Lung Cancer |

Primary Squamous Cell Carcinoma of the Trachea FREE TO VIEW

Amritpal Nat, MD; Amitpal Nat, MD; Sravanthi Nandavaram, MD; Arpan Patel, MD; Robert Lenox, MD
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Internal Medicine, SUNY Upstate Medical University, Liverpool, NY

Chest. 2014;146(4_MeetingAbstracts):667A. doi:10.1378/chest.1993723
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SESSION TITLE: Cancer Student/Resident Case Report Posters III

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary tracheal carcinomas are rare and constitute about 0.1% of all the malignancies.

CASE PRESENTATION: A 53-year-old man with a limited medical history consisting of a 35 pack/year smoking presented to an outside facility with progressive hoarseness for 1 year. The patient did not have insurance and had not seen a provider in over 30 years. He also reported cough, hemoptysis, shortness of breath and unintentional 60 pound weight loss over one year. His cough worsened with eating, especially with liquids. Chest x-ray revealed hyperinflated lungs without any nodules or masses noted. He was initially treated with steroids, antibiotics, and had a nasopharyngeal endoscopy which showed right vocal cord palsy. His symptoms intermittently improved and he followed up with pulmonology as an outpatient for which he underwent a bronchoscopy with bronchial washings. The results revealed extensive tumor studding confined to the bottom two thirds of the trachea and a large TEF(Image 1 & 2). These lesions were biopsied and showed poorly differentiated squamous cell carcinoma. He was sent to our hospital for further management of the TEF. On exam, he was a thin disheveled caucasian male who was tachycardic and appeared in mild respiratory distress. Lung auscultation revealed bilateral diffuse ronchi. Staging of the tumor was unremarkable for hematogenous spread. A pulmonary and thoracic surgery consult was placed for possible interventions. A repeat bronchoscopy was performed. However due to necrosis and a large fistula over two thirds of the trachea, stenting of the trachea was not possible. A J-tube was inserted for nutrition and the patient was advised to maintain NPO status. After discussion, the patient decided to proceed with palliative chemoradiation with carboplatin and taxol. The patient tolerated the initial treatment session fairly well and improved his weight with enteral nutrition. Unfortunately, he developed aspiration pneumonia after the second cycle and died of hypoxic respiratory failure.

DISCUSSION: Given the rarity of this carcinoma, the data is limited[2]. Surgery, followed by adjuvant radiotherapy, is the treatment of choice; primary radiotherapy, in inoperable cases, can represent a curative management option[1]. Of the malignant primary cervical tracheal tumors, Squamous cell carcinoma is the most common in smokers. Complications include fatal hemorrhage, tracheal necrosis, tracheal stenosis, or as in this case tracheoesophageal fistula.

CONCLUSIONS: Smokers with hoarseness, hemoptysis, constitutional symptoms and lack of malignant finding on chest x-ray could be a carrier of tracheal neoplasm and early diagnosis is imperative for the management.

Reference #1: A primary squamous cell carcinoma of the trachea: Case report and review of the literature. Acta Otorhinolaryngol Ital. 2010 August;30(4):209.

Reference #2: Webb BD et al. Primary tracheal malignant neoplasms: University of Texas MD Anderson Cancer Center experience. J Am Coll Surg. 2006;202

DISCLOSURE: The following authors have nothing to disclose: Amritpal Nat, Amitpal Nat, Sravanthi Nandavaram, Arpan Patel, Robert Lenox

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