SESSION TITLE: Pediatric Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Monday, October 27, 2014 at 03:15 PM - 04:15 PM
INTRODUCTION: Primary intratracheal tumor in children is rare. We describe a case of a 4-year-old boy presented with asthma-like symptom for 4 months.
CASE PRESENTATION: A 4-year-old Thai boy was admitted to our hospital with progressive exertional dyspnea and noisy breathing unrelieved by outpatient management for presumed asthma for 4 months. Physical examination revealed tachypnea, biphasic stridor, prolonged inspiratory and expiratory phases and expiratory wheezing. He also had gasping for air during sleep. Subglottic lesion with fixed airway obstruction was suspected. A chest radiography revealed a smooth surface endotracheal soft tissue lesion. A CT scan showed an endotracheal mass of 7.4x6.1x4.6 mm in diameter originated from the right-sided tracheal wall at 3 cm above carina, occupied 80% of the tracheal lumen. Rigid bronchoscopy revealed a yellowish polypoid mass obstructing most of the tracheal lumen. Thacheostomy was performed to ensure adequate ventilation prior to tumor removal without tracheal resection. Pathology found a polypoid, soft yellowish mass. Histology reported spindle cells without pleomorphic feature. Immunochemistry was positive for CD68 and Vimentin and negative for desmin and S-100 consistent with benign fibrous histiocytoma.
DISCUSSION: Fibrohistiocytoma is a mesenchymal tumor which is uncommon in the respiratory tract. Unlike in adults, tracheal fibrohistiocytomas in children are low-grade malignant but at risk of local recurrence. Wheezing and night-time breathing difficulty misleaded to the initial diagnosis of asthma. But the biphasic stridor without hoarseness of the voice are the clues of fixed airway obstruction located below the glottis. CT scan of neck and chest provides more essential information for surgical planning. However, tracheostomy is an option in severe tracheal obstruction. Tracheal resection was recommended in the past decades due to the probability of recurrence. Yttrium alluminum garnet (YAG)-laser is recently reported to enabled tumor with no evidence of recurrence.
CONCLUSIONS: Despite tracheal tumors are rare neoplasm in children, tracheal tumors should be suspected in patients with progressive dyspnea and fixed airway obstruction. Proper investigations and pathological diagnosis are important for treatment planning and prognosis as the long-term natural progression.
Reference #1: Conforti S, Bonacina E, Ravini M, Torre M. A case of fibrous histiocytoma of the trachea in an infant treated by endobronchial ND: YAG laser. Lung Cancer. 2007;57:112-114
DISCLOSURE: The following authors have nothing to disclose: Nongnaphat Chirawutthinan, Haruntai Kamalaporn, Kangsdam Tanjararak, Pimpin Incharoen, Aroowan Preutthipan
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