|
1
|
Shu C, Liu Y, Zheng K, Tang X, Li M, Shen Y, Zhou Y, Du W, Ma N, Zhao J. Diagnosis and Treatment of Primary Tracheobronchial Tumors. Cancer Med 2025; 14:e70893. [PMID: 40289301 PMCID: PMC12034573 DOI: 10.1002/cam4.70893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 03/20/2025] [Accepted: 04/07/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Primary tracheobronchial tumors (PTBTs) are rare but life-threatening, accounting for approximately 0.2% of all respiratory neoplasms. Owing to their nonspecific clinical symptoms, PTBTs are often initially misdiagnosed as bronchial asthma or bronchitis in the early stages. In addition, standardized treatments for PTBTs are currently lacking. AIMS This study aimed to provide a comprehensive review of this diagnostic challenge and treatment modalities of PTBTs. METHODS Drawing on the latest literature and clinical guidelines, we carried out a comprehensive and systematic analysis of PTBTs, focusing on diagnostic modalities, and evidence-based treatment options. RESULTS AND CONCLUSIONS Primary diagnostic methods for PTBTs include pulmonary function tests, chest radiography, computed tomography, and fiberoptic bronchoscopy. Computed tomography, and fiberoptic bronchoscopy may be the most valuable diagnostic tools for patients with PTBTs or those highly suspected of having PTBTs. Currently, there are no consensus guidelines for PTBTs, and surgery is the most effective method for treating PTBTs if the patients have indications for surgery. In addition, radiotherapy, chemotherapy and interventional therapy may be useful complementary treatments for inoperable patients. Immunotherapy may be a significant management strategy for PTBTs in the future. Further researches should concentrate on both the early identification and enhanced therapeutic management of these tumors to improve survival and diminish morbidity and mortality rates by investigating the optimal design of systematic therapy.
Collapse
Affiliation(s)
- Chen Shu
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
- Department of Cardiothoracic SurgeryThe 902nd Hospital of the Chinese People's Liberation Army Joint Logistic Support ForceBengbuAnhuiChina
| | - Yu‐jian Liu
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
- Department of Cardiothoracic SurgeryCentral Theater Command General Hospital of Chinese People's Liberation ArmyWuhanHubeiChina
| | - Kai‐fu Zheng
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
- Department of General SurgeryThe 991st Hospital of the Chinese People's Liberation Army Joint Logistic Support ForceXiangyangHubeiChina
| | - Xi‐yang Tang
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
| | - Meng‐chao Li
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
| | - Yang Shen
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
| | - Yu‐long Zhou
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
| | - Wei‐guang Du
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
| | - Nan Ma
- Department of OphthalmologyTangdu Hospital, The Fourth Military Medical UniversityShaanxiChina
| | - Jin‐bo Zhao
- Department of Thoracic SurgeryTangdu Hospital, The Fourth Military Medical UniversityXi'anShaanxiChina
| |
Collapse
|
|
2
|
Barke MR, O'Neill C, Hurtado Castillo M, Pandey O. Delayed diagnosis of adenoid cystic carcinoma of the trachea. BMJ Case Rep 2025; 18:e263368. [PMID: 40280589 DOI: 10.1136/bcr-2024-263368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025] Open
Abstract
Adenoid cystic carcinoma (ACC) is a salivary gland tumour that may involve the respiratory tract and can cause symptoms that mimic benign conditions, such as chronic obstructive pulmonary disease and asthma. Standard of treatment consists of surgical resection, but radiation therapy may also be appropriate for incomplete and unresectable tumours. A Hispanic woman in her 40s presented with 2 years of progressive throat pain, dyspnea and cough during meals. CT revealed a polypoid tracheal mass 1.6×1.2×1.7 cm and asymmetric submucosal enhancement and thickening with severe luminal narrowing, which was concerning for malignancy. Rigid bronchoscopy revealed greater than 80% occlusion of the trachea, and biopsy confirmed the diagnosis of ACC with tubular and cribriform patterns. The patient underwent tracheal resection with reanastomosis followed by postoperative adjuvant radiotherapy. Over 1 year later, the patient remains symptom-free and without recurrence of ACC.
Collapse
Affiliation(s)
- Matthew R Barke
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Colleen O'Neill
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Marisabel Hurtado Castillo
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Department of Hematology and Oncology, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Om Pandey
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Department of Hematology and Oncology, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| |
Collapse
|
|
3
|
Chen Q, Xue K, Wu Y, Luo B, Lin Y. Primary malignant tumors of the trachea: a retrospective analysis of the clinical data of 79 patients treated in a single center. Front Oncol 2025; 15:1568589. [PMID: 40270602 PMCID: PMC12014432 DOI: 10.3389/fonc.2025.1568589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Accepted: 03/19/2025] [Indexed: 04/25/2025] Open
Abstract
Background Primary malignant tumors of the trachea are rare. There are few data on such tumors, the understanding of the disease is limited, and the best treatment plan has not yet been determined. Methods Clinical data obtained from the medical records of 79 patients with primary malignant tumors of the trachea treated in our hospital between August 2008 and August 2023 were retrospectively analyzed. The clinical data included demographic characteristics (age, sex), carcinogen exposure (smoking or drinking), symptoms, histology, primary tumor location (cervical trachea, intrathoracic trachea or bronchus), primary tumor range, lymph node status, and treatment. SPSS 26.0 software was used for statistical analysis. The Kaplan- Meier method was used to calculate the survival rate, and the log-rank test was used to compare the survival differences between groups. Multivariate analysis was performed using the Cox regression model. Results Patients with primary tracheal ACC were significantly younger than those with SCC were (45.5 years old vs. 66.0 years old, P = 0.000007). SCC is more common in smoking and male patients, whereas ACC and other pathological types are more common in nonsmoking and female patients. ACC patients were less likely to have lymph node metastasis than SCC patients were (12.5% vs. 36%, P = 0.047). The 3-year, 5-year and 10year overall survival rates were 69.9%,62.3% and 34.2%, respectively, and the median OS was 96 months. The 3-year overall survival rates of patients with ACC, SCC, and other pathological types were 86.3%, 47.1%, and 71.4%, respectively. The 5-year overall survival rates were 77.0%, 26.5% and 62.5%, respectively. The 10-year overall survival rates were 39.5%, 13.3% and 62.5%, respectively. The overall survival of SCC patients was the shortest among all pathological types, and the difference was statistically significant. The COX regression analysis further demonstrated that a higher N stage is significantly associated with an elevated risk of distant metastasis. Conclusion Primary malignant tumors of the trachea are rare, and the best treatment has not yet been determined. Although most patients in this center are treated via a variety of methods, whether this varied approach to treatment is the reason for the higher overall survival cannot be ascertained. Moreover, most patients in our center received a variety of treatments, so a survival analysis of specific treatment modalities was not possible. Thus, more studies involving more patients are needed to ascertain the optimal treatment plan for malignant tracheal tumors.
Collapse
Affiliation(s)
- Qiuyan Chen
- Department of Radiation Oncology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Keying Xue
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Yigen Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Bingqing Luo
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Yuyi Lin
- Department of Radiation Oncology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| |
Collapse
|
|
4
|
Ayed MB, Tbini M, Riahi I, Idriss S, Salah MB. Tracheal adenoid cystic carcinoma presenting as a locally advanced thyroid gland carcinoma. Radiol Case Rep 2025; 20:1406-1409. [PMID: 39807115 PMCID: PMC11728663 DOI: 10.1016/j.radcr.2024.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 11/17/2024] [Accepted: 11/21/2024] [Indexed: 01/16/2025] Open
Abstract
Tracheal adenoid cystic carcinoma is a rare malignancy. We report the case of a 65-year-old male who presented to our department due to a 3-month history of mild dysphagia without other associated symptoms. The neck, laryngeal, and hypopharyngeal examinations were normal. Ultrasound showed hypertrophy and marked hypoechogenicity of the left thyroid lobe without suspicious nodules. Fine needle aspiration of the hypoechogenic area revealed an adenoid cystic carcinoma. A tracheal origin was then suspected and it was confirmed by a flexible bronchoscopy that showed a tumor located in the proximal tracheal reducing its lumen by 50%. The biopsy confirmed the diagnosis of tracheal adenoid cystic carcinoma. We performed a computed tomography scan showing a mass at the angle between the trachea and esophagus infiltrating the left thyroid gland. Magnetic resonance imaging confirmed the tumor's important local and regionregional extension at the thyroid gland, esophagus, larynx, and mediastinum. The tumor was judged as unresectable and the patient received radiotherapy and an endotracheal sent. After a follow-up period of 2 years, the tumor remained stable, and the patient received This study aims to determine the clinical, radiological, and therapeutic aspects of advanced adenoid cystic carcinoma.
Collapse
Affiliation(s)
- Mariam Ben Ayed
- Department of Otorhinolaryngology Head and Neck Surgery, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis el Manar, Tunis, Tunisia
| | - Makram Tbini
- Department of Otorhinolaryngology Head and Neck Surgery, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis el Manar, Tunis, Tunisia
| | - Inès Riahi
- Department of Otorhinolaryngology Head and Neck Surgery, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis el Manar, Tunis, Tunisia
| | - Sarra Idriss
- Department of Otorhinolaryngology Head and Neck Surgery, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis el Manar, Tunis, Tunisia
| | - Mamia Ben Salah
- Department of Otorhinolaryngology Head and Neck Surgery, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine, University Tunis el Manar, Tunis, Tunisia
| |
Collapse
|
|
5
|
Schweiger T, Hoetzenecker K. Management of Primary Tracheal Tumors. Thorac Surg Clin 2025; 35:83-90. [PMID: 39515898 DOI: 10.1016/j.thorsurg.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
The diagnosis and treatment of patients with tracheal tumors is challenging due to the low incidence of these tumors. A precise diagnostic work-up and experience is necessary to distinguish between patients amenable to surgery and nonsurgical patients. An individualized treatment concept should be established for each patient in a multidisciplinary team and ranges from interventional removal of benign lesions to multimodal strategies in patients with extended malignant tumors. Early diagnosis despite unspecific symptoms and complete resection are crucially important to achieve long-term survival.
Collapse
Affiliation(s)
- Thomas Schweiger
- Department of Thoracic Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Vanderbilt University Medical Center, Department of Thoracic Surgery, Nashville, TN, USA
| |
Collapse
|
|
6
|
Morton A. Tracheobronchial adenoid cystic carcinoma in pregnancy. BMJ Case Rep 2025; 18:e261795. [PMID: 39828316 DOI: 10.1136/bcr-2024-261795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025] Open
Abstract
A case of tracheobronchial adenoid cystic carcinoma diagnosed around the time of conception and its progression during pregnancy is presented. The evidence that pregnancy may be associated with the progression of adenoid cystic cancer is discussed. It is important to consider tracheal disease before making a diagnosis of adult-onset asthma.
Collapse
Affiliation(s)
- Adam Morton
- Department of Endocrinology and Obstetric Medicine, Queensland Health, Brisbane, Queensland, Australia
- Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
|
7
|
Wu B, Sheng Y, Geng Z, Xu Y, Fan X, Yuan P, Li F, Qi Y. ECMO-assisted bilateral uniportal thoracoscopic carinal resection and reconstruction: a case report. J Cardiothorac Surg 2025; 20:1. [PMID: 39754164 PMCID: PMC11697856 DOI: 10.1186/s13019-024-03196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 12/15/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND Carinal resection and reconstruction are complex surgical procedures often necessitated by tumors or other pathologies involving the tracheobronchial junction. Traditional approaches to these surgeries are highly invasive. The advent of uniportal video-assisted thoracoscopic surgery (VATS) along with the integration of extracorporeal membrane oxygenation (ECMO) offer potential advantages in reducing surgical trauma and improving outcomes. CASE PRESENTATION A 42-year-old female patient was admitted to the hospital with the chief complaint of "chest tightness for 20 days". Enhanced chest CT revealed a soft tissue shadow on the tracheal bifurcation wall, protruding into the left main bronchus opening. After multidisciplinary discussions and the exclusion of surgical contraindications, we performed ECMO-assisted uniportal VATS carinal resection and reconstruction for the patient. The patient's postoperative course was uneventful, and she was discharged on postoperative day 4 with satisfactory respiratory function and no major complications. CONCLUSIONS This case demonstrates the feasibility and potential benefits of combining ECMO support with uniportal VATS for complex carinal surgeries. The approach minimizes surgical trauma, ensures stable intraoperative conditions, and may enhance postoperative recovery. Further studies are warranted to validate these findings and establish standardized protocols for such advanced surgical techniques.
Collapse
Affiliation(s)
- Bin Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinliang Sheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenyang Geng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueyuan Fan
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ping Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Qi
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
|
8
|
Ben Amara K, Bouassida I, Ayadi R, Affes M, Abdelkbir A, Abdennadher M, Ben Othmen S, Ayadi‐Kaddour A, Zribi H, Marghli A. Primary tracheo-bronchial adenoid cystic carcinoma: A surgical series with literature review. Respirol Case Rep 2025; 13:e70062. [PMID: 39844829 PMCID: PMC11753813 DOI: 10.1002/rcr2.70062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 11/09/2024] [Indexed: 01/24/2025] Open
Abstract
Tracheo-bronchial adenoid cystic carcinoma (TBACC) is a rare disease. Its treatment is mainly surgical. We herein describe the clinical and para-clinical varieties of TBACC as well as their surgical treatment and prognosis. We conducted a retrospective study of eight patients operated on between 1994 and 2022 and whose definitive pathological examination concluded with primary TBACC. There were three men and five women with an average age of 44 years. The bronchoscopy found a budding formation reducing the tracheal lumen at the cervical (two cases), middle (two case) and distal trachea and carina (four cases). Bronchial anastomosis resection and sleeve pneumonectomy were the most common procedures. Surgical resections R0 were achieved in five patients. Surgery followed by adjuvant radiotherapy was performed in two patients with incomplete surgical resection R1. The overall survival for all patients with primary ACC was 72% at 5 years. TBACC is a rare and low-to-moderate grade malignant tumour. The choice of the surgical procedure and the appropriate approach is challenging to obtain a promising prognosis.
Collapse
Affiliation(s)
- Kaouther Ben Amara
- Thoracic Surgery DepartmentAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Imen Bouassida
- Thoracic Surgery DepartmentAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Rahma Ayadi
- Department of PathologyAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Mariem Affes
- Department of RadiologyAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Amina Abdelkbir
- Thoracic Surgery DepartmentAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Mahdi Abdennadher
- Thoracic Surgery DepartmentAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Salma Ben Othmen
- Carcinological Surgery DepartmentSalah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Ayda Ayadi‐Kaddour
- Department of PathologyAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Hazem Zribi
- Thoracic Surgery DepartmentAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| | - Adel Marghli
- Thoracic Surgery DepartmentAbderrahmen Mami University Hospital‐Ariana, Faculty of Medicine of Tunis, University of Tunis El ManarArianaTunisia
| |
Collapse
|
|
9
|
Huang J, Chen M, Zhang L, Lin X, Lucero-Prisno DE, Zhong CC, Xu W, Zheng ZJ, Withers M, Wong MCS. Incidence, risk factors, and epidemiological trends of tracheal cancer: a global analysis. Mol Cancer 2024; 23:271. [PMID: 39696563 DOI: 10.1186/s12943-024-02188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 11/27/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Tracheal cancer is a rare malignancy with limited research but high mortality rates. This study aims to analyse recent data to understand the global burden, trends, and risk factors for tracheal cancer, facilitating improved prevention and treatment strategies. METHODS We conducted a study on tracheal cancer using data from the Global Cancer Observatory and the Cancer Incidence in Five Continents databases. We collected information on the incidence of tracheal cancer, risk factors, and the Human Development Index (HDI) at the country level. The univariate linear regression was used to explore the relationship between tracheal cancer and the various risk factors. We utilised joinpoint regression analysis to calculate the Average Annual Percentage Change (AAPC) in tracheal cancer incidence. RESULTS The global age-standardised rate of incidence of tracheal cancer was 2.9 per 10 million (3,472 cases in total) in 2022, with the highest regional incidence observed in Central and Eastern Europe (ASR = 9.0) and the highest national incidence in Hungary (12.5). Higher incidence was found among the males (3.8) than females (2.0); among the older adults aged 50-74 (11.9) than the younger population aged 15-49 (1.2). A higher tracheal cancer incidence ratio was associated with higher levels of smoking, alcohol drinking, diabetes, lipid disorders, and HDI. Despite the overall decreasing trends for all population groups (highest decrease in Thailand; AAPC: -15.06, 95% CI: -21.76 to -7.78, p = 0.002), there was an increase in some female populations (highest increase in Colombia, AAPC: 19.28, 95% CI: 16.48 to 22.15, p < 0.001) and younger populations (highest increase in Ireland; AAPC: 29.84, 95% CI: 25.74 to 34.06, p < 0.001). CONCLUSION This study provides a comprehensive analysis of tracheal cancer, focusing on risk factors and population-level trends. There has been an overall decreasing trend in the incidence of tracheal cancer, particularly among males and older adults, while the decline is less pronounced in females and younger individuals. Further research is needed to explore the underlying drivers of these epidemiological trends.
Collapse
Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mingtao Chen
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Xu Lin
- Department of Thoracic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Claire Chenwen Zhong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, USA.
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- School of Public Health, Fudan University, Shanghai, China.
- Department of Global Health, School of Public Health, Peking University, Beijing, China.
- School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
|
10
|
Yu X, Huang M, Ge H, Yang J, Huang B, Xu J. Primary sarcomatoid carcinoma of the trachea: A case report and literature review. Medicine (Baltimore) 2024; 103:e40766. [PMID: 39686439 PMCID: PMC11651425 DOI: 10.1097/md.0000000000040766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/13/2024] [Indexed: 12/18/2024] Open
Abstract
RATIONALE Primary sarcomatoid carcinoma of the trachea (PSCT) is a rare malignant tumor of the lower respiratory tract. Pathological types of tracheal sarcomatoid carcinoma (TSC)s include pleomorphic carcinomas, giant cell carcinomas, spindle cell carcinomas, pulmonoblastomas, and carcinosarcomas. At present, there are limited reports on PSCT, and pathologists lack sufficient knowledge about it. PATIENT CONCERNS Here, we report a case of malignant neoplasm involving the left posterior wall of the initial tracheal segment, characterized by atypical spindle cells and a small number of high-grade squamous intraepithelial neoplasia. DIAGNOSIS Spindle-shaped cells were moderately heterotypic, with 8/10 nuclear divisions (high-magnification field), and no obvious inflammatory cell infiltration was observed in the interstitium. Squamous epithelial cells showed moderate-to-severe atypia with regional cytoplasmic transparency. Immunohistochemistry: Fusiform tumor cells expressed vimentin, epithelial markers were negative, the Ki-67 proliferation index was 40%, and epithelial markers were expressed in squamous intraepithelial neoplasia. INTERVENTIONS After the biopsy diagnosis was confirmed, part of the tumor was removed by tracheoscopy under general anesthesia in the respiratory department of a superior hospital. A pathological diagnosis of TSC was made and local radiotherapy was performed. OUTCOMES As the tumor could not be completely cured, the patient experienced repeated coughing and shortness of breath and died of the disease 15 months later. LESSONS Pathological morphology and immunohistochemical analyses deepen our understanding of the pathological features of TSC and provide a diagnostic reference for clinicians who will encounter such cases in the future.
Collapse
Affiliation(s)
- Xiuwen Yu
- Department of Respiratory Medicine, The First People’s Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Mingqi Huang
- Department of Traditional Chinese Medicine, Faculty of Chinese Medicine Science Guangxi University of Chinese Medicine, Nanning, China
| | - Haiyan Ge
- Department of Pathology, The Second People’s Hospital of Xiaoshan District, Xiaoshan District, Hangzhou, Zhejiang, China
| | - Junjie Yang
- Department of Pathology, The First People’s Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Bin Huang
- Department of Pathology, The First People’s Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Jialing Xu
- Departments of Medical Oncology, The First People’s Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| |
Collapse
|
|
11
|
Chidambaram KS, Karakkandy V, Chappity P, Parida PK, Pradhan P, Samal DK, Sarkar S, Veetil AK, Sharma P, Chakraborty S, Shaikh Z, Adhikari A, Adhya AK, Mishra P, Mohapatra PR, Panigrahi MK, Bhuniya S, Bal SK, Misra S, Behera BK, Sahoo S, Das S, Sahu A, Mohanty CR, Singh N, Panda A, Sahoo AK, Das PK, Mohanty S, Sathia S, Mahapatra RP. Role of Percutaneous Trans-Tracheal Endoscopic Approach in Managing Thoracic Tracheal Pathologies: A Step Back for Better Outcomes. Indian J Otolaryngol Head Neck Surg 2024; 76:5699-5706. [PMID: 39559143 PMCID: PMC11569045 DOI: 10.1007/s12070-024-05069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 09/03/2024] [Indexed: 11/20/2024] Open
Abstract
Thoracic tracheal tumors are relatively rare in routine clinical practice. Though surgery is the preferred management choice, acute presentation is challenging for the surgeon and the anesthetist. In this study, we discuss the role of the percutaneous trans-tracheal endoscopic approach (PTTEA) in the modern era of minimally invasive surgery. Its indications, advantages, complications, and anesthetic options are enumerated. A retrospective review was performed of patients with thoracic tracheal lesions treated in our department between 2015 and 2022. A total of 16 patients underwent PTTEA in an emergency after a failed fiberoptic or transoral approach and were included in the review. Twelve patients were ventilated by intermittent apnea, and four had a Cardiopulmonary bypass. Amongst the 16 patients, nine had benign, and seven had malignant pathologies. All the benign lesions were excised completely, and patients were de-cannulated, except for one case with disseminated respiratory papillomatosis. Malignant lesions underwent debulking of the lesions for acute respiratory distress, followed by initiation of adjuvant therapy. PTTEA is an effective alternative to traditional fiberoptic or rigid bronchoscopy techniques for selected patients for whom minimally invasive techniques fail. The advantages of the approach include better surgical access, hemostasis, and airway control, resulting in reduced operative time and minimal complications.
Collapse
Affiliation(s)
| | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Preetam Chappity
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Pradipta Kumar Parida
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Saurav Sarkar
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Aswathi Kallyadan Veetil
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Prity Sharma
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Swagata Chakraborty
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Zaid Shaikh
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019 India
| | - Amit Kumar Adhya
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Pritinanda Mishra
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Manoj Kumar Panigrahi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Sourin Bhuniya
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Shakti Kumar Bal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Satyajeet Misra
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Bikram Kishore Behera
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Sangeeta Sahoo
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Subhasree Das
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Ajitesh Sahu
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Chita Ranjan Mohanty
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Neha Singh
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Aparajita Panda
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Alok Kumar Sahoo
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Prasant Kumar Das
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Satyapriya Mohanty
- Department of Cardiothoracic and Vascular Surgery (CTVS), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Siddhartha Sathia
- Department of Cardiothoracic and Vascular Surgery (CTVS), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Rudra Pratap Mahapatra
- Department of Cardiothoracic and Vascular Surgery (CTVS), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| |
Collapse
|
|
12
|
Armel K, Stamey T, Maitre J, Cunningham AR, Ju AW, Burke A, Speicher JE, Navaid M, Bhatt A, Larkins MC. Demographic, Disease, and Treatment Characteristics of Primary Tracheal Cancers. Ann Surg Oncol 2024; 32:10.1245/s10434-024-16520-1. [PMID: 39556179 PMCID: PMC11698749 DOI: 10.1245/s10434-024-16520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 10/30/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND Primary tracheal cancers (PTCs) are rare neoplasms underreported in the literature. No consensus guidelines exist for the treatment of these cancers and multimodal management of these cancers has not been adequately explored for cases diagnosed over the past 2 decades. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with PTC. Cox proportional hazards and log-rank testing was used to assess the association between demographic and treatment variables and 5-year cause-specific survival (CSS). RESULTS Among the 689 identified patients, age < 65 years at diagnosis (hazard ratio [HR] 0.64, p < 0.001), non-squamous cell carcinoma (SCC) histology (HR 0.22, p < 0.001), and treatment with surgery (HR 0.43, p < 0.001) were all associated with increased 5-year CSS. Regarding disease histology, patients with adenoid cystic carcinomas (ACCs) had increased 5-year CSS compared with those with neither SCC nor ACC histology and those with SCC histology (83.4% [76.0%, 90.8%] versus 50.3% [42.5%, 58.1%] and 28.8% [23.2%, 34.4%]; p < 0.001) based on univariate analysis. Despite the improved CSS associated with surgery, 55% of the identified cohort did not undergo surgery, with only 5.5% of these patients having ACC compared with 58% having SCC (p < 0.001). CONCLUSIONS Age < 65 years, ACC histology, and treatment with surgery were associated with improved 5-year CSS among patients with PTC, although the significant proportion of this group not receiving surgery represents an opportunity for improved outcomes.
Collapse
Affiliation(s)
- Kristen Armel
- Brody School of Medicine (BSOM), East Carolina University (ECU), Greenville, NC, USA
| | - Taylor Stamey
- Brody School of Medicine (BSOM), East Carolina University (ECU), Greenville, NC, USA
| | - Joseph Maitre
- Brody School of Medicine (BSOM), East Carolina University (ECU), Greenville, NC, USA
| | - Andrew R Cunningham
- Brody School of Medicine (BSOM), East Carolina University (ECU), Greenville, NC, USA
| | - Andrew W Ju
- Department of Radiation Oncology, BSOM, ECU, Greenville, NC, USA
| | - Aidan Burke
- Department of Radiation Oncology, BSOM, ECU, Greenville, NC, USA
| | - James E Speicher
- Department of Cardiovascular Sciences, BSOM, ECU, Greenville, NC, USA
| | - Musharraf Navaid
- Division of Hematology/Oncology, Department of Internal Medicine, BSOM, ECU, Greenville, NC, USA
| | - Arjun Bhatt
- Brody School of Medicine (BSOM), East Carolina University (ECU), Greenville, NC, USA
| | - Michael C Larkins
- Brody School of Medicine (BSOM), East Carolina University (ECU), Greenville, NC, USA.
- Department of Emergency Medicine, Boonshoft School of Medicine at Wright State University, Fairborn, OH, USA.
| |
Collapse
|
|
13
|
Piórek A, Płużański A, Knetki-Wróblewska M, Winiarczyk K, Tabor S, Kowalski DM, Krzakowski M. Tracheal Tumors: Clinical Practice Guidelines for Palliative Treatment and Follow-Up. Oncol Rev 2024; 18:1451247. [PMID: 39360235 PMCID: PMC11445028 DOI: 10.3389/or.2024.1451247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/23/2024] [Indexed: 10/04/2024] Open
Abstract
A substantial portion of patients with advanced cancer cannot be cured, regardless of the therapeutic methods employed. Hence, rational palliative causal treatment becomes crucial. Representative studies specifically addressing the exclusive palliative treatment of patients diagnosed with tracheal cancers have not been identified. In most studies, patients treated palliatively constituted a subset of the overall evaluated group. A thorough literature review was conducted, focusing on three types of palliative treatment: palliative radiotherapy, palliative surgical procedures, and systemic treatment for advanced disease. This review uniquely fills a significant gap in the existing literature by providing the first comprehensive and updated clinical practice guidelines specifically focused on the palliative treatment of tracheal tumors. The proposed guidelines emphasize the unique clinical challenges and treatment strategies pertinent to palliative care in tracheal tumors, which are not adequately covered in existing guidelines for other thoracic malignancies.
Collapse
Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Adam Płużański
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| |
Collapse
|
|
14
|
Ruenwilai P, Ekpumimas K. Tracheal Adenoid Cystic Carcinoma Successfully Treated With the Combined Core Out Technique, Cryoextraction, and Argon Plasma Coagulation: A Case Report. Cureus 2024; 16:e64150. [PMID: 39119440 PMCID: PMC11308734 DOI: 10.7759/cureus.64150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
We report the case of a 67-year-old male who presented with mild dyspnea two years ago, with increasing intensity, cough, and stridor on exertion. He underwent outpatient evaluation and received treatment for recurrent episodes of bronchitis and acute exacerbations of chronic obstructive pulmonary disease. His current medication included tiotropium 18 µg per day and salmeterol/fluticasone 50/500 µg twice daily. The patient received a short course of prednisolone at 40 mg per day for five days before admission. The physical examination showed a central stridor during both inspiration and expiration. Chest radiograph showed a normal lung parenchyma and no hilar enlargement. Spirometry revealed fixed airway obstruction. CT scan of the thorax revealed a 2.4 × 2.7 cm lobulated mass abutting the right side of the lower trachea with nearly complete obstruction. Due to the large tumor causing significant central airway obstruction, the medical team opted to remove the central airway mass through rigid bronchoscopy. Argon plasma coagulation was used to facilitate mass shrinkage. Mechanical mass removal was performed using a rigid bronchoscope. At the end of the treatment, re-evaluation by bronchoscopy exhibited no remaining mass. Histologic examination confirmed the diagnosis of a tracheal adenoid cystic carcinoma. No recurrence of the tumor was noted during 12 months of follow-up.
Collapse
Affiliation(s)
- Parinya Ruenwilai
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, THA
| | - Kulachat Ekpumimas
- Division of Respiratory Medicine, Central Chest Institute of Thailand, Nonthaburi, THA
| |
Collapse
|
|
15
|
Piórek A, Płużański A, Knetki-Wróblewska M, Winiarczyk K, Tabor S, Teterycz P, Kowalski DM, Krzakowski M. Treatment outcomes of patients with primary tracheal tumors - analysis of a large retrospective series. BMC Cancer 2024; 24:686. [PMID: 38840114 PMCID: PMC11155021 DOI: 10.1186/s12885-024-12450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE Primary tracheal tumors are very rare and their management is not definitely established. Due to its rarity, providing patient care in terms of optimal management poses a considerable challenge. The purpose of this study was to investigate treatment outcomes in patients with these rare tumors. METHODS We carried out a retrospective analysis of 89 patients with primary tracheal tumors treated at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, over sixteen years. The study assessed patient demographics, tumor characteristics and treatment. Different treatment options were compared in terms of overall survival, disease-free survival, and progression-free survival. RESULTS A total of 89 patients were included in the study. In the group presented, 45 patients underwent primary radical treatment and 44 were qualified for palliative treatment. Surgical resection was performed in 13 patients out of radically treated patients. The 5 year OS rates in the group of patients who underwent radical treatment and in the group of patients who underwent palliative treatment were 45.9% and 2.3%, respectively. In the group of patients who underwent radical surgical treatment, the 5 year OS was 76.9% compared to 35.8% in the group of patients who underwent nonsurgical treatment. CONCLUSION A multidisciplinary team should decide treatment options, including in-depth consideration of surgical treatment options.
Collapse
Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland.
| | - Adam Płużański
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 02-781, Poland
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 02-781, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| |
Collapse
|
|
16
|
Eichhorn F, Hoffmann H, Rieken S, Herth FJF, Winter H. [Tracheal Tumours]. Zentralbl Chir 2024; 149:286-297. [PMID: 38382560 DOI: 10.1055/a-2223-1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Malignant primary tracheal tumours are rare. The most common histological subtypes are squamous cell carcinoma and adenoid cystic carcinoma. These two entities have different prognoses and growth patterns. Tracheobronchoscopy and thoracic sectional imaging are standard diagnostic tools for tumour staging and local evaluation. Complete surgical resection of the affected tracheal segment is the treatment of choice for limited disease without distant metastases. Incomplete gross tumour resection with additional irradiation is an acceptable therapeutic option for adenoid cystic carcinoma. Interventional endoscopy with tumour debulking or tracheal stenting and/or definitive mediastinal radiotherapy are treatment alternatives in either a locally advanced or palliative setting.
Collapse
MESH Headings
- Tracheal Neoplasms/surgery
- Tracheal Neoplasms/pathology
- Tracheal Neoplasms/diagnosis
- Tracheal Neoplasms/therapy
- Tracheal Neoplasms/diagnostic imaging
- Humans
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Adenoid Cystic/diagnostic imaging
- Carcinoma, Adenoid Cystic/therapy
- Carcinoma, Adenoid Cystic/diagnosis
- Bronchoscopy
- Neoplasm Staging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Squamous Cell/diagnostic imaging
- Trachea/surgery
- Trachea/pathology
- Trachea/diagnostic imaging
- Prognosis
- Combined Modality Therapy
- Tomography, X-Ray Computed
- Stents
- Palliative Care
Collapse
Affiliation(s)
- Florian Eichhorn
- Abteilung für Thoraxchirurgie, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Hans Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Stefan Rieken
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universität Göttingen, Medizinische Fakultät, Göttingen, Deutschland
| | - Felix J F Herth
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| |
Collapse
|
|
17
|
Abstract
Carinal resections are consistently described in the literature as one of the most challenging procedures in thoracic surgery. Depending on the underlying disease and its extent, different resection forms and reconstruction techniques are required. From a surgical point of view, the complex anatomy, and the technique of reconstruction of the central airway are particularly challenging. However, complex airway management and extensive postoperative follow-up demonstrate that these procedures require a multidisciplinary team effort beyond surgical expertise. This article reviews the most important pre-, intra-, and post-operative aspects of these challenging procedures.
Collapse
Affiliation(s)
| | - Erich Stoelben
- Thoraxklinik Köln, St. Hildegardis-Krankenhaus, Köln, Deutschland
| |
Collapse
|
|
18
|
Piórek A, Płużański A, Teterycz P, Tabor S, Winiarczyk K, Knetki‐Wróblewska M, Kowalski DM, Krzakowski M. Clinicopathological characteristics of patients with primary tracheal tumors: Analysis of eighty-nine cases. Thorac Cancer 2024; 15:878-883. [PMID: 38429910 PMCID: PMC11016403 DOI: 10.1111/1759-7714.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Primary tracheal tumors are very rare and the literature on this subject is limited. The most common histological type of primary tracheal tumors is squamous cell carcinoma (SCC), followed by adenoid cystic carcinoma (ACC). Limited knowledge exists regarding the behavior and outcomes of different histological types of tracheal cancers. The present study aimed to address this gap by assessing the significance of the histological type of primary tracheal tumors based on our own data and to review the literature. METHODS We carried out a retrospective analysis of 89 patients with primary tracheal tumors treated at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, between 2000 and 2016. The study assessed patient demographics, tumor characteristics and treatment, with a focus on SCC, ACC, and other histological types. Different histological types were compared in terms of overall survival, disease-free survival, and progression-free survival. RESULTS SCC was the most frequently diagnosed histological type (56.2%), followed by ACC (21.3%). Patients with SCC were typically older (78% over 60 years), predominantly male (66%), and associated with smoking. In contrast, the ACC had a more balanced gender distribution and did not correlate with smoking. ACC displayed a significantly better prognosis, with a median overall survival of 129.4 months, compared with 9.0 months for SCC. CONCLUSION Histological type plays a crucial role in the prognosis of primary tracheal tumors. ACC demonstrated a more favorable outcome compared with SCC.
Collapse
Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Adam Płużański
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and MelanomaMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
- Department of Computational OncologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Magdalena Knetki‐Wróblewska
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| |
Collapse
|
|
19
|
Villeneuve J, Selvam R, Gomes MM, Souza C, MacPherson P. Acute Dyspnea With an Infiltrative Tracheal Mass. Chest 2024; 165:e49-e56. [PMID: 38336444 DOI: 10.1016/j.chest.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/06/2023] [Accepted: 10/21/2023] [Indexed: 02/12/2024] Open
Abstract
CASE PRESENTATION A 48-year-old woman presented to the ED with a nonproductive cough, shortness of breath, and stridor. She was otherwise healthy and had never used tobacco. The patient was mildly tachycardic but otherwise hemodynamically stable, afebrile, and saturating well on room air. She did not display any signs of increased work of breathing at rest. Although auscultation of her thorax indicated good air entry bilaterally without any adventitious sounds, stridor was elicited with forced expiration.
Collapse
Affiliation(s)
- James Villeneuve
- Department of Surgery, Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rajajee Selvam
- Department of Surgery, Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Marcio M Gomes
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Carolina Souza
- Department of Medical Imaging, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada; Department of Medicine, Division of Respirology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paul MacPherson
- Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada
| |
Collapse
|
|
20
|
Saini JK, Shastry S, V V, Srivastava A, A S. A Deceptive Tracheal Mass Mimicking Asthma. JOURNAL OF BROWN HOSPITAL MEDICINE 2024; 3:91419. [PMID: 40027395 PMCID: PMC11864405 DOI: 10.56305/001c.91419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/21/2023] [Indexed: 03/05/2025]
Abstract
Primary tracheal tumours represent a rare malignancy characterized by a generally slow growth pattern. Notably, most cases are not of primary tracheal origin; instead, they arise from the local invasion of cancers originating in the lung, thyroid, or esophagus. Adenoid cystic carcinomas (ACCs) represent the second most prevalent primary tracheal tumours, making up around 10%-15% of cases. They generally have a more favourable prognosis than squamous cell carcinoma, the most frequently encountered type. Herein, we present the case of a 35-year-old female patient misdiagnosed and treated as asthma. The diagnosis was confirmed by cryo biopsy and histopathological examination. Surgical excision remains the treatment of choice. An active follow-up surveillance is needed to look for recurrence.
Collapse
Affiliation(s)
- Jitendra Kumar Saini
- TB and Respiratory Diseases National Institute of Tuberculosis and Respiratory Diseases
| | - Shashank Shastry
- TB and Respiratory Diseases National Institute of Tuberculosis and Respiratory Diseases
| | - Vinay V
- Pulmonary, critical care and sleep medicine All India Institute of Medical Sciences Patna
| | | | - Swaroon A
- TB and Respiratory Diseases National Institute of Tuberculosis and Respiratory Diseases
| |
Collapse
|
|
21
|
Onorati I, Radu DM, Portela AMS, Peretti M, Guiraudet P, Bardet J, Freynet O, Didier M, Uzunhan Y, Chouahnia K, Duchemann B, Bourinet V, Dutau H, Berthet JP, Marquette CH, Tronc F, Sanchez ML, Trésallet C, Fournier C, Vénissac N, Miyara M, Vicaut E, Martinod E. Preliminary results in tracheal replacement using stented aortic matrices for primary extensive tracheal cancer. JTCVS Tech 2023; 21:227-236. [PMID: 37854807 PMCID: PMC10579861 DOI: 10.1016/j.xjtc.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Recent studies have demonstrated the feasibility and favorable long-term results of tracheobronchial replacement using stented cryopreserved aortic allografts. We propose to investigate the outcomes of this emerging technique in the subgroup of patients with extensive tracheal cancer. Methods This study was based on 13 patients with primary extensive tracheal cancer extracted from the prospective registry TRITON-01 (ClinicalTrials.gov Identifier: NCT04263129), which included 40 patients in total. We analyzed early and late outcomes in this subset of patients. Results From March 2019 to September 2022, 13 patients were included in the study. There were 9 female and 4 male patients, with a mean age of 53.9 years [36-71 years]. They had tracheal replacement for extended adenoid cystic carcinoma (n = 11), squamous cell carcinoma (n = 1), and mucoepidermoid carcinoma (n = 1). A venovenous extracorporeal membrane oxygenation was used in the 6 last cases. The mean length of resection was 81 mm [50-120 mm]. There was no 30-day postoperative mortality. A complete resection (R0) was achieved in 11 patients. The main late complications consisted of tracheal granulomas related to the stent and requiring repeated bronchoscopies (n = 9), pneumonia (n = 3), airway infection (n = 1), bronchoesophageal fistula (n = 1), mechanical stent obstruction requiring change (n = 2), and mediastinitis treated by antibiotics, drainage, and omentoplasty (n = 1). With a maximal follow-up of 3 years and 7 months, cancer recurrence was observed in 2 patients. All patients were alive at last follow-up except 2 (84.6%). Conclusions Airway replacement using stented CAA represents a feasible and promising solution for extensive tracheal cancer.
Collapse
Affiliation(s)
- Ilaria Onorati
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Dana M. Radu
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ana Maria Santos Portela
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marine Peretti
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Patrice Guiraudet
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Jeremy Bardet
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Olivia Freynet
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Morgane Didier
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Yurdagül Uzunhan
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Kader Chouahnia
- Oncologie, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Boris Duchemann
- Oncologie, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Valérian Bourinet
- Pneumologie, Centre Hospitalier Universitaire Sud Saint-Pierre, La Réunion, France
| | - Hervé Dutau
- Pneumologie, Assistance Publique - Hôpitaux de Marseille, Hôpital Universitaire Nord, Marseille, France
| | | | | | - François Tronc
- Chirurgie Thoracique, Hôpitaux Universitaires de Lyon, Lyon, France
| | | | - Christophe Trésallet
- Chirurgie Digestive et Endocrinienne, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | | | - Nicolas Vénissac
- Chirurgie Thoracique, Hôpitaux Universitaires de Lille, Lille, France
| | - Makoto Miyara
- Département d’Immunologie, Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpitaux Saint Louis-Lariboisière-Fernand Widal, Université Paris Cité, Paris, France
| | - Emmanuel Martinod
- Chirurgie Thoracique et Vasculaire, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
- Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| |
Collapse
|
|
22
|
Kinoshita T, Ishii H, Sakazaki Y, Azuma K, Sasaki J, Tokito T, Tominaga M, Ogou E, Kawayama T, Hoshino T. Proton Beam Therapy as a Curative Treatment for a Young Case of Unresectable Tracheal Adenoid Cystic Carcinoma. Intern Med 2023; 62:2877-2881. [PMID: 36792199 PMCID: PMC10602834 DOI: 10.2169/internalmedicine.0574-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/28/2022] [Indexed: 02/16/2023] Open
Abstract
Primary tracheal adenoid cystic carcinoma (TACC) is a rare malignancy without an established treatment. Central airway obstruction due to TACC often decreases the quality of life and has life-threatening consequences. A 19-year-old man with unresectable TACC and central airway obstruction suffered from progressive cough and dyspnea after exercise. Proton beam therapy (PBT) was selected as the preferred treatment over systemic anti-cancer chemotherapy for TACC. PBT led to complete remission of TACC and the almost complete disappearance of the respiratory symptoms without adverse events. PBT is a useful and safe treatment for unresectable primary TACC.
Collapse
Affiliation(s)
- Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Hidenobu Ishii
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Yuki Sakazaki
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Jun Sasaki
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Etsuyo Ogou
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| |
Collapse
|
|
23
|
Mikami E, Nakamichi S, Nagano A, Misawa K, Hayashi A, Tozuka T, Takano N, Noro R, Maebayashi K, Kubokura H, Terasaki Y, Kubota K, Seike M. Successful Treatment with Definitive Concurrent Chemoradiotherapy Followed by Durvalumab Maintenance Therapy in a Patient with Tracheal Adenoid Cystic Carcinoma. Intern Med 2023; 62:2731-2735. [PMID: 36642523 PMCID: PMC10569923 DOI: 10.2169/internalmedicine.1142-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/04/2022] [Indexed: 01/15/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare type of malignant tracheal tumor originating from the secretory glands. Complete surgical resection is the current standard of care for tracheal ACC. However, there have been few case reports of chemoradiotherapy for unresectable tracheal ACC. We herein report a 28-year-old man with unresectable tracheal ACC who received concurrent chemoradiotherapy (CCRT) followed by maintenance therapy with durvalumab. CCRT was completed with a good response and safety, and the patient is currently receiving durvalumab as maintenance therapy. Durvalumab after CCRT can be a treatment option for patients with unresectable tracheal ACC.
Collapse
Affiliation(s)
- Erika Mikami
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Atsuhiro Nagano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazuhito Misawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Anna Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Natsuki Takano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Katsuya Maebayashi
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Hirotoshi Kubokura
- Department of Thoracic Surgery, Graduate School of Medicine, Nippon Medical School Musashikosugi Hospital, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| |
Collapse
|
|
24
|
Zheng Z, Du Z, Fang Z, Shi Y, Chen X, Jin M, Liu K. Survival benefit of radiotherapy and nomogram for patients with primary tracheal malignant tumors: a propensity score-matched SEER database analysis. J Cancer Res Clin Oncol 2023; 149:9919-9926. [PMID: 37249645 PMCID: PMC10423124 DOI: 10.1007/s00432-023-04896-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to conduct a matched-pair analysis to assess the impact of radiotherapy (RT) on patients with malignant tracheal tumors using the surveillance, epidemiology, and end results database. Additionally, a predictive nomogram was developed for patients with malignant tracheal tumors. METHODS Propensity score matching (PSM) was used to minimize bias between the RT and no-RT groups. We utilized both univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for patients and subgroups. We developed a novel nomogram and evaluated its results using the C-index. RESULTS A total of 648 patients between 1975 and 2019 were included, and 160 patients in RT were 1:1 propensity score-matched with no-RT. The independent prognostic factors for patients with tracheal malignant tumors were surgery, marital status, disease extension, pathology, and age. The independent risk factors for patients without surgery included RT and disease extension. The C-index confirmed that the nomogram accurately predicted the prognosis of patients with tracheal malignant tumors. CONCLUSIONS Our findings suggest that RT may provide a survival benefit for tracheal cancer patients who did not undergo surgery. The nomogram can be a useful tool for predicting prognosis in patients with tracheal malignant tumors.
Collapse
Affiliation(s)
- Zhen Zheng
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Zhennan Du
- Department of Respiratory Medicine, Ningbo Yinzhou No. 2 Hospital, Ningbo, 315000, China
| | - Zhongjie Fang
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Yunbin Shi
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Xue Chen
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Ming Jin
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Kaitai Liu
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China.
| |
Collapse
|
|
25
|
Inomata M, Kuroki S, Oguri N, Sato Y, Kawano F, Maeda R. Pleomorphic adenoma of the trachea: A case report. Int J Surg Case Rep 2023; 109:108499. [PMID: 37459695 PMCID: PMC10439302 DOI: 10.1016/j.ijscr.2023.108499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Although pleomorphic adenoma is the most common type of parotid gland tumor, its occurrence in the trachea is rare. Here, we describe a successfully resected pleomorphic adenoma of the trachea in a woman with severe respiratory failure that had been preoperatively misdiagnosed as asthma. CASE PRESENTATION A 69-year-old woman presented to the emergency department with symptoms of worsening dyspnea and subsequent loss of consciousness. She had a history of progressively worsening wheezing and stridor over the course of 2-years and had been diagnosed with asthma. Arterial blood gas sample analysis indicated type II respiratory failure. A chest computed tomographic scan revealed a tumor in the trachea, which was almost completely obstructing the lower tracheal lumen. The tumor was located just above the carina. To alleviate airway constriction and achieve complete resection, carinal resection with reconstruction was performed. The postoperative diagnosis was pleomorphic adenoma of the trachea. CLINICAL DISCUSSION Pleomorphic adenoma is a rare tracheal tumor that may present with obstructive airway symptoms that mimic asthma. CONCLUSION Tracheal tumors should be considered in patients with chronic respiratory symptoms that do not improve with medication.
Collapse
Affiliation(s)
- Mayu Inomata
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Shoei Kuroki
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Nobuyuki Oguri
- Department of Diagnostic Pathology, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Fumiya Kawano
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Ryo Maeda
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan.
| |
Collapse
|
|
26
|
Marchioni A, Tonelli R, Samarelli AV, Cappiello GF, Andreani A, Tabbì L, Livrieri F, Bosi A, Nori O, Mattioli F, Bruzzi G, Marchioni D, Clini E. Molecular Biology and Therapeutic Targets of Primitive Tracheal Tumors: Focus on Tumors Derived by Salivary Glands and Squamous Cell Carcinoma. Int J Mol Sci 2023; 24:11370. [PMID: 37511133 PMCID: PMC10379311 DOI: 10.3390/ijms241411370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Primary tracheal tumors are rare, constituting approximately 0.1-0.4% of malignant diseases. Squamous cell carcinoma (SCC) and adenoid cystic carcinoma (ACC) account for about two-thirds of these tumors. Despite most primary tracheal cancers being eligible for surgery and/or radiotherapy, unresectable, recurrent and metastatic tumors may require systemic treatments. Unfortunately, the poor response to available chemotherapy as well as the lack of other real therapeutic alternatives affects the quality of life and outcome of patients suffering from more advanced disease. In this condition, target therapy against driver mutations could constitute an alternative to chemotherapy, and may help in disease control. The past two decades have seen extraordinary progress in developing novel target treatment options, shifting the treatment paradigm for several cancers such as lung cancer. The improvement of knowledge regarding the genetic and biological alterations, of major primary tracheal tumors, has opened up new treatment perspectives, suggesting the possible role of biological targeted therapies for the treatment of these rare tumors. The purpose of this review is to outline the state of knowledge regarding the molecular biology, and the preliminary data on target treatments of the main primary tracheal tumors, focusing on salivary-gland-derived cancers and squamous cell carcinoma.
Collapse
Affiliation(s)
- Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy
| | - Anna Valeria Samarelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy
| | - Gaia Francesca Cappiello
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Alessandro Andreani
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Francesco Livrieri
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Annamaria Bosi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Ottavia Nori
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | | | - Giulia Bruzzi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
- Otolaryngology Unit, University Hospital of Modena, 41121 Modena, Italy
| | - Daniele Marchioni
- Otolaryngology Unit, University Hospital of Modena, 41121 Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| |
Collapse
|
|
27
|
Nilssen Y, Solberg S, Brustugun OT, Møller B, Sundset A, Wahl SGF, Helland Å. Tracheal cancer: a rare and deadly but potentially curable disease that also affects younger people. Eur J Cardiothorac Surg 2023; 64:ezad244. [PMID: 37348858 PMCID: PMC10329490 DOI: 10.1093/ejcts/ezad244] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/26/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES The incidence of tracheal cancer is low, few clinicians get much experience and the awareness may be low. Recent data on the treatment and outcome are limited. The aim of the present study was to present updated, national data on the incidence, characteristics, treatment and outcome for patients with tracheal cancer. METHODS All tracheal cancers registered at the Cancer Registry of Norway in 2000-2020 were extracted. The patient and tumour characteristics age, sex, stage, histology and treatment modality (surgery and radiotherapy) were examined. Overall, median and relative survival were estimated. Cox regression models were used to identify independent prognostic factors. RESULTS The 77 patients diagnosed with tracheal cancer equals a crude incidence rate and an age-standardized incidence rate of 0.075 and 0.046 per 100,000 per year respectively. The mean age was 63.8 years (range: 26-94). The numerical preponderance of men (n = 41) is not statistically significant. Eighteen patients (23.4%) were diagnosed in the localized stage. The 5-year overall survival was 31.7% [95% confidence interval (CI): 21.0-42.9], and in those treated with surgical resection or curative radiotherapy, it was 53.7% (95% CI: 26.1-75.0) and 37.8% (95% CI: 18.8-56.7), respectively. Age, histological type and treatment modality were identified as independent prognostic factors. CONCLUSIONS Despite improved survival, the prognosis for patients with tracheal cancer is still poor. Few are diagnosed in the early stage and thus most are not eligible for curative treatment, mainly surgery. An increased awareness and diagnosis in the earlier stage is crucial.
Collapse
Affiliation(s)
- Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Steinar Solberg
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Odd Terje Brustugun
- Section of Oncology, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Arve Sundset
- Department of Pulmology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Sissel Gyrid Freim Wahl
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Åslaug Helland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
|
28
|
Wickramasinghe S, Munavvar M, Bittar MN, Jacob D, Nicholson S, Stockwell R, Devineni T. Adenoid cystic carcinoma of the trachea mimicking asthma. Respirol Case Rep 2023; 11:e01148. [PMID: 37090913 PMCID: PMC10116393 DOI: 10.1002/rcr2.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is primarily a salivary gland tumour that rarely involves the respiratory tract. A 58-year-old lady was admitted with worsening dyspnoea, cough and wheezing for 2 days. CT pulmonary angiogram was done due to persistent dyspnoea which revealed a 12 mm mass protruding into the posterior aspect of the trachea with multiple enlarged nodes. There was a complete collapse of the left lower lobe and right middle lobe with right upper lobe pulmonary embolism which was thought to be contributing to her hypoxia. She was struggling with secretion clearance and initial measures to clear her secretions were not successful. She was treated with a tracheal stent, followed by an interval endoscopic ultrasound-guided biopsy of the tracheal wall lesion which revealed ACC. She was referred to cardiothoracic surgeons for excision of the tumour after discussing in MDT. Surgery followed by radiotherapy is advised in cases with incomplete resection margins.
Collapse
Affiliation(s)
| | - Mohammed Munavvar
- Department of Respiratory MedicineLancashire Teaching HospitalsPrestonUK
| | | | - Deepa Jacob
- Department of PathologyLancashire Teaching HospitalsPrestonUK
| | - Sarah Nicholson
- Department of PathologyLancashire Teaching HospitalsPrestonUK
| | | | | |
Collapse
|
|
29
|
Ke M, Zeng J, Chen Z, Huang R, Wu X, Chu S. Stent loaded with radioactive Iodine-125 seeds for adenoid cystic carcinoma of central airway: A case report of innovative brachytherapy. Front Oncol 2023; 13:837394. [PMID: 37056329 PMCID: PMC10086341 DOI: 10.3389/fonc.2023.837394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) of central airway is very rare. More than half of ACCs are unresectable for tumor extension. There’s rare report on local ACCs only in central airway. We present a case of ACC in central airway who underwent an innovative brachytherapy. A 44-year-old woman was diagnosed with primary ACC in central airway without regional lymphadenopathy or metastatic disease. Stenosis was observed in lower trachea and both left and right main bronchi (stenosis in lumen ≥50%) with bronchoscopy. The tumor was unresectable due to local extension. A Y-shaped and stainless-steel stent loaded with radioactive 125I seeds was placed in the central airway using bronchoscope. The number and distribution of 125I seeds were planed using treatment planning system. The stent was removed three months later. The patient tolerated the procedure well. She was alive without relapse three years after removing the stent with 125I seeds. This case demonstrates the successful use of stent with radioactive 125I seeds for unresectable ACCs in central airway. In the procedure, the stent was placed with bronchoscope and under the vision from bronchoscope. This innovative brachytherapy is well-tolerated, safe, precise and individualized designed. The patient with unresectable ACCs could get a long-term relapse-free survival. Clinical trials could be taken to validate its effectiveness and tolerability in patients with ACCs of central airway.
Collapse
Affiliation(s)
- Mingyao Ke
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Junli Zeng
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Zhide Chen
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Rui Huang
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Xuemei Wu
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
- *Correspondence: Xuemei Wu, ; Shuyuan Chu,
| | - Shuyuan Chu
- Laboratory of Respiratory Disease, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
- *Correspondence: Xuemei Wu, ; Shuyuan Chu,
| |
Collapse
|
|
30
|
Morabito JE, Simmons CG, Zanotti G, Mitchell JD, Bartels K, Wilkey BJ. Airway and Hemodynamic Considerations for the Anesthetic Management of an Intraluminal Tracheal Plasmacytoma. Semin Cardiothorac Vasc Anesth 2023; 27:64-67. [PMID: 36418868 DOI: 10.1177/10892532221140235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Central airway obstruction due to tracheal tumors presents unique challenges to the anesthesiologist. We present the case of a 44-year-old male taken to the OR for biopsy and resection of an undiagnosed tracheal mass. Intraoperative management was complicated by bleeding and significant hemodynamic instability, necessitating rapid surgical and anesthetic intervention. This ultimately led to abortion of surgical resection. Pathologic examination revealed a primary tracheal plasmacytoma, a rare type of tracheal tumor. Here, we describe anesthetic and hemodynamic considerations for a tracheal plasmacytoma. We discuss the approach to airway management in variable intrathoracic tracheal obstruction and the unpredictability of tracheal tumors.
Collapse
Affiliation(s)
- Joseph E Morabito
- Department of Anesthesiology, 12226University of Colorado School of Medicine, Aurora, CO, USA
| | - Colby G Simmons
- Department of Anesthesiology, 12225University of Colorado School of Medicine, Aurora, CO, USA
| | - Giorgio Zanotti
- Ascension Medical Group St. Vincent Indiana Heart Care, Division of Cardiothoracic Surgery, Indianapolis, IN
| | - John D Mitchell
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karsten Bartels
- Department of Anesthesiology, 12284University of Nebraska Medical Center, Omaha, NE
| | - Barbara J Wilkey
- Department of Anesthesiology, 12226University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
|
31
|
Wang B, Zhang Z, Guo Y, Yu F. Trachea repair using an autologous pericardial patch combined with a 3D carbon fiber stent: A case report. Front Surg 2023; 9:1086792. [PMID: 36700013 PMCID: PMC9869265 DOI: 10.3389/fsurg.2022.1086792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
This study is the first to use an autologous pericardial patch combined with a 3D carbon fiber stent for the plastic repair of a large trachea defect. Radical surgery is the optimal therapy for primary malignant tracheal tumors. Tracheoplasty or repair is required to guarantee trachea integrity and normal ventilation function after tracheal tumor resection. Here, we present a case of plastic repair of the trachea using an autologous pericardial patch and a 3D custom-made carbon fiber stent. A 4 cm trachea defect was successfully repaired after resecting a malignant schwannoma. The postoperative ventilatory function was normal without obvious symptoms of discomfort. Fiberoptic bronchoscopy showed a smooth mucosal surface of the endotracheal wall and patency of the airway. CT scans performed 3 years after surgery showed no recurrence. Therefore, we can conclude that a 3D carbon fiber stent is feasible for abolishing patch floating and preventing tracheal stenosis.
Collapse
Affiliation(s)
- Bin Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhe Zhang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuanwei Guo
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China,Correspondence: Fenglei Yu
| |
Collapse
|
|
32
|
Fukumitsu K, Ning Y, Kanemitsu Y, Tajiri T, Okuda K, Fukuda S, Uemura T, Ohkubo H, Takemura M, Maeno K, Ito Y, Oguri T, Takakuwa O, Niimi A. Tracheal Glomus Tumor Complicated with Asthma Exacerbation in a Pregnant Woman. Intern Med 2022. [PMID: 36450466 PMCID: PMC10400392 DOI: 10.2169/internalmedicine.0510-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 34-year-old pregnant woman in the 34th week of gestation with uncontrolled asthma was admitted because of asthma exacerbation. Although she received bronchodilators and systemic corticosteroids, respiratory failure rapidly progressed. Chest computed tomography revealed a mass occluding approximately 80% of the tracheal lumen. After urgent Caesarean section, endobronchial resection was performed. The pathological findings of the resected tumor were compatible with tracheal glomus tumor. Tracheal tumors are often misdiagnosed as asthma, but its complication with asthma is rare. Even if the diagnosis of asthma is definitive, clinicians should consider coexisting diseases, including tracheal tumors, when asthma control is poor.
Collapse
Affiliation(s)
- Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yangyi Ning
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tomoko Tajiri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Science, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takehiro Uemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Osamu Takakuwa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| |
Collapse
|
|
33
|
Messina G, Bove M, Natale G, Di Filippo V, Opromolla G, Massimilla E, Forte M, Rainone A, Vicario G, Leonardi B, Fiorelli A, Vicidomini G, Santini M, Pirozzi M, Caterino M, Della Corte CM, Ciardiello F, Fasano M. Ventilation challenge in rigid bronchoscopy: Laser tube as an alternative management in patients with lung cancer and central airway obstruction. Thorac Cancer 2022; 14:24-29. [PMID: 36419381 PMCID: PMC9807437 DOI: 10.1111/1759-7714.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Central airway tumors involving the trachea and main-stem bronchi are a common cause of airway obstruction and a significant cause of mortality among the patients of thoracic diseases with respiratory failure. Debulking in rigid bronchoscopy is quick, safe, and effective. It can be complex and hard in patients with severe bronchial or tracheal obstruction and/or with intraluminal bleeding tumors because of inadequate distal airway control. We have used laser tube as a new technique of ventilation for severe central airway obstruction. MATERIALS AND METHODS Forty-six patients with severe airway obstruction undergoing rigid bronchoscopy from September 2020 to June 2022 at the Thoracic Surgery Department of the University L. Vanvitelli of Naples underwent placement of laser tube. RESULTS In all patients who underwent rigid bronchoscopy with the use of the laser tube, a reduction of obstruction of more than 50% was obtained and in all patients no hypoxia (saturation < 88%), nor hypercapnia, nor significant bleeding were reported. DISCUSSION The results of this study suggest that rigid bronchoscopic debulking with the use of laser tube is a safe and effective technique in the management of central airway obstruction. CONCLUSIONS The use of the laser tube allows the monitoring of gas exchange, which controls hypoxemia. Thanks to the double cuff put distally to the tracheal obstruction or in the contralateral bronchus to the obstructed one, the laser tube prevents the flooding of blood from debulking below the stenosis. Rigid bronchoscopy with laser tube will expand its use in the future.
Collapse
Affiliation(s)
- Gaetana Messina
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mary Bove
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giovanni Natale
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Vincenzo Di Filippo
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giorgia Opromolla
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Eva Massimilla
- Otorhinolaryngology UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mauro Forte
- Anesthesioly and Intensive Care UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Anna Rainone
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giuseppe Vicario
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Beatrice Leonardi
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Alfonso Fiorelli
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giovanni Vicidomini
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mario Santini
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mario Pirozzi
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Marianna Caterino
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | | | - Fortunato Ciardiello
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Morena Fasano
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| |
Collapse
|
|
34
|
Shen YS, Tian XD, Pan Y, Li H. Treatment of primary tracheal schwannoma with endoscopic resection: A case report. World J Clin Cases 2022; 10:10279-10285. [PMID: 36246804 PMCID: PMC9561569 DOI: 10.12998/wjcc.v10.i28.10279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/21/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath. The clinical symptoms of tracheal schwannoma depend on the location of the tumor, and the most common clinical symptoms are cough and hemoptysis. The most effective treatment for benign tumors is complete resection of the primary lesion at an early stage. Our experience has demonstrated that primary tracheal schwannoma can be safely excised with a high-frequency electric knife in a minimally invasive manner.
CASE SUMMARY We report a 61-year-old asymptomatic woman who underwent chest computed tomography (CT), which accidentally found an intraluminal tracheal mass without enlarged lymph nodes. Then, the patient underwent bronchoscopy, which found that the tracheal mass originated from the left wall of the upper trachea, was less than 1.5 cm in size, immovable, smooth and 4 cm away from the vocal cord, resulting in partial upper respiratory tract obstruction. Treatment was performed using an endoscopic resection for en bloc removal of the tracheal mass. The diagnosis was primary tracheal schwannoma. A follow-up was performed after endoscopic surgery, and bronchoscopy and thoracic CT were used to monitor whether there was a recurrence. At present, there is no evidence of recurrence, and the patient had a good quality of life. Endoscopic resection may be effective and safe in the treatment of primary tracheal schwannoma.
CONCLUSION Primary tracheal schwannoma is a very rare benign tumor. In this case, we cured it by complete endoscopic resection.
Collapse
Affiliation(s)
- Yong-Shuai Shen
- Department of Endoscopy, Tianjin Cancer Hospital Airport Hospital, Tianjin 300000, China
| | - Xiang-Dong Tian
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Yi Pan
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Hua Li
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| |
Collapse
|
|
35
|
Xu XH, Gao H, Chen XM, Ma HB, Huang YG. Using ketamine in a patient with a near-occlusion tracheal tumor undergoing tracheal resection and reconstruction: A case report. World J Clin Cases 2022; 10:8417-8421. [PMID: 36159522 PMCID: PMC9403677 DOI: 10.12998/wjcc.v10.i23.8417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation. Due to its rarity, there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors, therefore individualized strategies are necessary. There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction (TRR) in the literature. We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR. CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis. Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis, which occluded > 90% of the tracheal lumen. The patient was scheduled for TRR. Considering the risk of complete airway collapse after the induction of general anesthesia, we decided to secure the airway with a tracheostomy with spontaneous breathing. The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders: a time-consuming process. Coughing and movement needed be minimized; thus, we added intravenous ketamine to local anesthetic infiltration. After tracheostomy, an endotracheal tube was placed into the distal trachea, and general anesthesia was induced. The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall. We performed a video-laryngoscopy to place a new endotracheal tube. Finally, the surgeons anastomosed the anterior tracheal walls. The patient was extubated uneventfully. CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.
Collapse
Affiliation(s)
- Xiao-Han Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hui Gao
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xing-Ming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hao-Bo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Yu-Guang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
| |
Collapse
|
|
36
|
Caramujo C, da Cruz RM, Marques RV, Jesus E. Primary adenoid cystic carcinoma of the trachea: an elusive diagnosis of chronic dyspnoea. BMJ Case Rep 2022; 15:e250227. [PMID: 35944942 PMCID: PMC9367189 DOI: 10.1136/bcr-2022-250227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/03/2022] Open
Abstract
Primary adenoid cystic carcinoma (ACC) of the trachea is a rare entity, with a 5-year survival between 50% and 80% for resectable cases and 30% in case of unresectable disease. We report a case of a primary ACC on a woman in her 70s that presented with a drawn-out history of dyspnoea. She was diagnosed with an unresectable obstructive tumour of the trachea, which required the placement of a Y-shaped stent. The patient underwent concomitant chemoradiotherapy, with partial response, and is still in follow-up, without evidence of disease progression.
Collapse
Affiliation(s)
- Cecília Caramujo
- Department of Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Rafael Moiteiro da Cruz
- Department of Pathology, Hospital de Santa Maria, Lisboa, Portugal
- Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
| | - Rui Vale Marques
- Department of Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Emanuel Jesus
- Department of Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| |
Collapse
|
|
37
|
Dracham C, Khosla D, Kapoor R, Dey T, Periasamy K, Elangovan A, Madan R, Goyal S, Kumar N. Expanding role of radiotherapy in adenoid cystic carcinoma of the tracheobronchial tree: a new horizon. TUMORI JOURNAL 2022; 108:347-356. [PMID: 33977780 DOI: 10.1177/03008916211012461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Primary adenoid cystic carcinomas (ACCs) of central trachea-bronchi system are rare and heterogeneous tumors. Definitive radiotherapy (RT) is the recommended treatment in surgically unresectable or incomplete resection or in the presence of severe comorbidities. OBJECTIVE To evaluate the clinical features and outcomes of patients with ACC of trachea-bronchi treated with radiotherapy. METHODS Retrospective medical records review was done in all patients with histologically confirmed ACC of trachea-bronchi between January 2010 and December 2019. Patient disease and treatment characteristics and toxicity data were analyzed. Overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were computed using Kaplan-Meier method (log-rank test). RESULTS Nineteen patients (10 women and 9 men) were included in this analysis with median age of 40 years (range, 14-70). Of these patients, 63.2% (n = 12) presented in stage IV disease. Twelve and three patients received definitive (median dose 67.8 Gy) and adjuvant (median dose 50 Gy) RT, respectively. The median follow-up was 42.5 months (range, 4-120); 15 patients were alive and 4 were dead at that time. Local recurrence or progression was observed in 52.6% and distant metastasis found in 47.3% of patients. The 5-year OS, LRFS, and DMFS for all patients were 81.2%, 52.8%, and 39.6%, respectively. Baseline lymph node involvement showed significant impact on OS (56.3% vs 100%, p = 0.011). Among patients receiving definitive RT, patients with higher RT dose (⩾66 Gy) had significantly better survival outcomes (5-year LRFS: 75% vs 16.7%, p = 0.013). CONCLUSION Definitive RT is an exemplary treatment for unresectable disease. Higher dose is recommended to improve long-term outcomes.
Collapse
Affiliation(s)
- ChinnaBabu Dracham
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Treshita Dey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Elangovan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
|
38
|
Elhidsi M, Zaini J, Ghanie A, Huswatun AL, Beginta R, Mety SH, Syahruddin E. Therapeutic bronchoscopy followed by sequential radiochemotherapy in the management of life-threatening tracheal adenoid cystic carcinoma: a case report. J Med Case Rep 2022; 16:243. [PMID: 35718781 PMCID: PMC9208154 DOI: 10.1186/s13256-022-03452-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adenoid cystic carcinoma of the lung is a distinctive salivary-gland-type malignant epithelial neoplasm that rarely presents as a primary tumor of the respiratory tract. Complete surgical resection remains the treatment of choice for adenoid cystic carcinoma. We present a case of large ACC tumors that caused severe central airway obstruction and were effectively treated with therapeutic bronchoscopy followed by radiotherapy and chemotherapy. Case presentation A 31-year-old Malay Indonesian female patient who was a nonsmoker and had no family history of cancer was admitted to the emergency ward because of worsening breathlessness accompanied by stridor since 1 week prior. Chest computed tomography revealed segmental atelectasis of the left lung; a mass on the left main bronchus, with infiltrates in segments 1, 2, and 3 of the left lung; and consolidation in the left inferior lobe, with narrowing of the main left bronchus. Lobulated masses obstructing almost the entire distal trachea up to the carina and the entire left main bronchus were found on bronchoscopy. Owing to the large tumors causing severe central airway obstruction, the medical team decided to perform central airway mass removal through rigid bronchoscopy. A neodymium-doped yttrium-aluminum-garnet laser was used first to facilitate mass shrinkage. After the laser treatment, mechanical mass removal using a rigid scope was performed. The tracheal and carinal lumens were opened to > 50% of their diameter, with the left main bronchus lumen opened only slightly. After the treatment, the patient was stable, and no stridor was found. Adjuvant intensity-modulated radiotherapy and chemotherapy were performed after the therapeutic bronchoscopy. At the end of the entire treatment, reevaluation by thoracic computed tomography scan and bronchoscopy revealed no remaining mass. Conclusions In cases of nonresectable large adenoid cystic carcinoma tumors with life-threatening central airway obstruction, therapeutic bronchoscopy followed by sequential radiochemotherapy might achieve a complete response outcome.
Collapse
Affiliation(s)
- Mia Elhidsi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia. .,Indonesian Bronchoscopy Society, Perbronki, Jakarta, Indonesia.
| | - Jamal Zaini
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Aziza Ghanie
- Faculty of Medicine, Universitas UPN Veteran Jakarta, Jakarta, Indonesia.,Department of Radiology, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Aida Lutfi Huswatun
- Department of Radiotherapy, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Romi Beginta
- Department of Pathology, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Susan Hendriarini Mety
- Department of Thoracic, Cardiac, and Vascular Surgery, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia.,Thoracic, Cardiac, and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Elisna Syahruddin
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| |
Collapse
|
|
39
|
Mann DR, Patel KJ, Baker T, Gibney BC. Rare Case of Tracheal Fibromyxoma in Obstructive Tracheal Mass. Cureus 2022; 14:e24471. [PMID: 35651394 PMCID: PMC9132757 DOI: 10.7759/cureus.24471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 11/05/2022] Open
Abstract
A 77-year-old male with a history of chronic obstructive pulmonary disease (COPD) who presented with cough, congestion, and stridor and was found to have a near obstructing tracheal mass. He subsequently underwent excision of the mass. On pathologic examination, it was diagnosed as fibromyxoma of the trachea. Primary tumors of the trachea are rare, and fibromyxoma of the trachea is extremely rare. This is the third report of a fibromyxoma on the tracheal wall. In this report the clinical manifestations, and surgical management were compared with the other two reported cases.
Collapse
|
|
40
|
[Relationship between EGFR, ALK Gene Mutation and Imaging
and Pathological Features in Invasive Lung Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:147-155. [PMID: 35340157 PMCID: PMC8976203 DOI: 10.3779/j.issn.1009-3419.2022.101.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND At present, the research progress of targeted therapy for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene mutations in lung adenocarcinoma is very rapid, which brings new hope for the treatment of advanced lung adenocarcinoma patients. However, the specific imaging and pathological features of EGFR and ALK gene mutations in adenocarcinoma are still controversial. This study will further explore the correlation between EGFR, ALK gene mutations and imaging and pathological features in invasive lung adenocarcinoma. METHODS A total of 525 patients with lung adenocarcinoma who underwent surgery in our center from January 2018 to December 2019 were included. According to the results of postoperative gene detection, the patients were divided into EGFR gene mutation group, ALK gene mutation group and wild group, and the EGFR gene mutation group was divided into exon 19 and exon 21 subtypes. The pathological features of the mutation group and wild group, such as histological subtype, lymph node metastasis, visceral pleural invasion (VPI) and imaging features such as tumor diameter, consolidation tumor ratio (CTR), lobulation sign, spiculation sign, pleural retraction sign, air bronchus sign and vacuole sign were analyzed by univariate analysis and multivariate Logistic regression analysis to explore whether the gene mutation group had specific manifestations. RESULTS EGFR gene mutation group was common in women (OR=2.041, P=0.001), with more pleural traction sign (OR=1.506, P=0.042), and had little correlation with lymph node metastasis and VPI (P>0.05). Among them, exon 21 subtype was more common in older (OR=1.022, P=0.036), women (OR=2.010, P=0.007), and was associated with larger tumor diameter (OR=1.360, P=0.039) and pleural traction sign (OR=1.754, P=0.029). Exon 19 subtype was common in women (OR=2.230, P=0.009), with a high proportion of solid components (OR=1.589, P=0.047) and more lobulation sign (OR=2.762, P=0.026). ALK gene mutations were likely to occur in younger patients (OR=2.950, P=0.045), with somking history (OR=1.070, P=0.002), and there were more micropapillary components (OR=4.184, P=0.019) and VPI (OR=2.986, P=0.034) in pathology. CONCLUSIONS The EGFR and ALK genes mutated adenocarcinomas have specific imaging and clinicopathological features, and the mutations in exon 19 or exon 21 subtype have different imaging features, which is of great significance in guiding the clinical diagnosis and treatment of pulmonary nodules.
Collapse
|
|
41
|
Walker E, Karthik S, Chengot P, Vaidyanathan S. It's not all about the thyroid! Extrinsic and unusual pathology affecting the thyroid gland: A pictorial review. Clin Imaging 2022; 85:29-42. [DOI: 10.1016/j.clinimag.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/11/2022]
|
|
42
|
Parshin VD, Rusakov MA, Parshin AV, Mirzoyan OS, Vizhigina MA, Simonova MS, Parshin VV, Ursov MA. [Surgery of primary tracheal tumors]. Khirurgiia (Mosk) 2022:12-24. [PMID: 35920218 DOI: 10.17116/hirurgia202208112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the main forms of primary tracheal cancer (PTC), to specify the indications for various surgeries in these patients depending on extent and localization of lesion. MATERIAL AND METHODS There were 263 PTC patients. Benign tumors were diagnosed in 68 (25.9%) patients, malignancies - in 195 (74.1%) cases. Tracheal cancer includes 3 basic morphological variants - adenocystic cancer (49.7%), carcinoid (18.7%) and squamous cell carcinoma (19.0%). Other forms of malignancies were much less common. We applied endoscopic intraluminal and open surgeries. In malignant PTC, open surgeries were performed in 165 (84.6%) out of 195 patients. Baseline palliative endoscopic treatment was performed in 30 patients. They underwent airway recanalization (with subsequent tracheal stenting in 19 patients). Endoscopic resection was preferred for benign tumors. RESULTS Twenty (12.1%) patients died after open surgery, and 1 (3.3%) patient died after endoscopic procedure. Most lethal outcomes occurred in early years of development of tracheal surgery. The causes of mortality were tracheal anastomotic failure in 12 patients, pneumonia in 6 patients, and arterial bleeding in 2 patients. Severe postoperative period was observed in all 3 patients after tracheal replacement with a silicone prosthesis. Long-term treatment outcomes depended on morphological structure of PTC. Favorable results were observed in patients with neuroendocrine tumor (carcinoid), worse outcomes in adenocystic cancer and unfavorable results in squamous cell carcinoma (p<0.0013). Five-year survival rates were 75%, 65.6%, and 13.3%; 10-year survival rates were 75%, 56.2%, and 13.3%, respectively. These outcomes after combined treatment of primary tracheal cancer were significantly better compared to lung cancer (p<0.05 when compared to global data). CONCLUSION Treatment of primary tracheal cancer should be based on classical principles of modern oncology (combined therapy, tumor resection with lymphadenectomy). Open and endoscopic interventions are justified. PTC is characterized by more favorable outcomes compared to lung cancer. It is difficult to analyze long-term results in tracheal cancer depending on various features of tumor process due to small number of observations. Accurate conclusions require multiple-center studies, preferably with international participation, which can convincingly prove certain concept.
Collapse
Affiliation(s)
| | - M A Rusakov
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O S Mirzoyan
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - M A Vizhigina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - M A Ursov
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
|
43
|
Soriano L, Khalid T, Whelan D, O'Huallachain N, Redmond KC, O'Brien FJ, O'Leary C, Cryan SA. Development and clinical translation of tubular constructs for tracheal tissue engineering: a review. Eur Respir Rev 2021; 30:30/162/210154. [PMID: 34750116 DOI: 10.1183/16000617.0154-2021] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory medicine. The trachea is a 10-11 cm long fibrocartilaginous tube of the lower respiratory tract, with 16-20 tracheal cartilages anterolaterally and a dynamic trachealis muscle posteriorly. Tracheal resection is commonly offered to patients suffering from short-length tracheal defects, but replacement is required when the trauma exceeds 50% of total length of the trachea in adults and 30% in children. Recently, tissue engineering (TE) has shown promise to fabricate biocompatible tissue-engineered tracheal implants for tracheal replacement and regeneration. However, its widespread use is hampered by inadequate re-epithelialisation, poor mechanical properties, insufficient revascularisation and unsatisfactory durability, leading to little success in the clinical use of tissue-engineered tracheal implants to date. Here, we describe in detail the historical attempts and the lessons learned for tracheal TE approaches by contextualising the clinical needs and essential requirements for a functional tracheal graft. TE manufacturing approaches explored to date and the clinical translation of both TE and non-TE strategies for tracheal regeneration are summarised to fully understand the big picture of tracheal TE and its impact on clinical treatment of extensive tracheal defects.
Collapse
Affiliation(s)
- Luis Soriano
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Joint first authors
| | - Tehreem Khalid
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Joint first authors
| | - Derek Whelan
- Dept of Mechanical, Biomedical and Manufacturing Engineering, Munster Technological University, Cork, Ireland
| | - Niall O'Huallachain
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen C Redmond
- National Cardio-thoracic Transplant Unit, Mater Misericordiae University Hospital and UCD School of Medicine, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Cian O'Leary
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
| | - Sally-Ann Cryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland .,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
| |
Collapse
|
|
44
|
A case of adenoid cystic carcinoma of trachea: treatment complications and radiotherapy role. J Contemp Brachytherapy 2021; 13:588-592. [PMID: 34759984 PMCID: PMC8565636 DOI: 10.5114/jcb.2021.109853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/20/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Adenoid cystic carcinoma (ACC) of trachea is a relatively rare malignant neoplasm, for which there is a lack of prospective clinical trials investigating treatment effectiveness. Most of the authors prefer surgical resection followed by post-operative radiation therapy in case of incomplete excision. There are no available prospective data on post-relapse treatment. Case presentation The current paper presents a case of tracheal ACC in a young woman, treated solely with surgical resection without radiotherapy due to postoperative neurological complications requiring additional diagnostics, management, and treatment. As a complication itself, spinal cord dysfunction after tracheal surgery is extremely rare, in which radical radiotherapy and brachytherapy were successfully administered after disease recurrence. Conclusions Lack of post-operative radiotherapy resulting from neurological complications could be a reason for ACC recurrence in our patient. Administration of radiotherapy after incomplete resection of recurrent disease may lead to long-term locoregional control.
Collapse
|
|
45
|
Kovacs AC, Vodanovich D, Mogridge EK, Wun L, Corry J. A case of primary tracheal squamous cell carcinoma arising from malignant transformation of recurrent respiratory papillomatosis, with a complete response to concurrent chemoradiotherapy. SAGE Open Med Case Rep 2021; 9:2050313X211054623. [PMID: 34707869 PMCID: PMC8543711 DOI: 10.1177/2050313x211054623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/22/2022] Open
Abstract
Recurrent respiratory papillomatosis is a human papillomavirus-mediated condition characterised by the development of benign squamous papillomata of the respiratory tract. Malignant transformation of recurrent respiratory papillomatosis, while rare, carries a poor prognosis and there are limited data surrounding treatment options, particularly in inoperable disease. We present the case of a 64-year-old male who developed malignant airway obstruction secondary to primary tracheal squamous cell carcinoma in the setting of a 5-year history of recurrent laryngotracheal papillomatosis, requiring placement of tracheostomy while on veno-venous extracorporeal membranous oxygenation. He was managed with cisplatin-based definitive chemoradiotherapy and had a complete metabolic response on post-treatment positron emission tomography/computed tomography, and remains free of recurrent squamous cell carcinoma at 16 months following treatment. This case supports the use of combined chemoradiotherapy as a potential therapeutic option for patients with primary tracheal squamous cell carcinoma, and emphasises the challenges associated with the long-term management of recurrent respiratory papillomatosis.
Collapse
Affiliation(s)
- Aaron C Kovacs
- Department of ENT/Head and Neck Surgery, St
Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Domagoj Vodanovich
- Department of ENT/Head and Neck Surgery, St
Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Emily K Mogridge
- Department of ENT/Head and Neck Surgery, St
Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Lisa Wun
- Department of ENT/Head and Neck Surgery, St
Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - June Corry
- GenesisCare Radiotherapy, St Vincent’s
Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, The University of
Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
|
46
|
Xu X, Chen S, Li S, Zhu B, Huang Y. Use of double-lumen tube adaptor to enable cross-field two-lung ventilation through two endotracheal tubes in carinal tumor resection: A case report. J Clin Anesth 2021; 73:110357. [PMID: 34087661 DOI: 10.1016/j.jclinane.2021.110357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China
| | - Shaohui Chen
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China
| | - Shanqing Li
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China
| | - Bo Zhu
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China.
| | - Yuguang Huang
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China
| |
Collapse
|
|
47
|
Brochu V, Tamber GS, Rayes RF, Fiset B, Caglar D, Camilleri-Broët S, Tabah R, Walsh LA, Spicer JD, Fiset PO. High-Grade Neuroendocrine Carcinoma Within a Tracheal Polyp: A Case Report. JTO Clin Res Rep 2021; 2:100169. [PMID: 34590020 PMCID: PMC8474438 DOI: 10.1016/j.jtocrr.2021.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Primary carcinomas of the trachea are rare, with a reported annual incidence of one in a million. We present a case of a previously undescribed polypoid high-grade neuroendocrine carcinoma of the trachea. Resection of the carcinoma revealed only superficial invasion of the mucosa and without evidence of local or distant metastatic disease. Histologically, the tumor had high-grade features with necrosis and a high mitotic index. Methods Characterization of this rare neuroendocrine carcinoma of the trachea was performed by immunohistochemistry and whole-genome sequencing. Results Immunohistochemistry result was positive for neuroendocrine markers, p16 and an elevated Ki-67. Whole-genome sequencing of the lesion was performed and revealed a very unusual and very distinct mutational signature without relationship to other relevant neuroendocrine carcinomas. Neither known driver nor targetable mutations were found by whole-genome sequencing. Analysis of the sequence of numerous viral elements of human papillomavirus-18 suggests that the pathogenesis of the lesion is related to viral integration. The patient developed distal recurrence, which progressed to widespread pulmonary dissemination, presumably through aerogenous spread of disease. Conclusions This is the first characterization of this type of tracheal tumor, including genomic findings, pathogenesis, and natural history.
Collapse
Affiliation(s)
- Victor Brochu
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gurdip Singh Tamber
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Roni F Rayes
- Division of Thoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada.,Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Benoit Fiset
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada
| | - Derin Caglar
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sophie Camilleri-Broët
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Roger Tabah
- Department of General Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Logan A Walsh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Jonathan D Spicer
- Division of Thoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
|
48
|
Wu J, Tao Y, Liu Y, Wang Y, Zhang C. 18F-FDG PET/CT of Primary Tracheal Adenoid Cystic Carcinoma. Clin Nucl Med 2021; 46:766-767. [PMID: 34374681 DOI: 10.1097/rlu.0000000000003747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary adenoid cystic carcinoma in the trachea is a very rare tumor. A 40-year-old woman presented with persisting cough and wheezing over 2 months. A CT scan showed a mass in the tracheal wall. The bronchoscopic biopsy confirmed adenoid cystic carcinoma. 18F-FDG PET/CT was performed to evaluate the tracheal mass, which showed an FDG-avid mass in the right posterior tracheal wall.
Collapse
Affiliation(s)
- Junhao Wu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; and Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, People's Republic of China
| | | | | | | | | |
Collapse
|
|
49
|
Intensity modulated radiation therapy may improve survival for tracheal-bronchial adenoid cystic carcinoma: A retrospective study of 133 cases. Lung Cancer 2021; 157:116-123. [PMID: 34020823 DOI: 10.1016/j.lungcan.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
PURPOSES This study aimed to evaluate the role of radiotherapy (RT) and intensity modulated radiation therapy (IMRT) in adjuvant and definitive settings of tracheal-bronchial adenoid cystic carcinoma (TACC) treatment. MATERIALS/METHODS TACC patients (n = 133) treated with surgery and/or RT curatively in our institution between January 1st, 1984 and December 31st, 2017 were analyzed retrospectively. RESULTS Among the 116 patients undergoing surgery, 50 (43.1 %) achieved complete resections and 66 (56.9 %) had positive surgical margins. For patients with positive margins, overall adjuvant RT was correlated with no significantly improved OS (10-year: 58.0 % vs. 47.9 %; P = 0.340) and a slight LRFS benefit (5-year: 81.9 % vs.75.6 %; P = 0.056), but adjuvant IMRT showed significant superiority in both OS (10-year: 82.9 % vs. 47.9 %; P = 0.031) and LRFS (5-year: 100.0 % vs. 75.6 %; P = 0.001) in comparison with no postoperative RT. Multivariate analysis also identified adjuvant IMRT as a significant favorable factor with OS (HR = 0.186, 95 %CI: 0.039-0.883; P = 0.034). For 17 patients receiving definitive RT, IMRT achieved promising 5-year OS of 88.9 % and LRFS of 64.3 %, yet no significant difference from non-IMRT group was reached (P = 0.447 and 0.706). Different therapies presented no significantly different impact on DMFS, whilst DMFS explained more of the OS variances (P < 0.001, R2 = 0.480) than LRFS (P < 0.001, R2 = 0.323). CONCLUSION IMRT could confer greatly improved OS and LRFS in postoperative setting for TACC patients with positive surgical margins. IMRT was also a good therapeutic option for definitive TACC with promising survival and local control.
Collapse
|
|
50
|
Behbahani S, Barinsky GL, Wassef D, Paskhover B, Kaye R. Patterns of Care and Outcomes of Primary Adenoid Cystic Carcinoma of the Trachea. Ann Otol Rhinol Laryngol 2021; 131:78-85. [PMID: 33870720 DOI: 10.1177/00034894211008101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Primary tracheal malignancies are relatively rare cancers, representing 0.1% to 0.4% of all malignancies. Adenoid cystic carcinoma (ACC) is the second most common histology of primary tracheal malignancy, after squamous cell carcinoma. This study aims to analyze demographic characteristics and potential influencing factors on survival of tracheal ACC (TACC). METHODS This was a retrospective cohort study utilizing the National Cancer Database (NCDB). The NCDB was queried for all cases of TACC diagnosed from 2004 to 2016 (n = 394). Kaplan-Meier (KM) and Cox proportional-hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. RESULTS Median age of diagnosis was 56 (IQR: 44.75-66.00). Females were affected slightly more than males (53.8% vs 46.2%). The most prevalent tumor diameter range was 20 to 39 mm (34.8%) followed by greater than 40 mm in diameter (17.8%). Median overall survival (OS) was 9.72 years with a 5- and 10-year OS of 70% and 47.5%, respectively. Localized disease was not associated with a survival benefit over invasive disease (P = .388). The most common intervention was surgery combined with radiation therapy (RT) at 46.2%, followed by surgery alone (16.8%), and standalone RT (8.9%). When adjusting for confounders, surgical resection was independently associated with improved OS (HR 0.461, 95% CI 0.225-0.946). Tumor size greater than 40 mm was independently associated with worse OS (HR 2.808; 95% CI 1.096-7.194). CONCLUSION Our data suggests that surgical resection, possibly in conjunction with radiation therapy, is associated with improved survival, and tumor larger than 40 mm are associated with worse survival.
Collapse
Affiliation(s)
- Sara Behbahani
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David Wassef
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|