SESSION TITLE: Bronchology Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 27, 2013 at 01:15 PM - 02:45 PM
INTRODUCTION: While relatively common in the skeletal system in general, cartilaginous tumors are almost never seen originating from the trachea. Here we report a rare case of a tracheal chondroma presenting with hemoptysis.
CASE PRESENTATION: Patient is an 85 year-old man with medical history significant only for a 20 pack-year smoking history who presented to an outside facility complaining of a single episode of hemoptysis not associated with dyspnea. Chest CT revealed a 1cm anterior tracheal wall mass without any parenchymal lung disease or lymphadenopathy. Bronchoscopy was performed in the outside facility which showed a polypoid vascular lesion. Brushings and forceps biopsies were nondiagnostic so he was referred to our interventional pulmonology clinic. Patient denied any further hemoptysis. There was no stridor on exam. Repeat bronchoscopy at our institution confirmed the presence of a polypoid white lesion originating from the anterior tracheal wall measuring 1.3 x1.0 x0.7cm and obstructing about 20% of the mid trachea. The lesion was successfully debulked from the base with biopsy forceps. On gross examination, the lesion was a tooth-like structure in shape and consistency with a vascular base. Surgical pathology revealed chondroma with atypia. Due to the potential of malignant transformation, repeat bronchoscopy and cautery of the involved mucosa were performed, and follow-up and repeat bronchoscopy in 6 months are planned.
DISCUSSION: Chrondromas are benign cartilaginous tumors generally arising from bone or synovial tissue. When associated with the airway they are almost always laryngeal in origin; chrondromas of the trachea such as presented here have been reported fewer than two dozen times in the literature 1. The differential of a cartilaginous tumor also includes the benign hamartoma, tracheopathia osteoplastica, and the malignant chondrosarcoma. Distinguishing among the cartilaginous tumors can be difficult given the overlap of histologic features, and some have even recommended classifying chondromas and chondrosarcomas as a single entity 2. Surgery remains the treatment of choice for tracheal cartilaginous tumors given the potential for malignant transformation 3, however endoscopic resection and thermal therapy is a reasonable option in an elderly patient such as ours.
CONCLUSIONS: Tracheal chondroma is a rare finding, however along with other tracheal tumors must be considered in patients presenting with hemoptysis. Surgical resection must be considered due to the possibility of malignant transformation.
Reference #1: Milisavljevic, D et al. Stridor as initial clinical presentation of tracheal chondroma. Acta Oto Esp 2011. 62(2):164-166
Reference #2: Umezu, H et al. Tracheal chondrosarcoma. Gen Thorac Cardiovasc Surg 2008; 56:199-202
Reference #3: Rea, F et al. Extended tracheal resection for chondroma. Lung Cancer 2007. 55:233-236
DISCLOSURE: The following authors have nothing to disclose: Christopher Vaughan, Ray Shepherd, Samira Shojaee
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