SESSION TITLE: Bronchology/Interventional Procedures Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Glomus tumor is a rare benign vascular tumors exhibiting sheets of smooth muscles and glomus cells. Due to the rarity and wide spectrum of possible presentations in almost all parts of body it poses a diagnostic and therapeutic challenge. The endobronchial glomus tumor mainly involves the trachea. To the best of our knowledge, only 4 cases of carinal involvement with the lesion have been reported. Here, we report a case of middle-aged female with chronic obstructive pulmonary disease (COPD) who presented with hemoptysis.
CASE PRESENTATION: 50 year-old female significant smoking history, moderate COPD presented with 1 week of hemoptysis. Exam was positive for wheeze. Chest X-ray normal. Computed Tomography scan revealed an endobronchial lesion at carina extending into the right main bronchus (RMB) [Figure 1A]. A bronchoscopy revealed a large friable, exophytic hemorrhagic tumor arising from the carina with >80% obstruction of lower trachea and RMB [Figure 1B]. Endobronchial biopsies showed sheets of spindle shaped cells surrounded by small blood vessels. The cells had eosinophilic cytoplasm with central nuclei, positive for smooth muscle actin but negative for keratin AE1/AE3, chromogranin, S-100 and CD34. These findings were consistent with glumos tumor. Initially undervent laser ablation of the mass with total patency of airway. Following final diagnosis, tumor resection with carinal reconstruction performed.
DISCUSSION: Glomus tumors accounts for 2% of soft tissue tumors. Common site is nail bed (70%) but has been reported in cerebero-cervical region, gastrointestinal tract, lung parenchyma and airways. This is the second report of glomus tumor of trachea in a smoker. Smoking may increased it's risk. Out of reported 25 cases of tracheal glomus tumor only 4 originated from carina. Mostly benign however may become aggressive so complete resection and reconstruction of carina is currative. No recurrence has been reported to date post resection.
CONCLUSIONS: Glomur tumors are rare but should be included in differential diagnosis of tracheal and carinal lesions. Smoking may increase it's risk. Resection is curative.
Reference #1: Gombos Z et al. Glomus tumor. Arch pathol lab med 2008:132(9): 1448-1452.
Reference #2: Parker KL et al. Tracheal glomangioma in a patient with asthma and chest pain. Journal of clinical oncology 2010: 28(2): e9-e10.
Reference #3: Lang-Lazdunski et al. Glomus tumour: A rare differential diagnosis of bronchial obstruction in a smoker. Gen Thorac Cardiovasc Surg 2012: 60(11): 774-776.
DISCLOSURE: The following authors have nothing to disclose: Khawaja Zaki, Zahra Aryan, Atul Mehta, Michael Machuzak
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