinoids in 28 cases and atypical carcinoids in 3. Surgical treatment was mainly radical resection (pneumonectomy in 19 patients). A parenchymal-preserving surgery (sleeve resection of left main bronchus and end-to-end anastomosis) was only possible in 2 cases. Mediastinal lymph nodes were involved in 30% of cases. Most patients had widespread extraluminal extension. Follow-up revealed recurrence in one patient. No deaths were recorded, and complications were mainly atelectasis and air leak. Radical resection remains the mainstay of surgical management of bronchial carcinoids in cases of late presentation with destroyed and bronchiectatic distal pulmonary parenchyma. Parenchymal-preserving surgery should only be carried out when indicated.

Xie L, Fan M, Sheets NC, et al.
The use of radiation therapy appears to improve outcome in patients with malignant primary tracheal tumors: a SEER-based analysis.
Int J Radiat Oncol Biol Phys. 2012; 84(2):464-70 [PubMed]

PURPOSE: To conduct a matched pair analysis assessing the impact of radiotherapy (RT) in patients with resectable and unresectable primary malignant tracheal tumors using Surveillance, Epidemiology and End Results (SEER) database.
PATIENTS AND METHODS: The SEER registry was used to identify every patient (or "case") who received RT between 1988 and 2007 for primary malignant tracheal tumors, and to search for corresponding "controls" (not treated with RT), with the same prognostic and treatment factors (surgery on the trachea, disease extension, histology, and gender). Overall survival (OS) was calculated with the Kaplan-Meier methods. Results of OS and cumulative incidence of death from tracheal cancer in the cases and controls, and in various subsets, were compared using log-rank and Gray's tests.
RESULTS: Two hundred fifty-eight patients who received RT were identified, and 78 of these had appropriate matched controls identified, forming the basis of this analysis. In the 78 (+RT) cases, the median follow-up was 60 months (range, 10-192) in the survivors vs. 55 months (range, 2-187) in the controls (no-RT group). Patients in RT group had significantly better OS, and a lower cumulative incidence of death from tracheal cancer than no-RT patients (p < 0.05). Treatment with radiation was associated with improved survival in patients with squamous cell histology [p < 0.0001], regional disease extension [p = 0.030], or those that did not undergo resection [p = 0.038]. There were four deaths in RT group and three in no-RT group attributed to cardiac and respiratory causes.
CONCLUSION: Our data suggest a survival benefit for the use of RT broadly for all patients with tracheal cancer. Nevertheless, the retrospective nature of this observational study limits its interpretation.

Bharadwaj SC, Unruh HW
Leiomyoma of the trachea.
Ann Thorac Surg. 2012; 93(2):669-70 [PubMed]

Primary tracheal tumors are rare. Approximately 1% of them are leiomyoma. Given the rarity of these lesions, optimal management has not been defined. Bronchoscopic, local surgical excision and partial tracheal resection have all been described. One report of recurrence after resection has been published. The incidence of recurrence following local excision is unknown. We report a case of an incidental tracheal leiomyoma diagnosed and treated with a combined approach.

Khodadad K, Karimi S, Arab M, Esfahani-Monfared Z
Primary anaplastic large cell lymphoma of trachea with subcutaneous emphysema and progressive dyspnea.
Hematol Oncol Stem Cell Ther. 2011; 4(4):188-91 [PubMed]

Primary anaplastic large cell lymphoma of the trachea is a rare tumor. Common complaints are dyspnea and cough that could mimic a partially refractory asthma in some cases. We report a 16-year-old female with an anaplastic large cell lymphoma (null cell type) in which tracheal involvement was presented with life-threatening airway obstruction and subcutaneous emphysema. After debulking the tumor by endobronchial curettage, the patient was treated with chemotherapy followed by local radiotherapy. She had no evidence of local or distant recurrence after 25 months. Primary anaplastic large cell lymphoma of the trachea is a rare life-threatening disease. Nevertheless, this condition has a good prognosis if diagnosed immediately and treated with chemotherapy and radiotherapy.

Li Y, Wang J, Li H, et al.
Myoepithelial carcinoma: first case reported in the trachea.
Pathol Int. 2012; 62(1):55-9 [PubMed]

Myoepithelial carcinoma displaying exclusively myoepithelial differentiation mainly occurs in the salivary glands and breasts, and is considered extremely rare in the trachea. We present the first documented case of a primary myoepithelial carcinoma in the trachea. The patient was a 23-year-old man who presented with shortness of breath and cough for four months. Bronchoscopy and computed tomographic (CT) scan revealed an intraluminal mass in the trachea. A standard sleeve of trachea resection with end-to-end reconstruction was performed. The tumor was mainly composed of spindle cells and epithelioid cells which exhibited relatively uniform nuclei with finely distributed chromatin and inconspicuous nucleoli, suggesting that it may arise from benign myoepithelioma. Moreover, the tumor displayed marked cytologic atypia and an infiltrative tumor border in some areas, suggesting that it was a malignant tumor. Immunohistochemically, the tumor cells were diffusely positive for AE1/AE3, Vimentin and myoepithelial makers (Calponin, P63 and GFAP). The patient's postoperative course was uneventful with no evidence of recurrence at six months after surgery.

Mogi A, Kosaka T, Yamaki E, et al.
Successful resection of a glomus tumor of the trachea.
Gen Thorac Cardiovasc Surg. 2011; 59(12):815-8 [PubMed]

Extracutaneous glomus tumors are uncommon, and their occurrence in the trachea is rare. We present a case of a surgically resected glomus tumor of the trachea in a 56-year-old woman who presented with worsening dyspnea and cough. Bronchoscopy and computed tomography showed a polypoid tumor arising from the posterior membrane of the lower trachea just above the carina; the tracheal lumen was approximately 80% occluded. The patient underwent successful tracheal sleeve resection with primary reconstruction. The histological characteristics and immunohistochemical profile were typical for this tumor. The clinicopathological features of this unusual neoplasm are discussed, and the literature is reviewed.

Filipović A, Vucković L, Mijović M
Invasive follicular thyroid carcinoma infiltrating trachea.
Vojnosanit Pregl. 2011; 68(10):891-4 [PubMed]

INTRODUCTION: Although follicular thyroid carcinoma is a rare malignant tumor, up to 20% of the patients are threatened by potential complications resulting from infiltrating tumor growth into surrounding tissues.
CASE REPORT: A 66-year-old female came to hospital with the presence of a growing thyroid nodule of the left lobe. Ultrasonic examination showed a 8 cm hypoechoic nodule in the left lobe. Thyroid scintigraphy showed a cold nodule. CT scan and tracheoscopy showed tracheal infiltration without tracheal obstruction. An extended total thyroidectomy was done, with the left jugular vein, strap muscles and tracheal 2 cm long circular resection. The pathologist confirmed invasive follicular thyroid cancer. After the surgery the patient was treated with radioiodine therapy and permanent TSH suppressive therapy. The patient was followed with measurements of the thyroid hormone and serum thyroglobulin level every six months, as well as the further tests (chest xray, ultrasound of the neck and a whole body scintigraphy) were done. After more than three years the patient had no evidence of the recurrent disease.
CONCLUSION: Radical resection of the tracheal infiltrating thyroid cancer with circular tracheal resection and terminoterminal anastomosis followed by radioiodine therapy should be considered the treatment of choice.

Jungebluth P, Alici E, Baiguera S, et al.
Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study.
Lancet. 2011; 378(9808):1997-2004 [PubMed]

BACKGROUND: Tracheal tumours can be surgically resected but most are an inoperable size at the time of diagnosis; therefore, new therapeutic options are needed. We report the clinical transplantation of the tracheobronchial airway with a stem-cell-seeded bioartificial nanocomposite.
METHODS: A 36-year-old male patient, previously treated with debulking surgery and radiation therapy, presented with recurrent primary cancer of the distal trachea and main bronchi. After complete tumour resection, the airway was replaced with a tailored bioartificial nanocomposite previously seeded with autologous bone-marrow mononuclear cells via a bioreactor for 36 h. Postoperative granulocyte colony-stimulating factor filgrastim (10 μg/kg) and epoetin beta (40,000 UI) were given over 14 days. We undertook flow cytometry, scanning electron microscopy, confocal microscopy epigenetics, multiplex, miRNA, and gene expression analyses.
FINDINGS: We noted an extracellular matrix-like coating and proliferating cells including a CD105+ subpopulation in the scaffold after the reseeding and bioreactor process. There were no major complications, and the patient was asymptomatic and tumour free 5 months after transplantation. The bioartificial nanocomposite has patent anastomoses, lined with a vascularised neomucosa, and was partly covered by nearly healthy epithelium. Postoperatively, we detected a mobilisation of peripheral cells displaying increased mesenchymal stromal cell phenotype, and upregulation of epoetin receptors, antiapoptotic genes, and miR-34 and miR-449 biomarkers. These findings, together with increased levels of regenerative-associated plasma factors, strongly suggest stem-cell homing and cell-mediated wound repair, extracellular matrix remodelling, and neovascularisation of the graft.
INTERPRETATION: Tailor-made bioartificial scaffolds can be used to replace complex airway defects. The bioreactor reseeding process and pharmacological-induced site-specific and graft-specific regeneration and tissue protection are key factors for successful clinical outcome.
FUNDING: European Commission, Knut and Alice Wallenberg Foundation, Swedish Research Council, StratRegen, Vinnova Foundation, Radiumhemmet, Clinigene EU Network of Excellence, Swedish Cancer Society, Centre for Biosciences (The Live Cell imaging Unit), and UCL Business.